The Nigerian Medical Student: A Ticking Time Bomb

By Fatima DAMAGUM

Our elders say that when two elephants fight, it is the ground
that suffers. These mighty creatures pay no heed to the ground as
they push, pull and hit one another. Indeed, it is the ground
beneath them, the grass that is crushed, the soil that is ruined
and the poor insects that are destroyed who suffer the most. This
is the parable of that of the Nigerian medical student.

Once upon a time, it was only ASUU strikes that affected medical
students. Our six-year sojourn in university would be prolonged to
seven, eight or even up to ten years due to the incessant ASUU
strikes. Now, however, new associations in the health sector have
also joined in the fight for justice and better working conditions
in Nigeria. It pains my heart, when I realise that almost all
strikes that involve teaching hospitals inadvertently affect
medical students. First, it was JOHESU (Joint Health Sector Union)
composed of all health workers apart from doctors, whose strike
caused the hospital to offer only skeletal services. The wards were
closed and patients were discharged as nurses who are typically in
charge of the wards were on strike. Medical students suddenly woke
up one morning and realised that they had no or fewer patients to
practice on. Then came the NARD (National Association of Resident
Doctors) strikes which also affect the students as the patients are
once again discharged and there is no one else to use for
demonstration.

For the benefit of those who do not understand the Nigerian
Medical University system, I will explain how our undergraduate
system works. Medical school is traditionally six years in Nigeria.
The first three years are called pre-clinicals where students are
taught the basics of Medicine: Anatomy, Physiology and Biochemistry
in the university. Therefore, at the university level only ASUU
strikes affect the students. In the fourth year, medical students
move to the teaching hospital where they are being taught the core
subjects of Medicine: Surgery, Medicine, Obstetrics and Gynaecology
and Paediatrics. They are also exposed to other subspecialities
like Psychiatry, ENT, Radiology etc. In the teaching hospitals they
are taught by both Consultants (who belong to ASUU, MDCAN and NMA)
and Resident doctors.

Now this is where it gets confusing; the consultants typically
give lectures in classrooms and then teach during ward rounds on
patients. However, during this ward rounds, they are expected to
teach not just medical students, but residents as well. And so, the
students don’t really learn much. I remember my first consultant
ward round in surgery when I heard them discussing a patient and it
felt like they were speaking German. Much of what they discuss is
too concentrated for the medical students. It is the residents
(registrars and senior registrars), who themselves are in training,
who recognize the helplessness of the students, that come to their
aid. These residents, sacrifice their time and energy, by
organising patient bedside teaching, tutorials at night and mock
exams so that medical students understand the core principle of
medicine. Bear in mind that these residents also have their work to
do. So, after seeing their patients, they return to the hospital in
the evenings and night to teach students. Many a time, we would be
relaxing in our hostels or in class reading at night, only to be
told that the doctor on call asked us to come over to witness
another exploratory laparotomy for typhoid perforation. Most of us
learnt how to insert an IV cannular from residents during call
hours. These residents, bless their heart, taught and still
continue to teach medical students the fundamentals of practice.
Doctors all over the world, know the struggle all too well.

Even now, while on strike, I know a few, who sneak and organise
tutorials for students, just so they can help them pass their
exams.

So now that they are on strike, and school is open- the mighty
question everyone is ignoring is- what happens to the medical
students? Residents in any hospital, outnumber their consultants.
Are the consultants supposed to see all the patients and teach
students as well? With which number? And on which patient? The
wards of tertiary hospitals have since been closed as the
consultants cannot provide both in-patient and out patient care and
teach students at the same time. And because the wards are closed,
there are no patients for the students to clerk and examine. How
then do they practice? I watched and assisted in close to a hundred
caesarean sections since medical school before I was confident
enough to hold a scalpel. How can a student who spent two weeks in
ENT posting, during this strike and not seen a single tracheostomy
(which is a very common ENT emergency procedure) being done claim
to be a doctor? How can a student be in O&G for a month claim
not to have seen a Manual vaccum aspiration for miscarriage?

