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aMsul aMs D gest


NOW THAT WE ARE EBOLA-FREE 5 things Nigeria must do to #KeepNigeriaEbolaFree

#AMSULSPEAKS Would you practise Medicine in Nigeria on graduation and why?


What you won’t learn anywhere else


Medical breakthroughs in the last decade

SPECIALTY TEST What medical specialty fits your personality?



N OV E M B E R 2 014


Get a digital copy of this edition




After a long hiatus, AMSUL digest is back. Didn’t they say good things come to those that wait?












Great Ideas start from a thought. We celebrate the top 10 medical breakthroughs of the last decade.



JUST LIKE EVERY OTHER DAY First times are supposed to be a moment of overwhelming emotions and lots of memories.








OPINION NOW THAT WE ARE EBOLA-FREE The WHO has declared Nigeria free of the Ebola Virus Disease. But is this Happily Ever After for Nigeria?







TOP 5 SPORTS-RELATED MEDICAL CAREERS Career meets Passion, Sports Medicine is blooming and here is a breakdown of the top 5 careers therein.



LIFE AS A BASIC MEDICAL STUDENT Live. Die. Repeat!!! Okay, the schedule is not as dramatic but it comes a close second.

With the huge workload and so little time, it’s hard to find time for a love life and harder if you don’t know how.


Find out if that specialty you’ve always dreamt of is actually the right one for you.



“Eko for show”, those three words have been used to summarize the city of Lagos and all associated with it. But what really makes us tick?




We are said to ‘play’ God, but a license to kill takes that to a whole different level, The God-Level.


There’s no written rule that says medics shouldn’t dress classy. Take these tips and you’ll not only move stuffs but heads too.



AMSUL had a busy 2014 calendar year with events spanning from academic to humanitarian, medical and of course, social.

Out with the old and in with the new. But the new cool is actually old. Here’s to the comeback of your grandad’s ties.

This page is sponsored by: ROYAL SPRINGS EYE HOSPITAL, LAGOS




eep within each of us lies the desire to express ourselves. To be known for who we truly are. To be heard. Over the years, the hope of having a student publication to serve our need has not been successful. This year, we have dared the odds. The AMSUL Digest serves to excite, educate & inspire us like never before. Every part of this work has been specially designed with you in mind. We have structured content; design and pictures to meet and exceed your expectations! With Nigeria's Ebola free status comes the need for increased vigilance. How do we maintain awareness? Finding out the right career path that suits your unique personality is a challenge we all grapple with... How do we address this? For those of us that missed several AMSUL events; we finally get another chance to catch up on all the fun.











These and much much more have been put together just for you! We sincerely hope you find this work as rewarding as we do. Yours Nnewuihe Obinna Editor-in-chief.

Graphic design and Art: WHIZZKEYZ DEZINES | +234 812 309 0221 Print and Publishing: Photography:


