What I Learnt in My First Month as a Clinical Student
After the hustle and bustle of preclinical school, I finally got to walk the floors and corridors of the teaching hospital and to practically appreciate and apply some of the things we had been taught in theory up to this point.
My excitement, however, was dampened when I saw the distributions of the postings and discovered that I had been posted to the endocrinology unit of internal medicine which focuses on diagnosing and treating hormone-related diseases and conditions. I had been hoping to be posted to a unit like cardiology, which deals mainly with the heart, or neurology, which focuses on the brain and everything else relating to the nervous system. I felt that there would be so much more to learn in these two fields and hopefully many interesting things to experience. With endocrinology, there was not so much to expect, or so I thought. Was it going to be anything more than diabetic feet and a few cases of thyroid disorders?
It turns out no aspect of medicine is less important than another; every field is significant and vital in the maintenance of whole health among families and in the society at large.
To my utmost surprise, the endocrinology unit is very busy, and unlike I thought, there is so much to learn. It turns out no aspect of medicine is less important than another; every field is significant and vital in the maintenance of whole health among families and in the society at large. I was surprised to find that we had to deal with not a few but A LOT of cases of diabetic feet. It was shocking to discover the extent to which diabetes prevails in my community. The daily influx of patients to the endocrinology unit daily, the domination of the male and female medical wards by patients whose diabetic disease has progressed into complications like foot ulcers, the number of people who were on the verge of losing their sight, their legs, or some other part of their body to diabetes was alarming to me.
At one point, it seemed as though almost every person above the age of forty was either a diabetic or a prediabetic. I was always shocked, every time we met a patient, every time a patient was diagnosed in front of me as diabetic or prediabetic, even those who looked relatively healthy, who came into the clinic with a complaint not directly related to diabetes. After a hectic day in the clinic, I would pass through my street and notice an elderly or middle-aged woman sitting in her stall where she sold everyday provisions, a bottle of coke in her hands, and I'd begin to wonder when last she checked her sugar levels, and if she also was diabetic.
After a hectic day in the clinic, I would pass through my street and notice an elderly or middle-aged woman sitting in her stall where she sold everyday provisions, a bottle of coke in her hands, and I'd begin to wonder when last she checked her sugar levels, and if she also was diabetic.
Diabetes looked to me like that subtle epidemic that was silently but steadily taking over my community, bringing upon as much damage, if not more, than COVID-19 but not getting as much attention, probably because it is not communicable like COVID-19, or because it ran more of a chronic, progressive and gradually destructive course, unlike COVID-19 which more often runs a rapid and fatal course under a short time.
After clerking more than a few cases of people whose history of presenting complaints, signs, and symptoms more often than not pointed to diabetes as compared to other endocrine disorders, I got interested in the subject of diabetes and the reason for its drastic prevalence in my community.
Research over the years has shown a drastic increase in the prevalence and a demographic transition in the epidemiology of diabetes in recent years, such that populations previously unaffected or minimally affected by diabetes are now reporting soaring figures. And this is no surprise. There are quite a number of factors as regards our general makeup and lifestyle that tend to put us at risk of developing diabetes.
For one, there's the factor of obesity. Research shows that about one in four Nigerians are obese and that the prevalence of obesity in Nigeria can be regarded as an epidemic. Obesity is a powerful risk factor in the progression of diabetes, especially type 2, which is more prevalent among the middle-aged and elderly, and is indeed the more common form of diabetes that we see in the endocrinology unit every day.
The general pattern and running of our society is another factor that puts us at risk. Most middle-aged to elderly women run different kinds of businesses from small shops to big stalls. In many of these cases, these women end up spending most of their time sitting almost throughout the day, from where they carry out most of their transactions and activities. Even those who are teachers or bankers still spend most of their days seated on their backs and less time actively moving and expending some calories. There is little that pushes many people to intentionally challenge their bodies. Subjects like exercise are reserved for those who have some extra time on their hands and are willing to indulge themselves a little bit. It is considered more a matter of recreation than an important factor in the maintenance of whole health.
