Setting: Ikoyi branch of the St. Francis Hospital in Lagos, Nigeria
Position: Private general practitioner
About 70 percent of my patients are locals, and the rest are expatriates living overwhelmingly in Lagos. They rarely come from other cities in Nigeria. The main motives for consultation are (in decreasing order of frequency): Fever, gastrointestinal disturbances, skin lesions and trauma. Pediatrics is an important segment of daily practice, as well as obstetrics and psychological disorders in women.
Pregnancy monitoring can be challenging. Although the city has more than 6 million people, ultrasound exams are only available at the general hospital and in a single clinic. Serologies can solely be performed at hospitals where quality control and availability of results are serious issues. It creates a feeling of insecurity; for these and other reasons, many expatriate women decide to fly back home to deliver their babies. Nevertheless, some choose to give birth in the city where they live, like the wife of my neighbor, who is a French news correspondent in Nigeria. From him, I learn tremendously about the country’s social structure and political mores.
I have never witnessed any adverse outcome from delivering a baby locally, an option that is much less costly than flying to Europe. At any rate, a highly educated British lady one day shares her feelings about her life in Nigeria, her interactions with nationals (mainly domestic help) and the state of Nigerian health care, as well as her racial views. She declares that under no circumstances she will allow her first child to be delivered by a black doctor. I tell her my professional experience in this respect. Predictably however, and as she wishes, one month prior to the expected date of delivery she takes a plane to London. About three months later she is back in my office and I am curious about her whole obstetrical experience in England. Everything went fine, she says, including the physician’s care. As I ask for his references to request a copy of her file and test results, I cannot stifle a chuckle. He has a Yoruba name! She sees my reaction and in a typical understated English humor lets out: I might have my second child here after all.
Lesson for the doctor: It often takes a strong dose of reality to dislodge a patient’s preconceptions.
Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.