Making do in Nigeria

Practising clinical medicine comes with its challenges, especially in settings of limited resources and infrastructure, excessive working hours, and relatively low income. On encountering some of these as an intern in a Nigerian teaching hospital, I wondered how much I could take.

A study in JAMA found that 24 hours without sleep results in psychomotor impairment similar to someone with a blood alcohol concentration over the legal driving limit (2005;29:1104-6). Imagine what that implies for someone who has been at it for a whole month. When I started as a house officer in surgery, I worked in the paediatric surgery unit for a month, which meant that I was on call everyday for a month not having a regular place to sleep. Efficiency is not easy in such conditions. I remember dozing off on one occasion while taking a history from a patient.

Where most facilities are lacking, improvisation becomes the norm to get the job done. Don't worry if you don't find a tourniquet, a drip set will do just fine. If you can't find an inhaler spacer device, look for a cut plastic bottle or if you can't find a gastrostomy tube, a Foley's catheter might just help you out. …