LEAVING YOUR COUNTRY IS LIKE BREAKING A LIMB…BUT A GOOD THING OVERALL

By Aghogho Umukoro

Outside the university hospital in Durham

At the hospital in Durham, England where I work as a medical doctor, a nose-bleeding and very distressed seven-year-old boy who I was trying to help blurted out:

“I don’t want to be touched by a black!”

I was numb from hearing that.

But let me rewind my story and explain how I got to the UK in the first place, because leaving one country, your country for another one that is not quite your own is like breaking a limb.

I secured a job in England in 2022. I was all too happy to leave the trauma and orthopedics training I was undergoing in Nigeria, which I had become disillusioned with at some point. No, it was not the training itself, but the country, my country. Like Chinua Achebe said, being a Nigerian (and living in Nigeria) is both abysmally frustrating and unbelievably exciting.

“I don’t want to be touched by a black!”

For me, deciding to leave Nigeria to practice elsewhere was the culmination of many frustrations and indignities anyone fortunate to work in the Nigerian healthcare sector as a clinician is all too familiar with. Such indignities include: working hours and hours on end, because, well, your work hours were not even defined in the first place; working in conditions that could spell doom for you and your patients, like suturing in the dark or having to re-use instruments not properly autoclaved because there would be no electricity for days.

“Like Chinua Achebe said, being a Nigerian (and living in Nigeria) is both abysmally frustrating and unbelievably exciting.”

I was convinced that doctors like me in Nigeria were not being properly treated, although put in the proper context, all Nigerian workers are equally afflicted by the Nigerian malaise. There were doctors in some states in the country who were being owed salaries for 12 months and more.

There is also the issue of not having the right materials for a clinician to work with, in some cases making a mockery of any attempts to save a patient’s life.

“For me, deciding to leave Nigeria to practice elsewhere was the culmination of many frustrations and indignities anyone fortunate to work in the Nigerian healthcare sector as a clinician is all too familiar with.”

I always thought the medical directors in the Nigerian hospitals where I worked post-qualification did more politicking than proper administration and did little, if anything to correct plummeting staff numbers or boost our morale. In any case, I knew it was good for me to leave and practice elsewhere.

The process it takes for a doctor to leave a slumbering health system like Nigeria’s for a top one like the UK’s is anything but easy. There are travel plans to make. Leaving is expensive. I do not have a rich uncle ready to splash the cash on demand.

There are exams to prepare for and ace amidst your suffocating schedule as a doctor. To qualify for the first part of the licensing exam for the UK (also called PLAB 1), we had to first prove we could communicate in English. It did not matter that Nigeria was colonized by the British, was named by an English woman, has English as an official language and that we generally attended universities where English was the sole language of instruction and obeisance. I surprised myself by passing the English test ( or IELTS) in one go, what with the precious little time I had studying for it and my friend Blessing constantly admonishing:

“Agho, you have to prepare for this exam. Don’t think you can pass it because you can speak or write good Nigerian English.”

Preparing for my PLAB 1 was even more arduous because I had just changed jobs at the time and was now working in a busy private teaching hospital. The results came and I was ten or so points shy of a pass mark, meaning I had to cough out another 230 pounds for the PLAB exam which was exchanging for just over N100,000 or half of my monthly take home. Good gracious, I aced my second attempt. This was already 2019 and I needed to now prepare for the second part of the licensing exam or PLAB 2 which can only be done in the UK. I remember the naira was doing much poorly compared to the pound at this point and I needed to pull the strings of my monthly budget even tighter to save up for the cost of taking the exam. An opportunity came for me to start training in orthopedics – something I always loved from my school days – in Nigeria’s finest: The National Orthopedics Hospital in Lagos. I quickly grabbed it. I mean, apart from the lure of orthopedics which I am fanatical about, my pay was also going to improve by 50 percent!

The COVID-19 outbreak disrupted 2019 and the year after. The exams were put on hold for a while and I did not get a chance to do them until January 2021. After this, I registered with the General Medical Council to become eligible to apply for UK jobs. At first, as you would expect, I applied for surgical or surgical-related jobs based on my experience of surgical training in Nigeria. I nonetheless got frustrated when after forty or so of these applications, no one was going to invite me for an interview for the almighty experience of working in the UK. A friend suggested that a role in the emergency department might be easier to get so I updated my applications. I was constantly refreshing my emails for months, looking for an interview invitation. One finally came from the University Hospital in Durham. And refreshingly, I got the job!

I was moving to the UK.

I had to travel home to Ughelli in the south of Nigeria to inform my family and say the necessary goodbyes. My mum was concerned, for good reason, that I was going as a single man.

“Who know wetin those oyibo women wey we dey see for film fit do to fine boy like you?”

