My Housemanship Experience – Struggles As A Nigerian House Officer

The obligatory one year housemanship (housejob) for fresh medical graduates (to get their full practicing license) is finally over for me. At first, I wasn’t sure I wanted to share my experience on the blog but one year later, I’ve decided to let you in on some of my experiences at Wuse District Hospital (WDH), Abuja.

Everything is a struggle in my dear country especially when government is involved. People think it’s easy for doctors to secure jobs after they graduate, that might have been the case in the past but not anymore. Getting a placement for the obligatory one year housemanship is a struggle. It’s a case of, “who do you know”? with very few on merit. I had to wait for 6 months after my induction to get a spot. 

Housemanship has 4 rotations in 4 departments with 12 complete weeks (3 months) in each. Some departments have their own rotations within the units in the department. Here’s a broken down glossary that will help you understand some terms in this post better.

• Call: This is duty after the normal working hours (8am – 4pm) where you’re responsible for all patients in the department till resumption time the following day. Starts at 4pm and ends 8am the following morning for weekdays and 8am to 8am the following morning for weekends and public holidays.
• Gynecology: the branch of medicine that deals with diseases specific to women’s reproductive system (women who aren’t pregnant).
• HMB: The board that governs and regulates all hospital employment and management (to some extent) for the FCT hospitals in Abuja.
• House Officer (HO): A newly graduated medical doctor undergoing the obligatory paid 1 year internship (housemanship also known as housejob) with a provisional practicing license under supervision.
• H.Pylori (Helicobacter pylori): a bacterium found in the stomach (usually asymptomatic) that when symptomatic causes gastritis and subsequent ulcers.
• Medical Officer (MO): A doctor who has completed internship and gotten full registration and license to practice and yet to take any specialist examinations.
• Neonates: Babies from birth to 28 days of life.
• Obstetrics: the branch of medicine that takes care of pregnant women till birth and post-partum period.
• Pediatrics: the branch of medicine that deals with children from 0-18years.

Getting a placement for the obligatory one year housemanship for medical doctors in Nigeria is a struggle and getting through that one year is another struggle. This post talks about some of those struggles. Click To Tweet

Ist Posting: Pediatrics Department

After I got my posting schedule from the medical director’s office, I was asked to resume the following day at the pediatrics department. It was totally unexpected as I was told by someone at the hospital management board (HMB) that all I needed to do was to go to the hospital to collect my posting schedule and inform the hospital of my resumption date.

It was a Wednesday and I was expecting to resume by the following Monday. Lo and behold, that wasn’t the case, I was asked to resume the following day (Thursday). What possible excuse could I have had not to do so when I’ve waited for 6 months to get this spot.

Honestly, Pediatrics department was one of the departments I avoided in Uni and it wasn’t because of the children. I had a very mean teacher and this usually discouraged me but I was always thrilled whenever I got the opportunity to carry some of the children. Going for classes then was because I had to, it usually started with “not this woman again today” for me.

My first few weeks at the pediatrics department went well with me learning and practicing clinical procedures. I was also noticing people that were giving me “the look”. You know, when people instantly judge you based on looks. “This one is ajebo”. “Oh you studied abroad, Ukraine? Hope you have stuffs?” Stuffs is the Nigerian medical slang for knowledge reciting textbooks.

…..and so it began!

After about 4-5 weeks into my posting, on one of my calls I fell sick (high grade fever, generalized weakness and pain) during the early hours of a Friday morning. Two of the MOs in the ward with me came to see me in the call room. One of them, Dr M was on call with me. She joked about me wanting to rest from the call but the other MO (Dr O) touched me and confirmed that my body was hot. Dr M replied her while smiling, ‘she’s been covering herself, of course her body will be hot.

Later that day, I commenced antimalarials so that by the following Monday, I’ll be back on my feet. I didn’t go to the staff clinic because I didn’t even know I was supposed to obtain an excuse duty for that day (I didn’t know it existed) as my fellow HOs were more than enough to cover the ward and the seniors (MOs) that we report to every morning already knew.

