JOHN NWOFIA does a reminiscence of his days as a medical student at the
University of Lagos, juxtaposes that with his experience as a resident in the
UK and wonders why making students go through hell is such a pleasure for so
many lecturers back home
Any medical student studying in
Nigeria in the 1980’s and 1990’s would have been exposed to intimidation and
fear in the dealings and meetings with their physician teachers. This was well
accepted as part of the curriculum. I was at the College of Medicine,
University of Lagos (CMUL) between 1982 and 198; and like the rest of my peers,
experienced these situations first hand. Everyone had stories to tell for every
year of medical school. There were some lecturers I was convinced just enjoyed
instilling fear into students, and probably bragged about it. Every department
had its stories.
In the 1st year of
medical school, the Anatomy department seemed to be the friendliest to
students. We had a relatively young professor who enjoyed being with students.
In the Biochemistry department, there was the professor whom legend had it that
he had been attacked two or three times (some even said he was shot) by
aggrieved former students for the unnecessary pain and suffering he put them
through.
In the 2nd year of medical
school we had a very amiable older professor and head of the Morbid Anatomy
department who believed a medical student did not have enough time in the 12
months to become a pathologist and as such did not believe in unrealistic
expectations from students. His next in command however did not subscribe to
such belief. He was mostly seen as a hater of students.
Most of the more exciting stories
came from the clinical years where we had such professors as the one named
‘Ghadafi’. Ghadafi was so named because he ruled with such a heavy hand that it
was believed some junior consultants were terrified of him. He was the head of
Obstetrics and Gynecology department. It was he that threatened to resign
rather than re-evaluate his scoring methods when told he could not fail over 70
percent of his students in an examination.
In the department of pediatrics, we
had the likes of ‘Fela’. He was so named probably because of his links with the
late Afrobeat maestro. We had so many tales about him. One of this was when he
was an external examiner for a neighbouring medical school. As expected,
none of the students was able to impress him and after the examination he
admonished them with the following words: “…you are all as bad as my students,
but at least, in Lagos, my students dress well”.
Just the thought of this professor
made every student nervous. But once he had this exceptional student who had to
defend his distinction score in the pediatrics department. The professor had
laid out a urine beaker with golden yellow liquid in it and asked the young
student to tell him about the specimen. After staring at the specimen container
for a while, the confused student went on to give the possible reasons why the
urine would be such a color.
After his presentation, the
professor reportedly took the beaker and drank the contents saying, “Now let me
see what your diagnoses will do to me”. He poured beer into the container and
berated the student for not smelling the specimen first. Ordinarily, this would
mean that the student could not defend his distinction score and should then
have his score dropped to a lower credit. But the professor would not have
that. He insisted that the student must fail his course. It was reported
that the university senate tried to intervene in this case but
the professor would not budge. It was only when a very well respected
professor in another department had threatened to resign if the student was
failed that the university prevailed on him.
In the department of Medicine, we
had a particularly terrifying professor who was dreaded by all. There was the
story of an examination candidate who on realising that this professor was
going to be his examiner, stood by the doorway to the examination room and
massaged both sides of his neck. When asked what he was doing, he said he was
doing carotid sinus massage. Someone must have
forgotten to teach him that he risked rendering himself unconscious if he was
truly attempting bilateral carotid sinus massage. Or maybe he knew what he was
trying to do and that unconsciousness may be better than the humiliation
he was expecting to receive.
Oh God,please deliver me from this
man is the prayer of many Nigerian medical students.
In the department of Surgery, we had
the professor who did not talk to students. He would rather talk at them. He
was well known to berate students and resident doctors. Even the junior
consultant in the department did not escape his humiliation. I recall my first
encounter with him as a house officer. As I went to the surgery department one
early morning to get my posting papers for a later shift at the surgical
Accident & Emergency Unit, I did not realise I had been moved to his
department and I was to resume that morning. I was helplessly ushered into his
office, wearing jeans and a tee shirt. He wondered aloud who I was and I
introduced myself to him. He ushered me into his inner office, shut the door,
and berated me for dressing “like Fela’s boy”.
He ended the berating by stating
that had I been a student under him I would not have graduated from medical
school, dressing the way I did. Mischief and some crazy confidence took
the better part of me and I told him that not only did I pass through him as a
student but that he had told my group that if anyone could be a successful
doctor in the group that it would be me. This was far from the truth, but I
knew he had no way of checking. He had every one on edge at his rounds; from
the senior resident (SR) to the medical student and the nursing staff. I would
start my rounds at 6.00 a.m., joined by the junior resident at 06.30 and
the SR at 7.00 a.m. After our rounds, we would go to the labs and
radiology units to have everything ready for him in chronological order and
then we’ll all wait by the 1st patient’s bedside at 07.55 a.m. The
nurses and matrons are also ready. At exactly 08.00 a.m. the doors will swing
open and ‘here comes the man’! He was never late. You could set your watch by
the door swing as he came in.