From The President's Desk


t is with gratitude to God almighty that I write this piece to commemorate yet another landmark event in the history of our dear association. It is such a great honor because the desire to publish a magazine/journal for the Association of Medical Students, University of Lagos has been burning for several years. Previous administrations have worked tirelessly for this dream to materialize but the challenges have been daunting. Since the inception of this administration we have worked with one goal in mind; this tenure must not end without us putting THE AMSUL DIGEST in the hands of AMSULITES. This has been long overdue as the last time THE AMSUL DIGEST was published was 2001. This is why we are proud to present this edition of AMSUL DIGEST, while praying that subsequent administrations would continue in this line. Much kudos to the EDITORIAL BOARD for doing the seemingly impossible. But for their courage, hard work and relentless effort, this project would have failed on arrival. We also appreciate every individual, organization and corporate body that has supported us in one way or the other; we appreciate you for believing in our dreams and for being part of our success story. The past year has seen AMSUL move from being an unorganized non-proactive body of students to taking our rightful place among not just the student bodies in the college of medicine, but also in the nation at large. The year has seen AMSUL emerge triumphant in every single competition or tournament it engaged in. It has seen AMSUL excel beyond expectations; it has seen us bring true joy and pride to the average AMSULITE. It has indeed been a great year for not just AMSUL but all AMSULITES. We must however realize that these success stories were born out of innovation, an uncanny passion for service, and a dint of hard work and dedication. These have combined to produce great results on the foundation that we have as medical students. But as it is with every success story, getting to the top is rather easy; the real task lies in staying at the top. So I want to implore us all to continue in this line of excellence, we should not hesitate to give our very best to our dear association whenever such assistance may be needed. The truth is, we will all leave at one time or the other but the legacy must be passed on. We have strategically repositioned the association in order to be able to face future challenges and also meet the needs of the average AMSULITE. This has seen us acquire new ADVISERS, PATRONS and GRAND PATRONS. Individuals who have been proven to show exceptional love for students and are ready to help the association or its members whenever such need may arise. We have acquired new infrastructure and refurbished old ones, in a bid to provide a sweeter experience for the coming generation. We believe this will further solidify AMSUL's status as the NUMERO UNO amongst MEDILAG student bodies. This year's health week, themed; Health Related Millenium Development Goals: The Journey So Far, was chosen in line with the 2015 deadline for the attainment of the MDGs by the United Nations. We as a body of medical students are interested in knowing how well our nation has fared in attaining

these goals and the role of medical students in the attainment of the MDGs. The 1st subtheme: Undergraduate Medical Education In Nigeria, The Past, The Present, The Future is aimed at enlightening the average medical student from an historical perspective, taking account of today's challenges and the prospects of tomorrow. The 2nd subtheme: Ebola Virus Disease: Facts, Fallacies And Way Forward was geared towards enlightening and educating the public about the scourge that ravaged the nation, and how we can protect ourselves and also prevent future recurrence. The variety of programs executed within the week buttress our interest in not just having a robust health week but also in impacting our members and the society at large. “We are what we repeatedly do, excellence therefore is not an ACT but a HABIT�- ARISTOTLE



ver the past ten years

medicine has made lots of

interesting advances. These advances have been as a result of breakthroughs within the field of medicine in most cases and outside the field of medicine in other cases, from cardiology and oncology to health laws and information and telecommunications technology. This list of breakthroughs is particularly interesting, as it goes on to show that perhaps plenty more breakthroughs can be achieved if medicine is taken outside the spheres of the medical field and beyond the walls of the hospitals. AMSUL Digest 2014


Although a first version of the human genome map was released in 2001, it was not until 2003 that it was completed, and we learned that humans have about 30,000 to 35,000 genes. The medical world hopes that his map will one day provide the path to better understanding how diseases occur in the body, as well as to finding more efficient treatment options. Studying and mapping our genetic

blueprint is important to learning how and why the human body works and how and why it fails, causing physical and mental illness. It is supposed to become the biggest hope for preventive medicine. Today genes for prostate cancer are being targeted by scientists in a bid to lower the risk of developing prostate cancer. Scientists hope to apply this to every other kind of illness possible.

CANCER PREVENTION AND DIAGNOSIS For the first time, a vaccine to prevent cancer has been developed, specifically targeting the strains of HPV that are linked to the development of cancer -and one of the two available vaccines also immunizes against the strains that cause genital warts. Using Mesothelin, a 17 year old was able to develop a dipstick for diagnosing pancreatic cancer, notorious for its rapid fatality. This method

detects pancreatic cancer at its earliest stages when there is a 100 percent chance of recovery. It is cheaper, faster and even more sensitive than other methods. The dipstick can be used to also diagnose ovarian and lung cancer, and with a few modifications his technique can be used to develop other similar diagnostic tools for other forms of cancer.

