RAMADAN MUBARAK 1439 (III)
Readers may recall that last year’s Ramadan we dedicated the series of columns to “Ramadan in Other Places” where people wrote in with their experiences of fasting in difficult or unfamiliar places and climes. As the series was closing last year, one more contribution came in which could not be accommodated, so we promised ourselves […]
Readers may recall that last year’s Ramadan we dedicated the series of columns to “Ramadan in Other Places” where people wrote in with their experiences of fasting in difficult or unfamiliar places and climes. As the series was closing last year, one more contribution came in which could not be accommodated, so we promised ourselves that if Allah extends our lives to this year’s Ramadan, we shall find a way to accommodate it.
It is from one of the greatest friends of this Column, the highly readable and insightful Professor Aisha Indo Mamman ([email protected]) of ABU Teaching Hospital, Zaria, which she titled “Iftar at Suhur Time: The Plight of the Young Muslim Medical Doctor.” It is dedicated to those young medics fasting this Ramadan and working in our various hospitals amid the strike by JOHESU.
The Pre-registration House Officer is the lowest member of the medical team and is usually the first point of contact in most teaching or specialist hospitals. The House Officer combines youth naïveté, and a real commitment to impressing the knowledgeable Consultant. The Registrar and Senior Registrar are considered as overbearing bullies who ‘oppress’ the house officer with their knowledge, clinical exploits and, in some cases, fashion tastes.
To the house officer, a good registrar or senior registrar is one who would give him a drink, a snack, or a handkerchief to wipe his sweat on a busy call duty period. Most times the house officer is an unmarried, recent graduate of one of the many medical schools in the world. The biggest challenges of the house officer working in Nigeria include food and uncooperative patient relatives, not to mention all other anomalies that characterise our health sector.
The significance of food to the house officer or houseman needs not to be overemphasised, as he needs all the energy to pace across the hospital on behalf of his consultant in patient care, follow-up on laboratory investigations, contact the pharmacy and many more. Simply put, the House Officer is the yeoman of the medical profession.
The period of Housemanship is one year during which he/she rotates through Medicine, Obstetrics and Gynaecology, Paediatrics and Surgery. Housemanship is so stressful that the doctor rarely celebrates the euphoria of salary earner immediately after graduating. Some of us actually lost weight at the end of the Housemanship year. Therefore imagine doing all these during the Ramadan fast.
Those of you readers who may have watched “Doctor in the House” actually did not get the full picture of the misery of the young Doctor. A new video that is trending on WhatsApp featuring ‘DR I AM SORRY’ is the closest to the truth.
I had my medical education in Ahmadu Bello University, Zaria, graduating in 1988. Having spent most of my growing years between Zaria, Bakori and Katsina, I decided to go to my uncle in Jos so that I could do Housemanship at the Jos University Teaching Hospital (JUTH). My uncle was then a Colonel with the Electrical and Mechanical Engineers of the Nigerian Army. I assumed work as a House Officer in September 1988. But Ramadan met me in the Department of Paediatrics.
Paediatrics posting in JUTH like most health facilities in developing countries was under-equipped, housed in an old colonial building of the old Jos Murtala Hospital and operated by overworked health personnel, me inclusive. The Emergency Paediatric Unit (EPU) of JUTH was a beehive of activity. The yell of ill children could be heard several metres from the unit – and those are the strong ones; the weaker children may either sob or whine, especially if they are too ill to give a loud yell.
Call duty in the EPU tests your knowledge and clinical skills as there is always an urgent need for prompt diagnosis and immediate intervention that could define the difference between life and death for the children. The huge numbers of children in dire need of attention brought by mothers who are poor and ignorant of the preventable nature of the children’s illnesses usually overwhelm the staff and the inadequate infrastructure.
The House Officer’s routine includes going from ward round or clinic to the children’s ward or EPU, and finally to the laboratory to collect specimen containers. A doctor who is interested in getting a job done must get his specimen containers and collect results from the laboratories; otherwise one would incur the wrath of the Registrars who in turn are in awe of the Consultant. The chain of fear makes the house officer the most overworked member of the team without anybody remembering that the young doctor was a medical student only a few months previously. And everyone expects space rocket efficiency with the skills of Swiss watchmaker from the young doctor.
The Ramadan fast of May 1989/Ramadan 1409 began while I was on my third posting in the Department of Paediatrics. This coincided with the end of the dry season as occasional drizzles heralded the onset of the rainy season. This also meant large numbers of children with meningitis, diarrhoea and malnutrition. Low humidity, contamination of water supply, and depletion of food are the contributory factors for ill-health in children.
One fateful Tuesday in Ramadan, after conducting the ward round, I made for the EPU to prepare for the call duty. From a distance, I saw a flood of mothers and their babies clutched with various countenances indicating that I was in for a tough call duty. Space constraints compelled us to admit three to four children on special high platform examination tables where they would have various forms of intravenous infusions. Malaria, the big-time childhood killer disease, destabilises the young house officer who needs to quickly exclude meningitis.
Apart from the routine history-taking and clinical examination, the house officer orders for at least five sets of investigations as dictated by the patients’ conditions. Some requests are sent to the laboratories, some are requests for reviews by other specialists while a small portion of the tests are performed by the house officers in side laboratories that are adjoining the wards. On this day, my reconnaissance entry to the EPU actually became a one day and one night detention.
The flood of distressed mothers consisted of women whose children had meningitis, diphtheria, seizures from a mix of feverish illnesses, and malnutrition. Most of the children needed immediate resuscitation, which meant setting up intravenous lines, administration of oxygen and desperately sometimes impatiently coercing parents and guardians to go and donate blood for urgent transfusion. Accidental poisoning cases which included kerosene and alcohol ingestion were among those requiring resuscitation.
The confusion and despair sometimes call for the bosses in Registrar cadre to offer some assistance. My registrars combined efforts to attend to the severely-ill children. I was only able to break my fast with a few sips of cold water, struggling to offer the maghrib prayer and had to dash back to the EPU to relieve my boss who had an urgent need to go home. House Officers usually spend the night in the call duty rooms that adjoin the wards. Patient sorting and disposition lasted until after some minutes before 4am. At that point I had to go home in the house officers’ quarters to take suhur.
On reaching home, my Caribbean flatmate, Dr Sonya Edginton, asked me where I had been and I narrated how I survived breaking my fast on sips of water and keeping watch over drunken babies, among other severely ill children. In Hausa, she said, “Shi ke nan sai bua baki ya zama sahur”. Meaning, the sunset breakfast (iftar) may as well be used for pre-dawn meal(suhur) to usher in the following day’s fast.
May Allah pardon our slips and grant us mercy now and in the hereafter.