Did I hear someone say- You tube videos? Yes, they may be a
temporary solution, but all doctors will tell you that there is
nothing like observing with the naked eye and actually assisting
that can compare to any video. Besides, how can a video guide you
to do a lumbar puncture? You will just go and injure the patient’s
spinal cord! These things need constant practice and in many cases
are taught by a senior doctor guiding your hand. Each doctor’s
style is unique, and so as we observe, we pick out the techniques
we like and simulate them back in our hostels. We learn from
consultants, residents, and nurses.

So, what is the way forward? Do we halt the semester whenever
NARD or JoHESU goes on strike? That is not fair. Besides, there are
other students apart from medical students. What about when ASUU
goes on strike and NARD and JOHESU do not? Will students continue
bedside teaching only without progressing in the university? Nope.
The system is therefore designed for both ASUU, NARD, JOHESU and
MDCAN (Medical and Dental Consultants association of Nigeria) to
work together in harmony for a common goal- the patient and the
students.

In all this, it is the Nigerian medical student that suffers.
The Nigerian government has turned this strike into a media frenzy,
a debating platform, an avenue to trade lies and insults. I do not
have to remind you that many of these politician’s children school
abroad and therefore are not subject to our dwindling educational
system. But is it not penny wise, pound foolish, if these students
turn out poorly? The money used to travel abroad because one doctor
botched up your surgery, would it not have been better invested to
teach them how to do these procedures properly?

This fight is not about ego, or teaching resident doctors a
lesson. The problem in the health sector should be addressed
comprehensively so that we do not wake one day and wonder how we
crashed so violently. That Nigeria is exporting doctors to other
countries now is because, we were taught well. I dare say that
Nigerian doctors excel well outside the country because we still
have high standards in our medical schools. But is that still the
case? With what these young ones are going through, will that still
be the case five years from now?

What the FG is doing now is a clear case of cutting one’s nose
to spite the face.

By Fatima DAMAGUM

Our elders say that when two elephants fight, it is the ground
that suffers. These mighty creatures pay no heed to the ground as
they push, pull and hit one another. Indeed, it is the ground
beneath them, the grass that is crushed, the soil that is ruined
and the poor insects that are destroyed who suffer the most. This
is the parable of that of the Nigerian medical student.

Once upon a time, it was only ASUU strikes that affected medical
students. Our six-year sojourn in university would be prolonged to
seven, eight or even up to ten years due to the incessant ASUU
strikes. Now, however, new associations in the health sector have
also joined in the fight for justice and better working conditions
in Nigeria. It pains my heart, when I realise that almost all
strikes that involve teaching hospitals inadvertently affect
medical students. First, it was JOHESU (Joint Health Sector Union)
composed of all health workers apart from doctors, whose strike
caused the hospital to offer only skeletal services. The wards were
closed and patients were discharged as nurses who are typically in
charge of the wards were on strike. Medical students suddenly woke
up one morning and realised that they had no or fewer patients to
practice on. Then came the NARD (National Association of Resident
Doctors) strikes which also affect the students as the patients are
once again discharged and there is no one else to use for
demonstration.

For the benefit of those who do not understand the Nigerian
Medical University system, I will explain how our undergraduate
system works. Medical school is traditionally six years in Nigeria.
The first three years are called pre-clinicals where students are
taught the basics of Medicine: Anatomy, Physiology and Biochemistry
in the university. Therefore, at the university level only ASUU
strikes affect the students. In the fourth year, medical students
move to the teaching hospital where they are being taught the core
subjects of Medicine: Surgery, Medicine, Obstetrics and Gynaecology
and Paediatrics. They are also exposed to other subspecialities
like Psychiatry, ENT, Radiology etc. In the teaching hospitals they
are taught by both Consultants (who belong to ASUU, MDCAN and NMA)
and Resident doctors.