HEALTH INFORMATION TECHNOLOGY My personal favourite, Health Information Technology! Patients may not even think of it as they sign in with a pad and pen, then sit in the waiting room while the nurse pulls their file. Patients have changed from passive members of the health team and are beginning to get more involved. Today some patients may arrive at hospitals armed with more information about their conditions than their doctors. Information and Telecommunication technology has done even

more than keep patients informed- it has also bettered patient care at all levels, disease and epidemic outbreak tracking using data from mobile health applications, diagnostics and treatment support for remote health workers in rural communities, communication and training for health workers using e-learning, remote monitoring of patients and data collection, using mobile devices, electronic health records, telemedicine and telesurgery and the use of virtual reality in surgical training and practice.

ONCE A DAY HIV PILL Ever since HIV was discovered, researchers have been searching for ways to treat, cure and prevent infection by the virus. The year 2010 was particularly eventful with regards to AIDS and HIV research: A once-a-day pill that not only treats HIV but also help to prevent the infection (called pre-

exposure prophylaxis). The study focused on gay and bisexual men and found that those who took the daily pill along with using condoms reduced their risk of HIV infection by 44 percent. And those who followed the daily dosage closely had 73 percent fewer infections at the end of the study.

ANTI-SMOKING LAWS Well outside the practice of medicine into the field of Law, smoking bans have cut exposure to secondhand smoke, which, in turn, has contributed to a reduction in heart attacks and death

from heart disease. While public smoking bans protect people from secondhand smoke, doctors say they also motivate people to quit.

AMSUL Digest 2014


NEAR ERADICATION OF GUINEA WORM From 3.5 million cases in 1986 to only 3,000 in 2009, Guinea Worm has been 99% eradicated from the globe. Nigeria, once the worst affected country, has not had a case in 12 months. The Guinea worm is ingested as larvae in contaminated drinking water and within a year can grow to be three feet long before slowly burrowing out of the skin and causing excruciating pain for months. Humans are the

only host for the parasite, and with the last case of human infection the worm will have lost its parasitic life cycle “habitat.� The introduction of mesh filters for drinking water, and pipe filters that can be worn around the neck by nomadic peoples, has Guinea Worm disease poised to be the first disease eradicated without vaccines or medications, and the next since smallpox to vanish from the Earth.

BLOOD TESTS FOR DOWN SYNDROME DETECTION Ten years ago a patient would typically be left with a 10-inch scar when a doctor removed a kidney. Since 2007; however, doctors have been removing kidneys through a single incision in the patient's navel using a technique called Natural Orifice

Translumenal Endoscopic Surgery or NOTES. This is not a stunt from a star trek movie scene, its real and it is earth shattering. The greatest benefit of tiny openings into the body rather than large incisions made by traditional surgery are shorter and less painful recovery time.

While amniocentesis represents a reliable method to detect the Down syndrome in an unborn fetus, this particular procedure does carry some

risks. In 2008, scientists developed a less invasive test that can identify the syndrome simply by drawing blood from the mother.


STEM CELL RESEARCH Probably the most controversial area of medical research, it is the future of regenerative medicine and the hope for repairing damaged specialized tissues like the brain. For example, European researchers genetically manipulated AMSUL Digest 2014

bone marrow cells taken from two 7-year-old boys and then transplanted the altered cells back into the boys and apparently arrested the progress of a fatal brain disease called adrenoleukodystropy or ALD.

Researchers have now found a way to convert any blood type to type O. They have discovered two enzymes that remove the A and B antigens from blood, while keeping the blood safe and usable. An enzyme from the

bacterium Bacteroides fragilis strips the B antigen from blood, while another enzyme, from the bacterium Elizabethkingia meningosepticum, removes the A antigen.