And being skinny, I may find the cold unbearable as I have always found the harmattan season, growing up in Nigeria. My dad was more ecstatic, I reckon. He had a lot of flowery things to say about England, although he had never been to England himself. He was of the generation that had the day off from primary school when Queen Elizabeth visited the country in ’56. I grew up on a staple of stories from Shakespeare, Dickens and my favorite, Thomas Hardy. My dad went on and on about the seasons in England, how the industrial revolution changed the country and villages were deserted (as captured in the Oliver Goldsmith’s poem, parts of which he could still recite at 75!) and reminisced about some of the not-so-pleasant encounters with his white teachers in school in Okitipupa. One I remember very well is the principal of his school, Reverend Father McKennan. One time, he had arranged a wrestling match between some white altar boys and black boys to celebrate the visitation of the white Inspector of Education. The black boys generally did not want to anger the principal, and so flattered to please, threw light jabs or intentionally missed the target on purpose and hit the deck with little contact. This prompted lots of jeering from the spectators. I wonder if the jeering was what got under the skin of a particular black boy or not. In any case, when it was his turn, he threw caution to the wind and his white opponent onto the canvas in one deft scoop!

I went back to Lagos to make my final preparations for my trip. To the credit of the UK Home office, the visa application process was mostly seamless. Although, it has to be said this was post COVID-19 and generally doctors were now in higher demand in the Global North. The health surcharge that visa applicants had to pay, even if they were working in the NHS, UK’s health service, had been scrapped by the Boris Johnson government at this time (that man did some good after all) and all I had to do was pay the visa fee. Luckily, I had secured accommodation in the doctors’ quarters through the HR department of the hospital where I would start working. The rent was going to be deducted from my monthly salary.

The first place I called home in England

I am not sure if being a doctor gives one this overinflated sense of thinking you can survive anywhere or if I was simply coasting on my father’s words. You see, while I was with him, he had told me:

“You are a smart man, you can thrive anywhere.”

So, in a way, I thought leaving Lagos for Durham in the northeast of England would be no more complicated than leaving Ughelli for Ibadan in the west of Nigeria where I had medical training and spent a total of nine years.

I was wrong on so many levels.

First, it occurs to you on settling here that the English people are not quite like you. No, not in their fundamental humanity which you are also a member of but in their culture, mannerisms and of course, in the obvious ones – their mostly straight hair and pale skin. I remember my first day in the new job and how dizzying it all felt. It was to me like the floor of the stock exchange, what with phones going off every second and everyone talking at the same time.

“First, it occurs to you on settling here that the English people are not quite like you.”

I struggled initially with understanding what exactly some patients were saying when they used certain phrases or spoke in certain accents. For example, it took more than one patient telling me, “I have felt sick but have not been sick” for me to know they simply meant they had been nauseous but had not vomited! I had to be patient and listen attentively when some patients spoke during my first few months so I did not miss salient points in their history.

Sometimes too, it was my English they had problems understanding because of my own accent. On one occasion, a patient, bless her heart, simply instructed me to speak more slowly so she could understand whatever I was saying and I obliged. She thanked me, asked where I was from and mouthed an ‘oh’ when I answered.

To my credit, now I am able to spot someone from Durham or Edinburgh or London by their manner of speech. I think the Londoners, for example, tend to rattle when they speak – sounds like music but in my early days, I struggled to follow.

I understood almost immediately on getting here how time conscious the English people are. Meetings have their time durations properly stated before-hand and commenced promptly. Trains and buses came mostly on-time and it is easy to miss them by a minute or less. I had to, for example, learn to be at the bus stop as early as possible if I was not going to miss my bus, something I found quite obtrusive. I mean, in Lagos where I spent my last three years before arriving in England, I could get one of the yellow-and-black buses at any spot on the road (we did not need bus stops in Lagos!) and at any time. Now, buses do not even run at night! On one occasion, I got to the bus stop just as the driver was setting off and not even flailing my arms animatedly would make him stop. I waited another 30 or so minutes to catch another bus to town that day and learnt my lessons hard.

Durham Bus Station

“To my credit, now I am able to spot someone from Durham or Edinburgh or London by their manner of speech.”

One thing I did not quite understand though and perhaps still question was the seeming obsession with travel abroad I reckoned the English have. It was mostly what, for instance, dominated small talk in the staff room apart from the regular quibble about this or that patient. It was also what more than a few patients shared when you asked about their concerns during a consultation:

“I am traveling next week, is it ok to do so, doctor?”

In my head I went, why don’t they just stay home with family?

Nigerian immigrants often talk about loneliness abroad because of how communal we live in Nigeria and where everyone’s nose is in your business. I am not sure I have been lonely because I have always loved living alone and generally keep a handful of friends per time. My rule of thumb has always been to keep no more than five at any given time because there are five fingers to most hands really. No, I joke. More reasonably, the fewer, the easier to manage for one like me with a temperament best described as predominantly melancholic. As fate would have it, I met two other Nigerian doctors working in the same department as I was and we quickly bonded. Added to them was a colleague from Egypt and another from Nepal. We all had come into England within two months of each other and we formed a tight knit group almost immediately.

