Nigeria: Ike Anya spotlights broken healthcare system in ‘Small by Small’

It is a narrative that is laugh-out-loud funny in places and devastatingly sad and grim in others as it tells the story of Nigeria’s broken educational and health system.­­

A cautionary tale

The memoir is a coming-of-age story and a cautionary tale. Asked by a senior colleague how many of his friends and former classmates ended up as doctors, one of Ike’s newly qualified doctor friends offers a glib reply. “Lack of good career guidance and counselling at our school,” he says.

As we used to say in history exams, there were remote and immediate triggers.

Anya, who now works as a public health expert in the UK, provides some context around this and why he chose to write Small by Small.

‘‘As we used to say in history exams, there were remote and immediate triggers. The broader context was moving to the UK and with the benefit of distance looking at my training and early career in Nigeria. I started thinking about why I had chosen to become a doctor [had I even chosen to become a doctor?] and about the process of becoming a doctor,” he tells The Africa Report.

 It is an apt and befuddling summation; one that has led to unwelcome outcomes for many because the default thinking for parents of a certain generation was that once you are smart and do well in your studies, especially the sciences, the natural choice is medicine or engineering. For those excelling in the arts, law would be the first choice. There is no question of your aptitude or readiness for the course of study.

That was how Anya, who would have done well in the liberal arts, ended up in medicine where he battled against all odds to qualify as a doctor, but as Shakespeare said: ‘‘All’s well that ends well.”

Since Small by Small was published in May by Sandstone Press. The enthusiastic reception to its publication has propelled the author into the ranks of top medical memoirists like Adam Kay, author of the bestselling This is Going to Hurt; which has been adapted into a critically acclaimed television series.

Commenting on the reception of the book, Anya admits that it was a pleasant surprise. ‘‘I’ve swung from feeling it must be absolute rubbish, given the number of rejections it had from publishers to maybe it isn’t so bad when, for instance, Granta asked to publish an early excerpt and the editorial staff member wrote to say how much they enjoyed reading it,’’ he says.

Passing the second Bachelor of Medicine

Beginning from the eve of the announcement of his second Bachelor of Medicine (MB) exams, and running, albeit, not chronologically, to the end of his houseman-ship at the Lagos University Teaching Hospital (LUTH), the book is a chronicle of Ike Anya’s journey to becoming a doctor.

Ike is at the height of his powers as a raconteur, bringing into sharp relief moments of nail-biting anxiety, exhilarating joy, profound grief and loss, as well as moments of introspection, reflection, and leisure.

From his unique point of view, we travel through his idyllic childhood as the son of a university professor at Nsukka, all the way to secondary school at the prestigious Kings College in Lagos before going back home to study medicine at Nsukka and then Enugu.

Ike’s story segues between the present and the past, the personal and the public, expanding on his growing consciousness of what it means to be a student and young man staking his claim in the world.

The joy at passing his second MB exams, which he describes as a brutal “cull”, is palpable:

I search for my registration number, heart pounding, eyes moving quickly back and forth down the columns. When I spot  88 / 51393 and see PASS PASS PASS beside it, I have to look a  second time, and then a third to make sure that I am reading right. And then everything blurs, as I leap off the raised corridor onto the grass, screaming, running, not sure where, not looking, out into the road, happier than I have ever been…The wait is over: we will be doctors one day.

However, that joy will be tempered in the years to come as he fails paediatrics twice and then surgery too.

Nigerian political history looms large

Through his eyes, we learn of confraternities that blight Nigerian university campuses, armed robbers, and the mayhem they unleash. He recalls the extremely hierarchical structure of medical practice – from officers to registrars, then senior registrars to revered consultants, whose briefcases registrars “leap forward to reverently relieve…” them of the very tenuous power dynamics between nurses and doctors. We also learn that most OBGYN practitioners are male and that physicians consider themselves superior to surgeons.

In Ike’s memoir, Ibrahim Babangida, Sani Abacha, and MKO Abiola loom large and leap off the pages as main characters in Nigeria’s fraught history of the 90s. Students of Nigeria’s political history will do well to read this book.

Another main character is food. Ike is a raconteur and gourmet and in his book, food is not just for sustenance but for comfort, celebration, and bonhomie.

Looking to the future

If the book has any fault, it is in Anya’s penchant to over-describe, with an abundance of adjectives and repetitions, but that is the bane of the raconteur who must embellish to keep you glued to his tale.

I don’t mind if people read it and don’t like it, but I would hate for people not even to know it exists

Small by Small is a riveting, interesting, and well-told tale of becoming, and one wonders whether there will be a second instalment or maybe more.

“There’s plenty more material but…who knows,” says Anya. “My focus for now is to try and get Small by Small into as many peoples’ hands as possible. I don’t mind if people read it and don’t like it, but I would hate for people not even to know it exists and therefore never have the opportunity to read and decide for themselves. If that’s successful and there’s an indication that there’s an appetite for more, then….’’