8:12a.m met you running along the walkway to class, panting and wheezing as your asthma began to kick in. 8:15a.m found you with one arm outstretched as Mr. Mike was shutting the giant doors of TBS. 8:16a.m. met you wheezing in front of class, reaching into your pocket for your Ventoline inhaler, while the class snickered and Mr. Mike moved his hands in his famous gesture and shouted, 'Out!' 8:20a.m found you in your seat after much pleading, and after the lecturer told Mr. Mike to let you stay.



ou roll over and open your eyes, the feeling of calmness that normally greets you when you wake up changes to fright, and a mild anger. 'Jesus Christ!' You exclaim 7:21am. You quickly tap your roommates and then the mad rush begins. For some queer reason, the hostel gen is not on, and our Power Holding Company is living up to its name: Holding power. No light, means no water, no water means long queues in front of the tank in each block. Long queues means late students and unfortunately you were one of them. You were carrying your water up the stairs when the handle broke, as you struggled to save what was left of your water, your classmate

strolled by. He was dressed in a crisp white shirt, blue tie and navy blue trousers. He was heading to class. 'Hey, please what's the time?' '7:45am.' You ran to the tank to see how long the queue was, but to your dismay, it was two times as long as it had been when you left, and guys were already tilting the tank to get the little water left at the bottom. So you shrugged and decided to 'manage' what you had. Managing was impossible and 7:58a.m met you in the bathroom, all covered in soap, bitter and upset. Eventually, the gen's roar came and some minutes later, the shower began to spurt water from its rusted holes. You braved it and hurriedly rinsed your body.

10.15a.m found you dozing off in class, only to be called to answer a question, when you had no idea what the class was about. 5.00p.m met you walking towards the hostel, after a hectic day, interspersed with two laboratory sessions, and over 500 Powerpoint slides to go over. 9.00p.m met you at 'Collabo' shouting, 'One fried rice and one Moi-moi', holding out two hundred naira in one hand and your reading lamp in the other. 2.00a.m found you trudging like an automaton to your hostel with sleepy eyes and a tired face. 3.00a.m found you finally falling asleep after trying to empty your mind of all the Morbid and Pharmac you had stuffed inside. 7.21a.m found you rolling over again, with the same exclamation of, 'Jesus Christ', until you realized that you did not have Morbid Anatomy first, and so you calmed down. But hey, it was just another day in your life as a 'final year' Basic Medical student. AMSUL Digest 2014


INTRODUCTION Hypertension is defined as a systolic blood pressure of ≥140mmHg, or a diastolic of ≥ 90mmHg, or taking antihypertensive medication (1) STATEMENT OF PROBLEM The number of people with hypertension rose from 600million in 1980 to nearly one billion in 2008,(2) this raised the global prevalence of hypertension to 40% (2) and it has been predicted that by 2025, the prevalence of hypertension will increase by 24% in developed countries and alarmingly by 80% in developing countries.(3) OBJECTIVE OF STUDY General Objectives To study the effect of vitamin C (Ascorbic Acid) ingestion on blood pressure in response to dietary salt loading in human subjects. Specific Objectives · To determine the effect of a high salt intake on blood pressure · To determine the effect of vitamin C on blood pressure in response to salt load HYPERTENSION AND SALT INTAKE High salt intake has been associated with high blood pressureas shown by experimental studies in Sprague Dawley rats (4) and Dogs (5). Epidemiological report has also shown that communities that ingest high salt in AMSUL Digest 2014

their diet (e.g. Northern Japan) have a high incidence of hypertension (6) while communities that consume little or no salt in their diet (Eskimos, Kalahari tribesmen of South Africa and Yanomamo Indians in Brazil) have very low incidence of hypertension(6). Some of the pathophysiological mechanisms that have been implicated in salt induced hypertension are; increased venous tone,(5) increased oxidative stress,(8), (9) increased sympathetic activity and increased vascular resistance.(7) METHODOLOGY 12 normotensive undergraduate male students (18 – 25 years) of College of Medicine, University of Lagos participated in this study. Participants followed their regular diet pattern and are not on any medication. They were randomly divided into 2 groups; 

SALT ONLY GROUP: participants (n=6) were placed on placebo for 14 days, and were later administered orally with 200mmol/L of dietary salt solution each day for next 5 days.