A night out with work friends Ibrahim and Yemi

Apart from them, I made friends from church, principally Nigerians. They along with some of my white British colleagues helped me settle. Perhaps, I should add at this point that my relationship with my Afro-British colleagues is best described as complicated and I am better not exploring that area, at least now.

Loneliness aside, the food and weather were the things I did not quite fathom in my early days. They were what, more than anything else, made me feel like I must have broken a limb or two in leaving Nigeria for England. I felt incomplete.

Living in a hospital-allocated accommodation, I had to, in my first month, rely on meals from the hospital restaurant where they were served at subsidized rates to staff. In my mouth, the meals tasted bland and unrecognizable, no matter how frequently I had them. I missed Lagos and the ease with which one could get some steaming jollof rice with dodo or amala with spicy ewedu and assorted meat from just across the road. The following month, someone introduced me to an Afro-Carribean store in town where I could buy Nigerian food items so I could start making my own meals.

The only Afro-Caribbean store in Durham

I had come to England in the summer heyday of 2022, attended a few outdoor events – I could not miss them, there was going to be swallow! – and was generally basking in the gift of sunshine. But then came the winter of November and the days were shorter and colder. It was dark at 5 p.m. and not daylight until past 8 a.m.! While I quite understood the geographical explanations of this, it was its effect on me I did not quite dig. Looking back now, I am convinced I suffered from some level of dysthymia, which is a fancy term for seasonal depression. My mood was low. I woke up and gathered just enough strength to go work in a busy A and E department. Making those walks from my residence to the department in those icy conditions took more effort than they normally would. It felt like the ice that covered the earth had somehow found its way into my soul as well. Everyone looked sad and in need of help to me as far as I remember. Or maybe, they were just a mirror of how I felt inside. In those days, I took coffee to help, sometimes four cups in a 10 hour shift for someone who previously took none and more breaks at work than I normally would. In any case, I could not wait for winter to leave. My mood lifted in springtime.

Do I dread the coming of another winter? No, I do not…(inserts sign of the cross).

“...I must have broken a limb or two in leaving Nigeria for England. I felt incomplete.”

Race is also another issue I have had to confront. Before coming here, race or racism was something I interacted with only when I watched western news media like BBC or CNN. It was not something I saw in my day-to-day life. I have now however become conscious that I am a black person. It is not my fault really.

On one occasion in my early days in the children's emergency assessment unit, I saw a seven-year-old child with a head injury and a nosebleed who I thought was more aggressive than just his injuries could explain. He had a minor cut on the forehead and torrential bleeding from the nose; the nose itself did not appear deformed. His mum said he had fallen onto some rocks at school. But then this child would flinch when I tried to touch him and didn’t stop screaming at his mum.

“I want to go home! Take me home!”

I tried to pacify him the best I could, explaining that he would go home once the bleeding stopped with my assistance. But then he blurted after a bit of tug-of-war:

“I don’t want to be touched by a black!”

I didn't quite know how to react. When I did recover, I could just about hear the boy’s mum offering an apology and I simply grunted affirmatively and left the room. I spoke to my supervisor for the day and he asked if I needed some time alone. I said no, I was fine and just about carried on with seeing some other children.

“Looking back now, I am convinced I suffered from some level of dysthymia, which is a fancy term for seasonal depression.”

This incident did not leave me for quite some time. I wondered why any child would say that to someone keen on helping them, even if they were a different color of toast than they were. And also what exactly white parents told their children about black people. I would not even say the incident has left me completely. These days when I need to attend to a child at work, I try to first smile and then look into their eyes to be sure they even want to be in the same room with me!

“It felt like the ice that covered the earth had somehow found its way into my soul as well.”

Overall, I will say living in the diaspora is a good thing. My scope of thinking has improved by virtue of living here. I suppose this is what happens to most people who choose to leave the familiar and comfortable, which is what their home country is, for a strange place. The challenges, especially when you are very new, force you to think.

What really happens is one is confronted head-on by another culture and the mind becomes a sort of battle ground, an arena for the clash of cultures – the one you have been used to for three decades on one hand and this foreign one you despise at first but must welcome and absorb nonetheless if you are to thrive.

“...the mind becomes a sort of battle ground, an arena for the clash of cultures…”

I guess it is this process of acculturation that feels like breaking limbs. Before long, it gets better the more one understands the big puzzle of this new culture and where exactly one fits in it.

Aghogho Umukoro is an A/E doctor in Durham, northeast of England. He enjoys traveling and talking about politics.

Twitter @AghoghoU