As the last HO from my batch to resume (5 weeks after my colleagues), I didn’t get any orientation, I learnt as the days went by. The one thing I was told while collecting my schedule was, “if you have any problem, inform your head of department”. Everything else, I had to ask my colleagues or figure it out by myself. At that time, none of them had fallen ill and needed an excuse duty.

Fast-forward to Saturday night, I started having intermittent abdominal pain that worsened everytime I took the antimalarials. On Monday morning, the pain was so much after I took the medication that I was crying. I tried calling my head of department but he didn’t pick up so, I sent an SMS (which he read) about being sick. To me, that was a problem I needed to inform my head of department about as I was told. I also informed the HOs.

Later that day, I felt better and I also remembered that it was the only free day I had throughout that week. I was going to be the only house officer in the department by the following week which meant increased workload plus alternate day calls. Having used turbans (which Dr M teased me about) and scarves the previous week, I decided to use the few hours that I felt better to get my hair done (crochet, something quick).

The pain continued but I finished the antimalarial by Monday night. The next day, Tuesday morning I knew I needed to go to the hospital not just to work but to get myself checked out properly. On getting to the hospital, I was told Dr M had been shouting that I hadn’t been to work for 4 days (Friday – Monday) and that the last time she saw me was the previous Thursday. P.S. I wasn’t on call over the weekend and didn’t have to be at work.

I was shocked because Dr M and Dr O (who I later found out was the main instigator) saw me on Friday and even advised me to get myself checked out not just to take antimalarials. It was as though I was lying when I insisted they saw me on Friday. Luckily for me, one of my colleagues who came in while they were in the call room with me that Friday corroborated my story. I realized how it must have looked not telling them again by myself on Monday that I was still down but it could have been handled differently since I informed the HOD. 

Few minutes later, while in the ward, Dr M came in shouting at me. She was asking me where I’ve been the last 4 days, who I told and all what not. I tried to remind her that she saw me ill last Friday and she continued shouting right there in front of patients. Honestly, I’m not so good at keeping calm when I’m being disrespected regardless of who but I was told of the horror that is Nigerian senior doctors during housemanship that I kept repeating ‘remain calm, do not engage, don’t react’ in my head.

After she was done ranting, ready to start her rounds, I told her I needed to be excused to go to the staff clinic as I was still in pain. She was furious, I could see the way she was looking at me, “You’re really sick with makeup on your face and new hair?”. I tried to apologize several times but she told me she didn’t want to talk to me. Other times she would raise her hand signifying ‘don’t bother’. All I needed at that time was to feel better, I didn’t care what she was thinking anymore so, I stopped trying to apologize after a couple of days.

I eventually got some tests done, results showed I had malaria ++ and h.pylori was positive (1st time in my life). I was given some medications and 2 days excuse duty. Before I got back , she had reported me to one of her seniors, Dr V who called me to his office. At this time, the whole hospital was already spreading the story of my absence from work and return with new hairstyle.

Dr V asked my side of the story, advised me to go apologize to her even if I didn’t mean it so that she can let it go because he thought she was making it personal and a lot of the other senior doctors in the department listen to her. I couldn’t for the life of me understand why she was making it a big deal and blowing everything out of proportion.

The aftermath

She wasn’t satisfied, she told me that she was giving me an extra call (next day). I told her about my 2 days excuse duty which I didn’t even know was already counting. Apparently the excuse duty counts the day it was given as 1 day. I called her and and also called Dr O to inform them that I’ve gotten an excuse duty after my test results came back.

I still remember how Dr O was shouting over the phone, “that your excuse duty does not hold water!”. Dr M was asking in a very authoritative tone, “who gave you excuse duty? Tell me that doctor’s name”. Funny thing is, the Dr already knew what was going on and was expecting them to question his decision. He was waiting for them. I only wished he told me then that the excuse duty covered that day because I worked till closing time just to show them that I wasn’t running from work.

The head of department who I was supposed to give the excuse duty to was no longer in the hospital which meant that I had to bring it to him the next day (a day I was supposed to be excused from). Before heading to his office that day, I stopped by the staff clinic to pick up my folder (my evidence). Coincidentally, he was with Dr V and before even hearing why I came, he goes on about how he has been receiving several reports about me.