Now this is where it gets confusing; the consultants typically
give lectures in classrooms and then teach during ward rounds on
patients. However, during this ward rounds, they are expected to
teach not just medical students, but residents as well. And so, the
students don’t really learn much. I remember my first consultant
ward round in surgery when I heard them discussing a patient and it
felt like they were speaking German. Much of what they discuss is
too concentrated for the medical students. It is the residents
(registrars and senior registrars), who themselves are in training,
who recognize the helplessness of the students, that come to their
aid. These residents, sacrifice their time and energy, by
organising patient bedside teaching, tutorials at night and mock
exams so that medical students understand the core principle of
medicine. Bear in mind that these residents also have their work to
do. So, after seeing their patients, they return to the hospital in
the evenings and night to teach students. Many a time, we would be
relaxing in our hostels or in class reading at night, only to be
told that the doctor on call asked us to come over to witness
another exploratory laparotomy for typhoid perforation. Most of us
learnt how to insert an IV cannular from residents during call
hours. These residents, bless their heart, taught and still
continue to teach medical students the fundamentals of practice.
Doctors all over the world, know the struggle all too well.

Even now, while on strike, I know a few, who sneak and organise
tutorials for students, just so they can help them pass their
exams.

So now that they are on strike, and school is open- the mighty
question everyone is ignoring is- what happens to the medical
students? Residents in any hospital, outnumber their consultants.
Are the consultants supposed to see all the patients and teach
students as well? With which number? And on which patient? The
wards of tertiary hospitals have since been closed as the
consultants cannot provide both in-patient and out patient care and
teach students at the same time. And because the wards are closed,
there are no patients for the students to clerk and examine. How
then do they practice? I watched and assisted in close to a hundred
caesarean sections since medical school before I was confident
enough to hold a scalpel. How can a student who spent two weeks in
ENT posting, during this strike and not seen a single tracheostomy
(which is a very common ENT emergency procedure) being done claim
to be a doctor? How can a student be in O&G for a month claim
not to have seen a Manual vaccum aspiration for miscarriage?

Did I hear someone say- You tube videos? Yes, they may be a
temporary solution, but all doctors will tell you that there is
nothing like observing with the naked eye and actually assisting
that can compare to any video. Besides, how can a video guide you
to do a lumbar puncture? You will just go and injure the patient’s
spinal cord! These things need constant practice and in many cases
are taught by a senior doctor guiding your hand. Each doctor’s
style is unique, and so as we observe, we pick out the techniques
we like and simulate them back in our hostels. We learn from
consultants, residents, and nurses.

So, what is the way forward? Do we halt the semester whenever
NARD or JoHESU goes on strike? That is not fair. Besides, there are
other students apart from medical students. What about when ASUU
goes on strike and NARD and JOHESU do not? Will students continue
bedside teaching only without progressing in the university? Nope.
The system is therefore designed for both ASUU, NARD, JOHESU and
MDCAN (Medical and Dental Consultants association of Nigeria) to
work together in harmony for a common goal- the patient and the
students.

In all this, it is the Nigerian medical student that suffers.
The Nigerian government has turned this strike into a media frenzy,
a debating platform, an avenue to trade lies and insults. I do not
have to remind you that many of these politician’s children school
abroad and therefore are not subject to our dwindling educational
system. But is it not penny wise, pound foolish, if these students
turn out poorly? The money used to travel abroad because one doctor
botched up your surgery, would it not have been better invested to
teach them how to do these procedures properly?

This fight is not about ego, or teaching resident doctors a
lesson. The problem in the health sector should be addressed
comprehensively so that we do not wake one day and wonder how we
crashed so violently. That Nigeria is exporting doctors to other
countries now is because, we were taught well. I dare say that
Nigerian doctors excel well outside the country because we still
have high standards in our medical schools. But is that still the
case? With what these young ones are going through, will that still
be the case five years from now?

What the FG is doing now is a clear case of cutting one’s nose
to spite the face.