Eta, Bukola

Medicine

Nigeria

Since my migration to the United States as a teenager, I have not had the opportunity to explore the healthcare system of a developing country. One of my goals for this rotation is to learn about the healthcare system and clinical practice of a developing country in the setting of limited resources. I am interested in understanding the disparities in healthcare that exist between developing and developed countries. I also seek to understand simple, cost effective, available and safe measures that may be used to mitigate these disparities. I intend to expand my medical knowledge especially of diseases common in developing countries during this global health elective rotation as I participate in the delivery of compassionate and patient-centered care at the host institution in the developing country.

My other goal is to evaluate and gain insight into the particular ways by which information is effectively exchanged between the anesthesiologist and their patients as well as between anesthesiologist and other members of the healthcare team. This would be interesting given the different culture and environment with perhaps different methods of communication healthcare information.

Finally, I also plan to be involved in the teaching of junior residents at the host institution which will help prepare me for my career goal of teaching at a medical academic center. I hopeful that this opportunity would serve as a framework for future global health directed initiatives and prepare me for global health advocacy. 

I am a final year resident at Johns Hopkins Hospital which is a large hospital and referral center for many smaller hospitals in United States. I have never practiced medicine in a developing country, hence I felt privileged to have received the Paul S. Lietman Global Health Grant for Housestaff. This grant gave me the opportunity to experience healthcare in a developing country and has helped shaped my view of global health.

During my travel to Nigeria, I felt excited but also anxious. I was apprehensive about the unknown although I had certain expectations about my experience working in a developing country. One of my expectations was to observe and learn how healthcare providers care for patients given limited resources. I was expecting to see a lot of differences between how healthcare is provided in Nigeria and the United States. However, at the end of the rotation, I noticed there were more similarities with regards to healthcare than I expected. Just like in the United States, the healthcare providers I met in Nigeria worked very hard, and were very passionate about taking care of patients even when it meant going above and beyond general expectations.

The faculty and residents in the Anesthesia team at National Hospital, Abuja Nigeria were very welcoming and supportive. They were just as curious about healthcare in the United States as I was about healthcare in their country. They wanted to know about the United States medical training, the number of years required to become an independent practitioner, study materials, the structure of the healthcare system as well as the availability and management of healthcare resources in America. Many of the residents told me they know we have “a lot” in America and were of the opinion that the American healthcare system was wasteful.

Initially, I agreed with the resident’s view that the American healthcare system was wasteful but by the end of my rotation, I came to the conclusion that the healthcare system in my host country was also wasteful but perhaps in a different manner. While the healthcare system in America exhibits waste by ordering of unnecessary medical consults, excessive testing etc; the waste in Abuja was characterized by lack of maintenance and lack of optimization of available human resources. Like Johns Hopkins Hospital, the hospital I worked in was in the city and was also a big referral center. Hence, this particular hospital was heavily subsidized by the government and was able to afford many expensive medical equipment that were unavailable in the rural areas. However, the lack of a maintenance culture meant many of these expensive medical equipment were broken, damaged or abandoned only after minimal use.

It was also interesting to see some of the healthcare challenges in my host country and how the providers work to overcome these challenges. I remember one situation when we lost electricity during a major ongoing surgery. Usually there is a generator on the surgical floor that kicks in to supply electricity whenever electric power is lost but unfortunately the generator was faulty on this particular day. Immediately the patient’s ventilation was changed from automatic to manual while the surgical assistants and residents turned on the flashlight on their phones and directed the light towards the site of the surgery so the surgery could continue until the electric power generator was repaired. This was one example of how healthcare providers dealt with challenging situations while trying their best to provide safe care for patients.

In conclusion, I had a great experience working at the National Hospital, Abuja. This experience has positively shaped my view of global health and reinforced the idea that the world is fast becoming a global community with mostly similar but also different countries that are in some ways inter-dependent on one another.

People

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases
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September 2018

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