SALT + VITAMIN C GROUP: participants (n=6) took 500mg vitamin C daily orally for 14 days and were afterwards administered orally with 200mmol/L of dietary salt solution alongside 500mg vitamin C for next 5 days. Blood pressures, serum electrolytes, urine electrolytes measured both before and after salt loading were analysed using SPSS version 16.0. Statistical analysis was done using student t-test. 








104.5 + 2.63

121.67 + 4.31

112.67 + 2.85

115.83 + 2.27

P VALUE P<0.05 NS % CHANGE IN 14.11% INCREASE 2.72% INCREASE PRESSURE Vitamin C significantly (p<0.05)prevented eleva on ofsystolic blood pressure by 11.39%









P < 0.05


Vitamin C significantly (p<0.05)prevented eleva on of diastolic blood pressure by 13.53%








76.50 + 1.15

89.33 + 2.44

82.33 + 1.84

83.83 + 2.46



P < 0.05


Vitamin C significantly reduced mean arterial pressure by 12.60%





141.5 + 13.60

199.60 +12.26

29.11% INCREASE P < 0.05



33.86% INCREASE P < 0.05

Vitamin C significantly elevated urinary sodium ion excre on by 4.74% in the salt + vitamin C group

AMSUL Digest 2014

CONCLUSION This study reiterated an association between high salt intake and the development of high blood pressure. On the positive side is that salt-induced high blood pressure can be significantly prevented by oral vitamin C intake as shown by this study. RECOMMENDATION It is recommended that dietary salt intake be regulated and in salt sensitive individuals, vitamin C may be beneficial in preventing development of high blood pressure. ACKNOWLEDGEMENT I am extremely grateful to the almighty God, My parents, Professor O.A Sofola (my supervisor), the Department of Physiology and the Department of Clinical pathology for their uncountable supports in making this work a success. REFERENCES 1. Roger VL, Go AS, Lloyd-jones DM, et al. Heart disease and stroke statisticsâ&#x20AC;&#x201C; 2012 update: a report from the American Heart Association. Circulation. 2012;125(1):2-220 2. World Health Organization. Reports on noncommunicable disease. 3. Kearny, P.M., Whelton, M., Reynolds, K. (2005): Global burden of hypertension: analysis of worldwide data. Lancet 2005;365;217-23 4. Sofola, O.A., Knill, A., Hainsworth, R. and AMSUL Digest 2014






Drinkhill M. (2002): Change in endothelial function in mesenteric arteries of SprawgueDawley Rats fed on a high salt diet. Journal of physiology 2002; 54(1): 255-260 Hainsworth, R., Sofola, O.A., Knill A.J., Drinkmill, M.J. (2003): Influence of dietary salt intake on the response of isolated perfused mesenteric veins of the dog to vasoactive agents. Am J Hypertens. 2003; 16 (1):6-10. MenetonP. (2005): links between dietarysaltintake, renal salt handling, blood pressure and cardiovascular diseases. Physiol. Rev. 2005; 85(2):679-715 Sofola. O.A., Adegunloye, B.J., Knill, A. (2003): The effects of nifedipine and thapsigargin on the responses of pressurized rat mesenteric artery to 5-hydroxytryptamine and norepinephrine. VasculPharmacol. 2003; 40(1):29-33 Kedziora-Kornatowska K, Czuczejko J, Pawluk H, Kornatowski T, Motyl J, Szadujkis-Szadurski L. et al. (2004): The markers of oxidative stress and activity of the antioxidant system in the blood of elderly patients with essential arterial hypertension Cell MolBiolLett. 2004; 9:635-41. Simic DV, Mimic-Oka J, Pljesa-Ercegovac M, Savic-Radojevic A, Opacic M, Matic D, et al. (2006): Byproducts of oxidative protein damage and antioxidant enzyme activities in plasma of patients with different degrees of essential hypertension. J Hum Hypertens.2006; 20:14955.





