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The collective nightmare of a system!!!

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By Dr Nuruddeen Muhammad MBBS (BUK), MWACP (Ibadan), FMCPsych (Lagos)

The painful exit of Professor Abdulhameed Isah Dutse to the great beyond on Monday, the 5th of October, 2020, led me on a journey of self-reflection about the three clinical teachers that had made the most impact in my professional training as a medical doctor. He was one of them.

I heard the name of Dr Dutse the public figure when he served first as the commissioner of health, and later the Secretary to the Jigawa State Government between 1992 to 1994. His signature spectacles and fancy jackets were too imposing to miss on the official almanacs.

But it wasn’t until about five years later that I had my first personal encounter with the great physician. We had passed a critical exam and were freshly enrolled into clinical side in Aminu Kano Teaching Hospital by early 1999. That was the last lap to earn the ‘Dr’ title for ourselves and naturally we had to learn so many things at once. Everything was happening very fast. The target was to produce doctors good enough to represent a new medical school. We clearly understood the enormous challenges and the anxiety of the entire faculty. Dr Abdulhameed Isah Dutse sat at the top as the Dean.

Dr Dutse wasn’t your typical textbook doctor dressed in white coat and neck tie. No. He was always smartly dressed in white traditional attire and drives an equally smart white car to match! Though he expected, infact demanded that medical students dress and appear like doctors everywhere on earth. I was about to take my first tutorials on that, and the hard way too!

One fateful day the Dean sighted about five of us walking towards the Accident and Emergency building from the Medical Students’ Hostel as he drove past. He deliberately pulled over and called on us as we gestured respectfully to greet him. He asked if we were medical students, to which we answered in the affirmative. It was at that point that he said but some of us were dressed like carpenters! The ridicule wasn’t exactly in the ‘carpenter looks’ but for those who knew Dr Dutse, his demeanor while passing the message said it all . I owe my everlasting sense of proper professional dressing to that random reproach.

But his best was always in the clinics, during lectures and on ward rounds. He was the typical aggressive type who would push and humble even the most prepared of medical students. Though as he had boasted severally, no medical student is good enough or was ever prepared. He would often daze an entire class and force everyone into a silent and remorseful reflection of how they ended up in a profession that is so intellectually demanding.

If Dr Dutse weren’t (ironically in a Hematology class) recalling the muscle with the longest names in the human body (lavator lavi superioris aleque nasii), he would be drawing the map of the world just to illustrate the geographical distribution of thallasaemias. When we consoled ourselves that (his) was probably a postgraduate proficiency, he would insist those were the basics that everyone of us must carry on their fingertips to eventually become a good doctor. It was at that point of self pity that Dr Dutse would drop his favourite punchline; “let me advise you guys”, he would reprimand, “It is a NIGHTMARE to become a bad doctor!”

Medical School, most especially the clinical years, is traditionally full of auspiciously intelligent young people who are technically into what they now love to hate. They discover (apparently too late), that what clinical medicine requires isn’t necessarily their superb talents but more of self-discipline, routines, then repetition of those routines and even further routines.

The thin line between those who would eventually become great clinicians and those who wouldn’t is as much a function of their intelligence quotient as it is about how each applies themselves to these arduous routines. Any average Joe who applied the consensus behaviour could excel much to the frustration of the most brilliant fellow who had heavily relied on his intelligence to survive.

It is typical to meet young, incredibly talented and smart folks literally trapped in the wrong body. The possibility of ending up as a bad doctor is real, not because they can’t be the good ones but because they won’t. The nightmare of this ‘inevitability’ is now real. It took Dr Dutse’s constant reminder to shape most of us into the proud Clinicians that we are today.

He wasn’t only the best, but the finest of all too. For it is only the finest that can bring the best out of so many others. I and many of his former undergraduate students had no compelling need to study topics like Anaemias or Acquired Immuno Deficiency Syndrome (HIV/AIDS) anymore because we were taught by the finest. He had rammed enough basic knowledge into most of us using unusual skills, intimidation and of course banters to last us a lifetime of general practice.