No one was allowed in after
him. No one! Then the junior resident (JR) would present the cases to him, he
would ask the senior resident (SR) questions about the patient. He then talked
at the students and would then test the JR. I do not remember him actually
talking to the patients in our teaching rounds. He probably did at his own
round as he seemed to know a lot about his patients. I remember one particular
case on a round. We had a patient who had come in over the weekend following a
motor vehicle accident. He had sustained some chest injury with a ruptured
artery. The SR, having tried unsuccessfully to contact him had gone forward
to operate and save the man’s life. As he walked by the bedside, the first
question the professor asked was “And who is this on my bed?” The SR then
went on to present the case to him.
Without acknowledging the patient,
he went on to berate the SR for not trying hard enough to contact him. Then
without warning, the patient interjected and said something like this: “How
dare you attack and insult the man that saved my life? I have heard about you;
you scare everyone and act like you are God. Well, I don’t need you; I don’t
need to be your patient. I am the patient of the man that saved my life and you
can go to hell!”
You could have heard a pin drop from
a mile away. Everyone was dumbstruck; including the professor. Nothing was said
for a few seconds; seconds that seemed like several minutes. The professor
turned around and matched out of the ward. That was the end of the round. We
were elated. I could have hugged the patient. We could all have hugged the
patient but nobody dared show any outward sign of joyful emotion on this
attack on the professor.
I served one month as the only
intern in the unit; 30 days of calls and no time off. I went into his office to
get my papers signed for completion of the rotation and the first question he
asked me was “who are you?” I could not believe what I just heard. I had just
slaved in this department for 30 days and completed a long ward round with
him the previous day and he did not know who I was. I again re-introduced
myself to the professor I had just served for 30 days. His remark was “…
it means you have done nothing to impress me and nothing to incur my
wrath. I think that is the best place for you guys to be”. He signed me off
as ‘satisfactory’. I was livid. I had given 30 x 24 hours of service and
that was all I got. I could do nothing about it and went to the administrator’s
office to submit the paper. And, behold, I was the first person in five months
to have come out without extension added to their posting in the unit. I guess
from him ‘satisfactory’ meant exceptional!
There are many more stories to tell
about our encounters. We were terrified of the professors. You could not cough
or sneeze in a ward round. If you got a question wrong you were humiliated.
Your parents and family were not free from these attacks. Tests were made
to fail students not necessarily to test their competence. We were told that if
you made it through Lagos you would survive anywhere else. My question had
always been: “was that really necessary? Did it make us better doctors? Or did
it just make us better test takers?”
I remember my first training
position in England. As a matter of expectation, I addressed the consultant as
“Sir”. He then advised me that he was not a knight and I should address him by
his name. I was even shocked the more when one of the other consultants I later
trained under requested that we address him by his initials. In the US, the
director of my residency program wanted us to address her by her first name.
All these were foreign to me. I was used to addressing my consultants as ‘Sir’
or ‘Ma’. I did not think there was anything wrong with that. At the same time I
realised that while our teachers commanded a lot of fear, the ones in
the UK and the US commanded a lot of respect. Make no mistake about it- I
had a lot of respect for most of our teachers, and still do. We owe
several of them whatever success we may have achieved in our careers.
But you never forget the humiliation and unnecessary intimidation we had
to go through.
At College of Medicine University of
Lagos (CMUL) the pass rate was closer to 30percent for the first attempt while
in the US anything short of 100 percent pass rate was considered a problem. We were
not less smart in Nigeria as it can be seen that Nigerian trained doctors did
better in the US. Now some can say that was a vindication of the system in
Nigeria. But again, the question arises of whether it made us better doctors or
better test takers. I am in support of the later, and not the former.
Medicine is a disciplined profession
and not for the faint hearted. At the same time, medicine is a caring
profession and you do not make caring professionals by training them in a
harsh environment. I am of the opinion that an intimidated student doctor will
produce an intimidated patient. We do not have to pamper the student but teach
them in a caring manner. Monsters, for the most part, will create monsters
while angels will create angels.
We want our doctors to be caring,
respectful and engaging with their patients. Why then should we expect that
when we train them in a hostile, fearful and intimidating atmosphere?
Dr. John Nwofia, is on the editorial board of the Nigerian Health Journal.
He is an interventional physiatrist and rehabilitation specialist and Medical
Director, Pain and Spine Consultants, Tennessee.
I could relate to both sides of the story. Some Nigerian lecturers make it their sole mission in life to frustrate their students.
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