Welcome Johnny

Dear Johnny,

It was like yesterday when you finished your NYSC that we talked about your prospects in Naija or in the abroad. Now, it’s five years already since you graduated. You have done all possible medical jobs. You worked your socks off to pay for different foreign exams. PLAB was your quick fix. US for you is the goal. You have written USMLE Step 1. Your savings paled. You have sold your car to write these exams. You owe uncle Kola about 1M. Your friends who have gone before you opted to pay your registration fee.  You are owing in naira and pounds. You told yourself it doesn’t matter how, you must leave. To far away winterland. You janded. Junior doctor. But it feels like you’ve just graduated. You are a fresh doctor. Again.

You start to remember those subtle attitude you and your Nigeria-trained colleagues gave foreign-trained doctors back in Nigeria. You called them “Ukraine”. Their training, to everyone including nurses and ward assistants was made to appear substandard. You felt like you know (perhaps rightly) medicine more than Hippocrates himself. But them? They know nothing! Now in your first month in England, its your turn. You feel like you know nothing. You are not Ukraine, you are a “Plab doctor” “BAME doctor”, “IMG doctor”, “African doctor” There’s always an adjective behind your job title. You feel Ukraine. Hehe.

You notice that everyone looks at you somehow. You see it in the eyes of oyinbo F1/2 who move stuff like they are registrars back in naija, at least. You wonder what you’ve been taught or what you knew. Or if you knew anything at all. That accent that your Lagos friends have been telling you you’ve got? You can hear it now. Your English drips richly with Ijebu. Sometimes they cant understand your grammar, other times you just can’t hear them. You laugh at the jokes you don’t find funny just to not look awkward. You can’t reply. Haha. Although some terms are new to you, you can understand the pathophysiology and reason behind decisions. Google has been your helper with endless terminologies, shorthand and impossible abbreviations. Let me put it to you. You don’t understand what’s going on. You are a house officer. Again.

You thought you knew the basics. Until the emergency alarm went off and you didn’t know what on God’s earth to do. “ABG please”, the registrar demanded. You never thought this day would ever happen. You read it in the textbooks but because you never saw the needle let alone taken one arterial sample before, ABG was a test for the gods. Haha. No it’s not. “Doctor the patient is now NEWSing 7. Can you please review?” NEWS? NEWS gini? You couldn’t ask the nurse, “e dakun what’s NEWS?“

“Doctor please review this ECG for me” The nurse asked… You would send a referral to the almighty Cardio SRs back home to review ecgs for you. Well, you didn’t have to do many because you’re not always on call. Once in every two or three weeks. Here they bring ECG(s) for you to see everyday. E don happen. No clue. You laughed at yourself…

“Doctor this patient has AKI, can you review the dose of the antibiotics?” The ward pharmacist politely hands you the drug chart. ‘This other patient is “pen-allergic’ but you’ve prescribed Flucloxacillin’ Lobatan. Pen kini? Won ti get mi. You laughed internally at yourself. First, you’ve never seen a pharmacist on the ward in your life. Now you hear antibiotic pharmacist, ward pharmacist. Hmmn Orishirishi.

Can you do TTO please? And the EDL? Ward manager asked you like it’s an emergency. “Sorry, what’s TTO?  And EDL?” Hahaha. You dunno why is going on. You dunno. Welcome to the UK. You have never written a letter to any patient or primary care doctor. Ever. You will get it eventuarry.

You’ve spent one month now and you are still trying to get it. Calm down. You will get it. Don’t worry yourself too much. If you are not clear about anything, ask questions. That’s the number one rule. Ask. Don’t ‘form’ knowledge. Ask. Open the hospital intranet, type that treatment you’re looking for. You’re likely to find guidelines. If you have any doubts, ask already experienced colleagues. It’s better to ask than be wrong. Everyone is happy and expected to help mostly. The UK system is structured that way. Don’t hesitate to seek help when you are confused. Think patient safety first.

One other thing that’s quite useful to know is to understand the language of practice in the UK. The language is not English. It’s British. I’m not talking about accent. It is the language of handover, the language of referral, the language of documentation, the language of speaking to happy or difficult patients. The language of talking to nurses and teams. The language of writing the GP. The language of responding to complaints! It takes time to really get this.

Ok Johnny I know you are brainy. You know stuff. But here ehn, stuff means facts. It’s called evidence. That’s the language of practice in the West. We will talk more about this. And other things.

Lastly, I believe you have a community around you. Make friends with whites, brown, black if you can. They are different in certain ways of thinking as you may have started realising. It is called culture. They are not bad. They are just different. You are not bad too. You are just different. We are all human. With profound fundamental behavioural similarities.

I feel so pleased to write you. I will write you again.

Your friend in the abroad

@bamsky007