Sunday, November 25, 2012

Further Adventures in Medicine - part 1

Monday I flew to Abuja to have an MRI done. There are only a handful of large cities in Nigeria where there is a hospital with the right machinery. I stayed overnight at the 3Js hotel, my second trip there. The in-room internet still gives me trouble, but at least they have a cyber cafe where I can pay $1.25/hour or sometimes convince the guy in charge to let me work for free since my laptop has problems with their systems. I was thankful to have had a pleasant flight (if 2-3 hours late) and no problems getting to the hotel. I was also thankful the travel guy at HR got everything set up in record time and I made it to the airport on time despite not knowing when I was leaving until an hour before the flight ... in the middle of a class!

Nigerian beds remind me of hymn 86: How FIRM a foundation. It's sleeping on a board, almost literally. No bedsprings. Just a board and a mattress. I am thankful every night for the memory foam pad we brought with us to sleep on. When I woke up Tuesday morning, I was in agony. I needed both my cane and the support of the furniture around the small room to be able to move at all. Though I finally walked off most of the stiffness, I was in a quiet agony all day long.

I got to the hospital for my 9am MRI appointment and all wahalla broke loose (that's Hausa for problems).

It took me 20-30 minutes to find the right MRI building because Radiotherapy wasn't the right building and the building labeled MRI wasn't the right one either - no one was even in it! - and it turned out to be the building undergoing construction that housed the MRI staff and a crowd of despondant-looking fellow-sufferers waiting their turn to be seen at the National Hospital. No one would give me the information I needed or explain what was going wrong or tell me where I needed to be, or even look at me for the most part.

I would happily excuse everyone on the grounds being crowded and overwhelmed except most of the desks were empty as patients just sat forlornly on chairs and stared at me with those blank stares that could mean anything. They most vividly reminded me of the looks the locals give certain foolhardy, horror/adventure movie heroes entering the Dungeon of Despair and Doom or possibly colorless drones knowing my energy and will to live will slowly be sucked out of me as I wander the halls in madness until I become one of them. Quite uncanny.

The MRI staff asked for my green registration card which I never heard of. They then proceeded to ignore me for an hour. I got on the phone to our nurse at the AUN Clinic and she finally got someone to come talk to me. Without the green registration card they didn't know who I was or what I was doing there. Sure, I had an appointment, but what part of me were they even supposed to MRI? There was no indication.

The head secretary refused to help me. They didn't even have a fax machine to receive the referral. It took a solid hour to download the scanned referral form at the library from the AUN Clinic. With that in hand, I went back to the MRI. A doctor was actually there now! Three hours after my appointment, there was finally a doctor!

He told me they needed money. I said I had insurance. They didn't recognize my super-duper, internationally recognized, quite amazing really insurance. They were puzzled at even the CONCEPT of giving someone medical services first and being paid after. They wanted N100,000 up front [about $650]. I either needed cash or the insurance company needed a retainership with them.

I should probably interrupt at this point to share a funny experience I had getting my x-rays done a couple weeks before. I arrived at the German/Specialist Hospital and was told the x-rays would cost N4000 ($25). However, we were having trouble getting dollars from the bank to trade for Naira, and almost as much trouble getting Naira out of the account also, so we were short of funds. We paid our maid and I bought my medicine, and I had N2500 left in all the house. I explained this to them and they stared in shock at the Bature (white man) claiming poverty. I promised to pay them back on Tuesday, and I think as a joke they let me. It was a good thing to experience a little mortification. When I came back, the guards and secretaries all remembered me and were happy to see that I paid my bill as promised.

But back to the National Hospital in Abuja.

I began to realize I was not getting my MRI that day and would not be home again to teach my 4 classes Wednesday. I said some things in frustration while thanking the doctor for finally having the courtesy to talk to me. I had him explain the problem to the head nurse at the AUN Clinic. I had him explain it to HR. HR finally got hold of the insurance company. He explained it to the insurance company. The insurance company asked me if I knew of another hospital in Abuja with an MRI machine - as if I know anything! They don't have an office in Nigeria, you see, so it's the South Africa branch calling. She promises to call me every half hour. That was the last I heard of her. Of more than ten assurances I got that day from various people who promised to call me back, only one person did once. (Thank you, Jasmine).

3 more hours have passed like this. Thankfully they did have a cafeteria with some sufficient sustenance and staff with poor short-term memories but who were friendly about it. They asked if I wanted two bites of beef, or if I needed four.

By this point I had made peace with the doctors - the only people in the joint who will talk to me consistently. It was 2pm before I finally met The Doctor, who said the entire fiasco was AUN Clinic's head nurse's fault. He had made an appointment when she asked, assuming she knew what she was doing, but every phone call just made it more clear she does not understand the Nigerian system. We made arrangements to have the MRI done Wednesday, assuming either the insurance gets its act together or I came up with N100,000 cash. When I later spoke to the neurologist in charge of the AUN Clinic, he vented in frustration that he had told the head nurse all this specifically and was shocked nothing was done to prepare the way for me. I decided the better part of valor was to not complain at her because I was stranded in a foreign city in a foreign country and needed all the help I could get. After the number of times she hung up on the doctors or me trying to get questions answered and the constant miscommunications and poor planning, I'm still fairly frustrated.

I went outside to wait for an hour. That was the most pleasant time of the day. I laid down on the grass - the sharpest, most poke me through my clothes painful grass I ever met - and stared up at the beautiful blue sky, the puffy clouds, the pink flowers, the grass, and the statues. I read some more scriptures and some of a book about progress in Africa and enjoyed the time.

A security guard came over at one point to make sure I had a driver coming. I called, told the Abuja office that "There's a security guard here who is worried about the white man laying down on the grass," and was assured that the driver would be there in half an hour. He was.

I had the driver take me to a bank before it closed. After fighting with the teller (I have never been so furious at a bank teller who forced me to write a letter begging for my money out of my own account, and then to rewrite it because I didn't put a nice header on it, and nearly tried to get me to rewrite it again for not signing it "Most Sincerely,") I finally got N100,000 out of my account and retreated to the hotel.

There was one tender mercy that night. The restaurant had a burger. The fish and chips the night before had been good, but I needed comfort food. The waitress went to check to see if they could serve it. She came back to apologize, "It would have to be beef, sir." I assured her a beef burger would be fine. I did not investigate what else they might have. It was delicious. It was wonderful.

I am thankful that I have been trying to be thankful this month. I spent a lot of effort despite my pain trying to be very nice and respectful and thankful to anyone and not get too upset. It was a great challenge. Looking at my fellow patients, I could have had it a lot worse. I am also thankful that AUN paid for the flight and the hotel, and I have a couple more compliments to send its way once I finish the story in another post.

For earlier adventures in medicine, try here for the scary or here for the more reassuring.