he room was dark, hot and stuffy. 'This is it', we thought. We were going into the place we had dreaded for a long time. This was a place that held so many myths and mysteries, a place that had terrified so many before us, a place that few dared to trespass. This was the Anatomy Gross Lab. The fright was evident on our faces. We filed in cautiously, almost forming a straight line, and I tell you, that was something, for before this, we could barely maintain a queue of any kind. We crept on, the bravest of us in front. The smell hit us like a blast from a detonated bomb. No, this was not a whiff, this was beyond fathomable. The formalin-drenched room coupled with the embalmed bodies spurned a wave of nausea throughout the room. Trust me; the putrid smell is

what disorients you first and foremost, before the gloom that descends thereafter. In unbearable silence, we moved to our respective tables and bays. I stared at the cadaver which seemed to be staring back at me. 'oh stop taunting me', I thought. How could I possibly begin to cut up a fellow human being, a being that had once breathed, that dreamed, and lived? Judging from the faces around me, I could tell they all had the same thought. I simply couldn't take it. And so, I vomited… …Okay, who am I kidding? That over-flogged piece above was how it should have been in an ideal world. But ladies and gentlemen, that was far from the case. Au contraire! It was a fairly bright and sunny day. The room was dark, hot, and stuffy alright, but that was thanks to

PHCN. We filed in hurriedly and noisily. We received the smell like it was nothing. Hurrying to our tables, we began to discuss what it would feel like to work on our cadavers. Around me were serious looking faces eager to cut. There was no sadness, no fright, no disgust, nothing! We fit right in. It was now apparently normal and commonplace to attack the gut of lifeless bodies. Surveying the bodies for just a few minutes, someone said with alarming alacrity: “Hand me the knife”. So easily had we become automatons; like most of the freshly baked doctors churned out year after year. Our emotions had begun to shrivel, while our heads did all the thinking. It was bound to happen all aspiring doctors; that we might see the 'case' in a patient. AMSUL Digest 2014

“In practice, it is still the doctor who decides whether to perform euthanasia. He can suggest it, not give patients obvious alternatives, ignore patients' ambivalence, and even put to death patients who have not requested it.”


eception instead of ‘dignity' - that is the language of assisted suicide. How do you make something that's unthinkable into something palatable? Call it something else and that's exactly what the advocates of euthanasia have done; they have simply corrected the language, but if we return to the semantics of voluntary euthanasia and let us try replacing euthanasia with “kill” and “help to die”… when we do this, many of the most emotive support to its legalization fade away. Before I give reasons for leaning towards this divide on this issue that has become front burner in today's scheme of things it is only AMSUL Digest 2014

pertinent that I explain the major concept in this topic. The word euthanasia is defined in Collins English Dictionary as the act of killing a person painlessly especially to relieve suffering from an incurable disease while Steadman Medical Dictionary further describes it as a quiet painless death and an intentional putting to death by artificial means of persons with incurable diseases. Standing on this, I give the following reasons for my opposition. If euthanasia is legalized - Guess what? In practice, it is still the doctor who decides whether to perform euthanasia. He can suggest it, not give patients obvious alternatives, ignore patients'

ambivalence, and even put to death patients who have not requested it. Euthanasia enhances the power and control of doctors, not patients and it makes nonsense of the right to life of an individual as enshrined in every country's constitution and provided for in article 2 of the universal declaration of human rights “Everyone has the right to life, liberty and security of persons” and besides, the criminal code of Nigeria makes suicide or any form of assisted suicide for any reason a crime (sections 311,326,327 and 239). Doctors have stepped into a right-to-life row following the suggestion some hospital patients should be allowed to die because it cost so much to keep them alive.

