"Keep Up the Fight, Nigerians!"

I am a family physician, having graduated in basic medicine from India. Due to a myriad of circumstances out of my control, I ended up moving to South Africa. Working in an impoverished part of the country for over three years, I gained immense experience in all fields of medicine – more so in trauma and infectious diseases.

I then emigrated from South Africa to Canada, a rich country with the added promise of enhancing my own personal wealth. But as only fate can play its slyly wise games, I ended up working in an impoverished part of Canada, the inner city of Edmonton. While in Edmonton, I witnessed the varied influences poverty can have on our mental and physical health, but more importantly, my experiences led me to believe that it is possible to fight against poverty's influence on health.

Drawn to the Developing World

Because of who I am, invariably a part of me got restless with working in Canada, and I was drawn to going back to the developing world. To be very honest, it wasn't really due to any ill-conceived altruistic notion of giving back to the world that caused me to embark on my next mission. It was more from a sense of adventure. I was going to use the skills I had, and join an organization that could put my skills and sense of adventure to use.

"Lagos!?"

So I contacted Médecins sans Frontières (MSF), or "Doctors Without Borders" as I then knew them. After filling out a series of forms, taking part in a number of interviews, emailing back and forth and the like, MSF offered me a position as medical doctor in an HIV project in Lagos, Nigeria. I jumped at it!

You see, I had some experience with HIV, and this opportunity would only enhance my knowledge and skills. The fact that it was Lagos, a chaotic city, or Nigeria, a rich country – which most experienced humanitarian workers would scoff at – did not perturb me in the least. I was finally going to the real Africa (back then, South Africa was too first world to my naïve eyes) for my real adventure.

Surrounded by Poverty in a Rich Country

Once in Lagos, after getting used to the sticky heat and, for all practical purposes, the quite useless table fans, I began to notice all the other not-so-pleasant features of Nigeria. In this rather rich country (it is the seventh-largest oil producing country in the world), poverty surrounds every step you take! Except, of course, in the ritzy neighborhood that we at MSF had somehow managed to squeeze into. You see, we were the only ones without the BMWs or the air conditioners, or for that matter, decent utensils to cook with, let alone the butler my neighbor had. I was told that this was the true MSF spirit. I quickly adapted.

Slowly the poverty that surrounded me took away my naïve sense of adventure. Poverty was there amongst the multitude of beggars who painted fake wounds on themselves. It was there on the faces of the patients who couldn't pay for their transport to the hospital. Seeing this despair on the faces of patients, who couldn't pay for basic medication or admission to the hospital – even when they were emaciated beyond any describable terms – hit me. Yes, it hit me really hard.

Braving Bottlenecks and Roadblocks

I had worked with HIV patients in fair numbers in Edmonton's inner city and I had seen poverty in India. But every time I walked into the wards in Lagos General Hospital and saw a cachectic or ill-cared-for patient lying in their own feces, my insides churned! Every member of the MSF team, including myself, tried to give our best in this sometimes very frustrating, bottleneck-ridden, so-called rich country that is Nigeria. We had many roadblocks to deal with, including the inability to get the ARVs (antiretroviral treatment) into the country. We all persisted, bravely hanging on to that humanitarian spirit and trying not to get too jaded.

Although MSF was paying for almost everything that an HIV patient needed, we did not want to aggravate the Nigerian authorities by challenging the existing system of requiring admission fees for inpatient care. You see, our role was to provide outpatient care only, and leave inpatient care to our counterparts at General Hospital Lagos (GH-L). Invariably, as many of you know, HIV patients frequently need inpatient care. And very often there were many who could not afford it. So here I was, having my own little battles with my colleagues and supervisors about MSF paying for admission, and other little issues. All these perceived injustices caused a rage within my heroic if naïve little head, until the enormity of the real problem that HIV patients in Nigeria face began to enter my consciousness.

Nigeria is the most populated country in Africa. Even though an HIV prevalence rate of 3.5% might not mean much compared to the rest of Africa, it sadly affects four million of their citizens. And as you might have guessed, most of them are poor and cannot afford healthcare. They are the ones who end up in GH-L emaciated and yes, sitting in their own feces, because their caregivers never had the money to seek healthcare or to travel to the hospital to clean them up.

In this very environment, we had Nigeria's government charging 1,000 Naira (about US$7.50 or C$10) per patient every month (excluding all investigations, etc.) for HIV treatment. Our program, while free, initially had a policy of only taking those patients, from a specific area, who had never been treated. Not surprisingly, we had many patients come to our program lying to us about ever having been on treatment.

It was sometimes amusing to hear some of the elaborate lies the patients concocted to belong to the program. To some, it only added to the widely held notion that all Nigerians are cheats, liars, what have you. To me, it's kudos to the Nigerians for the inventiveness they so bravely display, in their admirable effort to stay alive!

Hooked & Hopeful

In conclusion, I have to convey my gratitude to Canada, for not only maintaining and fighting for universal free healthcare, but also allowing me to see that it doesn't have to be a worthless fight. I hope MSF will continue to be the David fighting the Goliath that is poverty. Soon I will again join MSF in this fight. I'm hooked!

And keep up the fight, Nigerians!

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