Notes from the field – A west Nigerian doctor practising medicine in northern Nigeria
The practice of medicine is guided by ethics and principles. However, culture, religion and beliefs often influence the practice of medicine in most regions of the country, including northern Nigeria.
It is pertinent to note that medical practice in the north is an interesting one based on its peculiarities that stem from many factors among which are the aforementioned.
It is worthy of mention that majority of northerners are muslims, with unique culture, belief and tradition.The north is also a highly populated region of the country.
The maternity wing of any hospital can attest to the population strength of any northern state. There is a good number of quite young primigravidae and of course, many great grand, multiparous women.
It’s far from anything surprising to come across women with their 10th, 13th or even 18th pregnancy and looking like they never had one. I must admit that northern women are exceptionally strong in terms of pregnancy and childbirth. The implications of this as a healthcare provider, in the obstetrics and gynecology department is that you must be ready for a huge, yet interesting task. It’s an avenue to see and gather experience from various obstetrics cases, ranging from normal labour, missed abortions to ruptured uterus.
The outpatient department is indeed another people-laden section of any hospital, as the population could be so large that a doctor may have over 50 to 70 patients to attend to within a shift.
One of the major reasons why the hospitals enjoy large patronage is because of the subsidization of healthcare by the governments in nothern Nigeria. In Kano, (northwest Nigeria), for example, caesarian sections in general hospitals are done free of charge.
The healthcare provider encounters various cases ranging from the ‘common’ malaria to some cases only seen in medical text books while undergoing training in the medical school. It’s often said that you really cannot boast of having experience in the medical field if you have never practiced in the north.
A very important peculiarity worthy of mention is the religious and cultural belief associated with consulting female patients. It is a common practice that only female medical personnel are permitted to attend to female patients. It is prohibited for a man, even a medical doctor to have any close association with a female, except in cases of emergencies where female healthcare workers are not available. This is sometimes a common cause of frictions and restrictions when attending to female patients in need of medical attention. This also accounts for the high demand for female obstetricians and gynaecologists in northern Nigeria.
The most frequently encountered challenge of medical practitioners in the north is late presentation of patients to the health facilities. This increases the number of complicated and sometimes irredeemable cases that the health professional has to attend to. There is usually an initial reluctance to attend the hospital, despite the fact that treatment is often free. Many locals would rather try out all sorts of herbs and patronise tradomedical healers before coming to a health centre.
Some of these practices include, traditional bone setting in cases of fractures, making incisions on the chest wall to let out blood in a case of chest pain, making incisions and cutting open swellings on parts of the body.
Another common practice is that which predisposes women to heart failure after childbirth. It is the habit of hot water bath and potash- in pap meal. It is indeed a common cause of peripartal cardiomyopathy amongst northern women and often complicated with heart failure.
All of these practices increase the incidence of diseases. It also makes managing other illnesses extremely difficult, considering the fact that there are a lot of such incidents and resources allocated to resolving health issues are limited.
All these said, it’s quite an interesting experience practicing in the north. It simply demands understanding the peculiarities and challenges, and finding a way aroud them.
Allah ya taimaka kuma ya bada zaman lapia.
Dr. Abdulazeez Abiola Ismail
Kano State, Nigeria