I was surprised and even started thinking of other seniors I might have had issues with, still couldn’t come up with any. He then goes, “what do you have in your folder and test results that we haven’t seen before? or do you think anyone is doubting that you’re ill?”. I told him I just needed him to see that I wasn’t lying because the medical officers were acting like I was (because of my new hairstyle).

He collected the excuse duty, told me one day was already gone and that he expects to see me at work by 8am the next day. I was so angry that the 2 days were already used but I learnt from it. In the ward during rounds, Dr M would make jokes about how she didn’t know fair people still needed powder (referring to my makeup) and other irrelevant jokes. 

The HOD called the 3 of us (Dr M, Dr O and me) to his office for us to tell him again what happened. At the end, it was just to fulfill all righteousness because he didn’t really care about my side of the story. The only good input he made was correcting Dr M about the 4 days she’s been saying since I wasn’t on call over the weekend. I apologized to the 2 MOs in front of him and he let us leave. Dr M didn’t reply my apology (didn’t even look my way) but she didn’t say anything further.

Little did I know, she wasn’t backing down. Her fellow MOs confirmed she didn’t have a forgiving heart based on their experiences with her regardless of her smiles and jokes. Ironically, her first name means good child in Igbo language. During 2 consecutive departmental meetings (2 weeks), my topic was brought up and then one of them said that they heard that I said I had ‘connections’ so, nobody can touch me in that hospital plus I used to be a beauty queen.

Everything was hear-say, only one consultant out of everyone there said, she would leave it at ‘hear-say’ as nobody present could actually verify that I said such. She asked me at a later time if it was true I was once a beauty queen and other details. I had a secondary school mate as a colleague who told some of the HOs in front of me few weeks after I came that I used to be a beauty queen.

That was the very first time anyone in that hospital heard. She was jokingly saying, “You guyz know we have a celeb amongst us right?.. who?.. Onyinye, she used to be a beauty queen”. I tried stopping her from going further and she couldn’t understand why. She thought I wasn’t proud of once being a beauty queen. If only she knew that one revelation was going to turn me to a target for the MOs to practice their non-existent superiority on. Stories spread like fire and everyone has their version when re-told.

Like I said earlier, people have told me certain things about surviving housemanship in Nigeria. Being a beauty queen is the last thing I would want to announce at the hospital. Subsequently, I did 2 extra calls, all my alternate day calls and 6 weekend calls back to back for 6 weeks as orchestrated by Dr M obviously. When my first 6 weeks were up, I moved from the ward to the neonatal unit. Things were calmer there except for the occasional beauty queen teasing.

The matron in charge of the neonatal unit would call me Agbani (because I’m slim and tall) and bring us special groundnuts from her village in Edo state. The day she was told I used to be a beauty queen, she said “no wonder!, she’s always composed and she looks like them”. Nobody there had an issue with me till I left and I made sure I did my work well to avoid issues. This was my resting place from all the craziness in the ward.

Two days to my final day in the department, the HOD came in to the unit to tell me that he was adding the 2 days I took off to the end of my posting. That I had served Dr M’s punishment so, that was his and it was non-negotiable. 

The 2 days were spent in the ward and they flew by quickly and i eventually traveled to Lagos for my 1 week break when I visited Lekki Consevation Centre.

2nd Posting – Obstetrics & Gynecology Department

This was a department that I didn’t really have much real life experiences from school and was really excited to start the posting. Plus it was a great escape from my horrible experience at the beginning of my one year. At a point in that pediatrics department, the drama was so much that some of the NYSC doctors were advising me to switch hospitals.

The doctors in the O&G department were all easy going and willing to teach and help me learn. They were friendly and helpful even when I was the only house officer left in the department for a week. Some were cunning but 2 can play the game. I was overworked on most days, women were giving birth and falling ill daily but I wasn’t under any pressure doing the job.

My experience in the department taught me that the nasty attitude of some Nigerian doctors wasn’t a Nigerian thing but an individual thing borne out of each individual’s character and not from the training they got. This was also the department that really showed me how careless some women can be with their health especially during pregnancy.

When you ask them why it took them so long to go to a hospital or register for antenatal, you hear things like “it happened in my 1st pregnancy too and I was told the baby was cursed”, “But mama Emeka was pregnant like me and delivered safely at home”. “I thought it was normal, it used to happen to mama musa and she never went to hospital, she took some herbal medications from her village and she was fine”.