Reports that leaked suggest that in some countries where it has been legalized some government papers revealed they should be denied food and liquid if they fall into a coma or are too ill to speak for themselves.


Reports that leaked suggest that in some countries where it has been legalized some government papers revealed they should be denied food and liquid if they fall into a coma or are too ill to speak for themselves. Note: The term “allowed” – is far from the truth. They are forced to die – an extremely slow, painfully cruel death by dehydration and starvation. Where is the humanity? Furthermore, legalizing euthanasia amounts to allocating the powers of God to mere mortals, in this case, doctors whose diagnosis has in recent times been proved wrong as the concept of divine healing from this supernatural being has been recorded in recent times and often times than not, no explanation

however illogical is even offered by science. Should humans be allowed to play the role of God? Legalizing euthanasia would do just that! The power to play with people's lives should not be handed out under a legal and/or medical disguise. Thus euthanasia should not be legalized. Euthanasia would give a small group of doctors “the power of life and death over individuals who have committed no crime except that of becoming ill or being born, and might lead to a state of tyranny and totalitarianism. More so, any physician's involvement with suicide is certainly contrary to their Hippocratic Oath, which is to save lives. The physician's role is to make

a diagnosis, and sound judgments about medical treatment, not whether the patient's life is worth living. They have an obligation to perform sufficient care, not to refrain from giving the patient food and water until that person dies. Medical advances in recent years have made it possible to keep terminally ill people alive for beyond a length of time even if it is without any hope of recovery or improvement. As shown in reports that revealed that 95% of cancer pain is controllable and the remaining 5% can be reduced to a tolerable level. Health care is concerned with life and should never have anything to do with hastening or causing death. AMSUL Digest 2014

Other than promoting abuse and giving doctors the right to murder, euthanasia also contradicts religious beliefs. Euthanasia manages to contradict more than just one religion and is considered to be gravely sinful. For instance, the Roman Catholic Church has its own opinion on Euthanasia. The Vatican's 1980 Declaration on Euthanasia said in part “No one can make an attempt on the life of an innocent person without opposing God's love for that person, without violating a fundamental right, and therefore without committing a crime of the utmost sin.” It also says that “intentionally causing one's own death, or suicide is therefore equally wrong as murder, such an act on the part of a person is to be considered as a rejection of God's sovereignty and loving plan.” In fact, a Jewish Rabbi Immanuel Jakobovits warns that a patient must not shrink from spiritual distress by refusing ritually forbidden services or foods if necessary for healing; how much less he may refuse treatment to escape from physical suffering. As there is no possibility of repentance or self-destruction, Judaism considers suicide a sin worse than murder. Therefore, euthanasia, voluntary or involuntary is forbidden. Islam too finds euthanasia to be immoral and against Allah's teachings. Actually, the whole concept of life not worthy of living does not exist in Islam! There is absolutely no justification of taking life to escape suffering in Islam. Patience and endurance are highly regarded and rewarded values in Islam. Some AMSUL Digest 2014

verses from the Holy Quran say – “Those who patiently preserve would truly receive a reward without measure” (Quran 39:10) and “And bear in patience whatever may befall you; this, behold is something to set one's heart upon” (Quran 31:17). The Holy Prophet Mohammad taught “When the believer is afflicted with pain, even that of a prick of a thorn or more, God forgives his sins, and his wrong doings are discarded as a tree sheds off its leaves.” When means of preventing or alleviating pain fall short, this spiritual dimension can be very effectively called upon to support the patient who believes that accepting and standing unavoidable pain will be to his/her credit in the hereafter, the real and enduring life. This shows that euthanasia is contradictory to most religious beliefs and is certainly baloney to those who believe in God and the sanctity of life. The truth remains that we should be wary of movements that feel the need to resort to feel-good euphemisms to hide the reality of their agenda and goals. Assisted suicide still remains what it is –suicide, and this term is descriptive and accurate. When it is legalized it amounts to state-approved suicide. This is the reality we must deal with and stop the pretense but we have failed to realize that the care of human life and happiness and not the destruction should be the first and only legitimate objective of good government. A favorite of euthanasia proponents is the autonomy/choice argument. Once again, and contrary to marketing rhetoric, patient’s