Our diet is another big factor. In Nigeria, things that largely form the bulk of our daily meals like white rice, bread, garri, and fufu are refined carbohydrates that contain large proportions of glucose and little or no amount of other nutrients like vitamins and fibers because they have been removed during the refining process. We are a society where most men, after spending two-thirds of their time at work on their seats, return home in the evening to consume a heavy meal of pounded yam or semolina along with huge chunks of meat and a proportion of efo riro that does not adequately commemorate with the amount of the pounded yam, then down the meal with a bottle of carbonated drink, only to go to bed one or two hours later without making any deliberate effort to aid the process of digestion or to relieve the weight of the heavy meals on their bodies. Repeating the cycle everyday for like five days a week, eating these same varieties of food, yet maintaining the same sedentary lifestyle with exercise almost completely absent from our everyday routine, it is no surprise that the incidence of obesity, diabetes, hypertension and metabolic syndrome is on the high rise in this part of the world now more than ever.
We are a society where most men, after spending two-thirds of their time at work on their seats, return home in the evening to consume a heavy meal of pounded yam or semolina along with huge chunks of meat and a proportion of efo riro that does not adequately commemorate with the amount of the pounded yam, then down the meal with a bottle of carbonated drink, only to go to bed one or two hours later without making any deliberate effort to aid the process of digestion or to relieve the weight of the heavy meals on their bodies.
What’s worse is that in this part of the world, illiteracy and poverty still heavily influence people’s ways of life and choices; for example, one out of five out-of-school children in the world (10.5 million) can be found in Nigeria. Combine this with high levels of superstition, and limited functionality of primary health care facilities, many people do not grasp the importance of or take the subject of regular medical check-ups seriously. Consequently, most people present to the hospital only by the time the disease has progressed a considerable length and is on the verge of causing some form of damage to the body. This only makes the disease more difficult to tackle and many times, more expensive.
More than ever before, I became conscious of the long-term impact of my lifestyle and diet on my health and my life as a whole. Managing diabetes is not an easy task. While it can be properly managed in such a way that it will not interfere in any way with a patient's life and activities, it can be quite expensive especially in this part of the world. Maintaining steady doses of metformin or insulin shots regularly and continuously for years unending can significantly impact the finances of the patient.
These days, I find myself thinking twice before downing a bottle of coke, asking myself again and again if the pleasure of a few minutes that comes with filling my system with so much refined sugar is worth the health risk at which I would be putting myself, not just now but in the long run. I find myself being concerned more than ever before about the health and lifestyle of my parents and the elderly people around me, imploring them time and time again to eat healthily and to find time to exercise regularly.
Eating healthily does not mean doing away with carbohydrates completely. It just means eating the right types of carbohydrates in healthy proportions. While it is better to do away completely with refined sugars, fiber-rich complex carbohydrates are health-friendly. Low-fat dairy products, whole grains, cocoyam, water yam, sweet potatoes, and plantain are some healthy sources of carbohydrates for the body. Garnishing meals with the right proportions of vegetables and fruits, drinking lots of water, and less refined sweetened drinks, are healthy ways to balance one's diet and ensure that the body is getting the right proportion of every nutrient that it requires.
The past month has been quite an interesting journey for me. There is so much to learn about the human body, about the science of health and wholeness, and I am afraid that even in the next twenty, thirty years, I will still not have exhausted in knowledge the intricacies and details of the workings of the human body both on a macro- and a micro-level. However, one important thing that I have learnt so far is that while maintaining a healthy life may sometimes feel tedious and boring, at times requiring that we deny ourselves the things that our bodies so earnestly crave, sometimes pushing ourselves out of our comfort zones to give our bodies the exercise that it requires, when we'd rather “Netflix and chill”, stuffed on our couches two-thirds of the day, the price to maintain whole health is nothing compared to the price that will have to be paid to manage a chronic health condition like diabetes. It is worth it, no matter how difficult it is, to make the necessary changes to lifestyle and diet required in maintaining a healthy life, because poor health saps out energy and resources on every level. Whoever came about this adage was not lying; they were absolutely accurate when they said, "Health is wealth". Truthfully, no man is more wealthy than a man who is healthy.