There were definitely bad days, watching women die even after everyone tried everything to save them or newborns dying but the joy of seeing new mothers carry their newborns in the labour room was unmatched. Childbirth is incredibly magical irrespective of the route.

3rd Posting: (Internal) Medicine Department

Prior to my resumption date, I already heard a certain Dr Ez (who everyone refers to as a lunatic) was waiting to ‘deal’ with me based on my incident with Dr M and the connection story. She boasted of how she needed to ‘handle’ me when i get to her department to clip my wings.

She pretended for a while but eventually showed her true colors. There are different ways to teach or correct someone but that’s a skill lost in Nigeria sadly. Eventually, I realized that the department thrives on eye service and did mostly that to get by on most days. Even after you’ve done your work, you should still be seen doing something.

The tall ‘oyibo’ doctor can’t get by easily. Dr Ez was in charge of making roster for calls and other administrative tasks for the department. She’s the most unladylike woman I’ve ever met in the last couple of years. Always looking like she had just returned from a fight, talks rudely to everyone including nurses and patient’s relatives. 

She had a co-conspirator, Dr Mo (your typical green snake in green grass). They decided I needed to be shaken one day and actually succeeded eventually. I got an extra call while still in the department, 3 extra calls while in a different department plus filling of an entirely new log book while in the new department. All the other medical officers were involved but those 2 were the leaders.

Sadly the head of department was either not aware of the eye service or ignored because she was the one that gave the instructions and still told me to take it in good faith as it wasn’t a punishment but a way for me to be more grounded in medicine. She said the decision was made based on my written assignment that I was given which they didn’t think I did well in. This was 6 different topics with only 2 days to complete and submit.

When I asked her if I offended anyone, why the decision was coming 2 weeks into my posting in a different department (3 weeks after I submitted the assignment and it was graded) and why I was hearing that I got 2 weeks extension of my posting when I haven’t been informed. She replied, “Young lady, you must really think you’re that important to insinuate this is personal. No one is out to get you, stop playing a victim. The decision was made solely based on your assignment, your chance to show that what the MOs have been saying about you were false”. It’s either the extra calls and filling of a new log book (which I had filled over the 3 months in the department) or extension. 

If the assignment was that bad, why couldn’t I just redo it properly. Other HOs (favorites) were given similar assignments and the opportunity to correct their mistakes but I wasn’t. Instead, I had to be in 2 departments at the same time just to get signed off at the end of the housejob. The truth is, it didn’t make me stronger, more grounded or whatever, more years of practice makes one better. I learnt absolutely nothing new.

4th Posting: Surgery Department

This is hands down the most work-friendly department in that hospital. Obstetrics and gynecology department had nice people but workload was more because some of them don’t do the work with you. In surgery department, everyone works! They don’t leave the work for the house officers only. This makes things faster and you can actually get some free time to do other things.

I made friends with a lot of the MOs and even attended an event with one (close friends with Dr M) who I thought was going to be my only challenge in the department. A lot of the surgeons are also very business-minded like me which made connecting with them easier. They know the world has evolved and one can be a doctor and still enjoy other things that make them happy. I even heard Dr M said she had been keeping tabs on me and that I got 2 weeks extension. Who cares?? I finished on the day i was supposed to, no additional day.

One year later, I survived against these odds. Signed out and got my full registration, now awaiting Nysc. In the end, life is really all about how you choose to live it. You don’t have to be terrible to other people because during your own training people were terrible to you.

We can all do better and be better, you never know what the future holds no matter how comfortable it looks now. I’ve had to battle with all these and still make myself happy by doing the things I love any chance I get. This year has had its low moments but I’m glad I’ve also achieved a lot this 1st half of the year and can only hope for more in the coming months.

How has the last one year been for you? If you are a medical doctor, I’ll really like to hear your housemanship experience because apparently some people I’ve asked still think these medical officers are still well behaved compared to the doctors they’ve passed through in teaching hospitals and the other government hospitals.

If you've ever wondered what some medical doctors pass through during their housemanship in Nigeria, here's one doctor's experience. Click To Tweet

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