Yet, had a very spacious heart to accommodate our youthful exuberance and indiscretions. Some of us became a little belligerent when things weren’t going right with the accreditation of the medical school. Dr Dutse would come to class looking stern with a serious warning; “I will take it personal if anyone of you says anything stupid”. But he never did. His kind heart obviously had no place to hold any grudge against anyone. Because despite these clear warnings, a couple of students had indeed crossed the red lines.

His best revenge was always to wait until it was lecture times when he would target an entire class and skin them alive with torrents of questions.
“Absolute rubbish”, he would exclaim amidst roars of laughter (after each wrong answer) as he would go round the class humbling everyone. But as we were to learn later, even that was to make us better than we would have ordinarily settled for.

He was our comic relief and best friend too! My set I think was one of his favorites. Never report us to the Dean because of any of our behaviours. Chances are that we would lock the door right behind your back and probably laugh ourselves up about you. And guess what, with the Dean himself as the cheerleader.

No surprise therefore when we unanimously chose Dr Dutse to write the forward in our yearbook when we graduated in 2003. There too, he dropped priceless words that will remain very relevant in our lives until our ultimate ends. “As you progress through life” he had written, “some of you will naturally be more successful than others, let that be a source of strength and unity among you rather than envy and jealousy”.

He was a teacher in every sense of the word who knew of the awesome potentials embedded in all of us. How right he was. A bigger fraction of the class are today specialist doctors who would proudly mourn him from across the globe in Europe, Asia, North America, around Africa and here at home.

Dr Dutse had successfully forewarned and saved many of us from the individual nightmares of ending up as bad doctors. He was also personally responsible for the training of so many highly specialised and skillful doctors of international repute through his pioneering efforts in Bayero University Medical College as Dean and Aminu Kano Teaching Hospital (AKTH) as it’s founding Chairman Medical Advisory Committee (CMAC) and later Chief Medical Director (CMD). No one individual can perhaps boast of having a direct role in the training of as many specialist doctors in Nigeria.

But beyond the nightmare he had forewarned us of is a bigger nightmare than his pay grade could fix. It is the nightmare of a stunted system. The Nigerian health system is fragile, weak and stunted all at once. Even the most skillful and successful of CMDs can only fix as much. It is a collective failure!

Functional systems do not exist in a vaccum. They are often the result of the aggregate consciousness of society’s empowered elements. But the Nigerian power elites are lost in the ‘convenience’, ‘status’ and ‘invincibility’ that medical tourism offers them. Those who of necessity need the health system to survive can’t fix it and those who can fix it ignorantly think they don’t need it. This is our tragedy!

One of the most lethal and perhaps even commonest of medical emergencies that kills adult Nigerians is most likely heart attack. Victims of some severe forms of this condition would need specialised heart procedures within minutes or at best a few hours afterwards if they are to have any chance to survive. Nigeria has no emergency system anywhere within it’s territory to do emergency coronary artery bypass and save the life of anyone, and that includes our President himself. We are all sitting on a medical time bomb!

I was most painfully made to understand that Dr Dutse himself could have been a victim of a heart related emergency. He had done his best to fix alot under the circumstances he existed. But what apparently was beyond the powers of anyone individual to fix consumed him. This irreparable loss is perhaps one of the loudest statements about the collective nightmare that our healthcare system is.

As we mourn, we must also pause and reflect, perhaps deeply this time around on the way forward. We mustn’t mourn his death and then wait for the next devastation to happen. There is the urgent need to generate actionable consciousness to collectively confront the most deadly of heart emergencies in Kano and beyond. Aminu Kano Teaching Hospital, should in the spirit of what Dr Dutse represented, dedicate sizeable energy for emergency coronary artery bypass surgery soonest. It is quite possible because we also did the first kidney transplant in the whole country.

There is no better way to immortalise the remarkable soul of this genius and make him proud of his accomplishments while he led, mentored and tutored us here on earth.

May Allah SWT repose the soul of this brilliant clinician, excellent academic, skillful administrator, teacher of teachers, compassionate soul, a goal getter and his humble servant.

Adieu Professor Abdulhameed Isa Dutse
MBBS (ABU), FWACP (Internal Medicine), DCP (London)

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