My first job as a doctor

 My first job after I graduated was as an intern at the University Training hospital, where I had trained. Even then, I was surprised that I was taken as it was usually reserved for the best of the best or you had to know someone. I did not consider myself a top student. Although I came from a village next to the city where the University was located, it seems that it is now engulfed by the city and now considered a suburb. As a junior doctor, you notice the effect immediately. As a medical student, you are chased away from the wards as they see you as a hindrance to the senior nurses' effective, well-rounded running ward. All the nurses now take special care of you as a doctor. I noticed that I had many mothers, sisters, aunts, etc. and even made the extra effort to ensure that you had eaten, especially when they found out we were from the same city. The cafeteria delivers food to each ward for the "doctor on call". Although, for all intent and purposes, your work is a glorified phlebotomist and ward clerk for most of the day, when all the other residents are around. But it does have its moments. Late at night, you might find yourself assisting neurosurgery or cesarean section, or you will find that operating on a patient's abdomen or doing a lumbar puncture assisted by a senior doctor. These were teaching sessions as the residents were preparing for their own exams. They could look at it from a different perspective.

I am writing this piece because of my experience in the Children's Emergency Clinic. Here is where children are brought for far too many cases than I can remember to die. Although many survived, more than necessary, children died there. These were from simple ailments which were initially mismanaged. An example is febrile convulsions which will cause a child to have fits due to the effect of high temperature on the young brain. The most essential thing is to reduce the temperature by giving a simple warm tepid and paracetamol. Removing the child's clothing and fanning the child also does wonders. When the child comes to UCH, it is believed by the local populace to be "a hopeless case". Traditional doctors would have used various concoctions and treatments. For example, you would see different types of leaves, palm oil, and concoctions, which may contain western drugs like antibiotics. Then there would be scarification marks on the wrists, arms, legs, head, etc. The traditional healer would have tried to apply herbs directly into the bloodstream. But, of course, things like tetanus, other bacterial infections, viral infections like Hepatitis, AIDS, etc., would have hitched a ride on the unwashed instruments used to break the skin. Then they were those cases from private clinics in and around UCH, managed by Nurses (who sat in as "doctors"), giving the child patient all combinations of medications or under-trained doctors. Therefore, one must be careful not to overdose the child on medication. You will find that you are not treating the child's initial aliment but the effect from the "treatment" they had received, like overdosage of medication or the inhalation of smoke which seems to be used to chase away the "demons" believed to have been tormenting the child. Then the use of fire is also for the same purpose. There are rare cases of multiple broken bone fractures because they use sticks and rods to "beat" out the demon. Hence, you find yourself treating third or fourth-degree burns, bone fractures, lacerations, etc. The mothers are also very secretive as they had been warned by friends and family and the traditional healer not to reveal what was done to the child. The signs and symptoms are not so clear cut as they had been modified and altered; hence you do not know what a sign of the disease is or that a reaction to a "drug", concoction or "treatment". So, we treat the symptoms, signs, and results of our investigations.

Since the mothers are sceptical about the vaccine, we find ourselves treating measles (a viral infection - back in the 90s, they were a few cheap antiviral agents). Hence, the best treatment is to let the virus rip through the system but only treat the symptoms. Most of the children who die would have been saved if they had the vaccine, another significant majority by good diet, and the third a combination. But most cases were anaemic due to infection, bloodletting, which was seen as a form of treatment and a poor diet. 

There are days when the Children's Emergency Clinic is filled with people. Cross-matched blood would arrive from the Blood Bank for one patient, the nurses would call out the name, and the mother would have slept off in the chaotic environment. Some mothers were known to arrive but left when they believed the doctor was not helping faster enough. The sleeping mother was only woken by the child gasping for air. There is insufficient blood to carry oxygen to the tissues due to anaemic heart failure. Hence, the heart will beat faster to ensure insufficient blood is used to carry oxygen to the tissues, and the child will breathe faster to get in more air. They would almost always seem out of breath, tired and very weak. Most of them had swollen bellies due to accumulation of fluids due to a combination of heart failure (swollen liver and the heart's inability to deal with the return blood, hence accumulation of fluid), poor diet - low protein. Eventually, the heart fails as it can no longer cope. The best treatment, in this case, would be a blood transfusion - usually red blood-packed cells, but with blood exchange's cultural and religious element, they have to bring their relatives and friends or buy blood. In the chaos of the treatment room, you could feel the frustration of everyone in the room and the pain of the mothers who felt that they were listening to their family and friends, none of them which were present with you in the early mornings or late at night but were all neatly tuck up in their warm beds with their bellies full. If the child dies, they will convince the mothers that it "was God's will". No one questions God's will in a land with a high level of religiosity. It is easy to convince the mother that God will protect her child, not the vaccine, and if the child dies, it is God's will. It's not dependent on the doctors or nurses that they live. Hence, it is a "get out of jail card" for the incompetent or lazy doctor. Many do not even come to work in some rural areas as it is God's will, whether a person dies or lives.

I looked at vaccines and their effect on the populace and the misinformation, like using aborted human fetuses used in vaccine production. The vaccine is the "mark of the beast", or the vaccine used to track and monitor people. The advice then could be easily given, especially by these "friends" and relatives who do not feel their direct repercussions, "do not take the vaccine" can quickly come out of your mouth when you only have to worry about yourself. In the world, Polio has almost been eradicated, like Smallpox which has disappeared and is one of the viruses under heavy scrutiny. In 1980, the World Health Assembly declared Smallpox eradicated, and no cases of naturally occurring Smallpox have happened since. Polio was found in only two countries, Nigeria and Pakistan. In Nigeria, it was found in the Northern part. There was a rumour going around that it would cause infertility in women or a way for the West to control the developing world population. Hence, a lot of mothers refuse to bring their children vaccines. 

I used to look at those days in UCH as ignorance of the populace of the city we practice in, and those in the Northern part of the country and the recurrence of Polio Myelitis was due to ignorance and religion. But now, more than 30 years later, going through it has made me look at life again, and the role of ignorance and religion is and was not as clear-cut as I thought it was. And it was "deja vu all over" again when I heard of people refusing the COVID-19 vaccine and dying due to ignorance.