“choice” is not assured. Really, when people are being killed without their own approval, it seems to me that choice turns out to be a lie. As with would-be jumpers on the bridge deck, a gaping chasm awaits those who would be “masters of their fate”, only in the end, the choice may cease to be theirs. Choice is a lie. Family relatives that often choose this option, I feel are only running away from the responsibilities they owe their loved ones which are to take care of their ill loved ones. Even if anguish and emotions are put forward as factors that would have prompted a family's choice to euthanize their loved ones, we should not forget that by their nature they obscure clear thoughts. I'll conclude by saying that there's absolutely nothing dignified about committing suicide with or without help. I want to live every moment that I can, whatever happens to me in future regarding health, and I dread someone who thinks they know better than me, one day deciding that I would be better dead. While there is life, there is always hope, however grim the prognosis. Many people will live in fear and dread if euthanasia is legalized. Euthanasia should not be legalized. It is by no means a solution to human suffering. Though euthanasia is a controversial subject, it is evident that it only disrupts the normal pattern of life and leads towards creating a more violent and abusive society. Life is a gift and a choice and practices such as euthanasia violates this vital concept of human society.

When we (the team) went to interview Omotayo Ojo, a Consultant Neurosurgeon at the Lagos University Teaching Hospital, we were warmly received. He is a very learned and easy-going man and we had a nice time interviewing him.

Can you please introduce yourself Well, I am Omotayo Ojo and I have been here a long time, I did my undergraduate studies here and my postgraduate too, well I have been here since 1991, a long time. Tell us about your family My parents are teachers, I am the second in line, we are six, my secondary school was not in Lagos, it was in Ilesha. I'm married with a son, eight years old. What do you like to do to relax when you are not acting as a Neurosurgeon? When I am not operating I will rather go home and stay with my family, as you can see the pressure of work is enormous, the tendency to get sucked in the routine is high, so as much as possible if I am not tied up at work, I will rather go home and fill in the gap and let them feel I am still a part of them.

That is what I do, stay with my family and go to church. Why Neurosurgery? What attracted you to it? When I was in my final year in secondary school I came across an article on 'Micro Neurosurgery' and I thought that was what I wanted to do. At that time I thought Micro meant a microscope and putting a slide under a microscope (laughs) and I wondered how that was possible. I came to Medical school with the intention to be a Neurosurgeon. Prior to Medical school, many of us had only seen Neurosurgeons in movies like Grey's Anatomy series. How does it feel to be one? Alright! I do not see myself as better than other doctors, I think every specialty is important. I am sometimes amazed when I see

endocrinologist managing Diabetes patients well, I cannot do that. So I think that everybody is important, whether you are a General practitioner or a Neurosurgeon. How would you describe the current state of Medical education in Nigeria especially in the University of Lagos? Well when I was in medical school, we were two in a room, now you about four or more? I did not need a bucket, because there was always water. I did not have to worry about many things, so there were little distractions. And the curriculum, I think the curriculum then was a lot better than now. Then we did two years of clinical rotation and public health in our final year, but now you do public health in between, I think the curriculum was better then. I remember when I had to write my

AMSUL Digest 2014

â&#x20AC;&#x153;I think whatever you do, do it right, do RIGHT right!â&#x20AC;?

project, I had to travel to get information and read many books, but now, you have your phones and Google, and you can get any information you want.

up? When and why? No! Like I said, I came to medical school with the intention to be a Neurosurgeon, no, there was never a time.

Considering your days as an Undergraduate Medical student and the environment medical student have to learn in now, do you think there are better opportunities for success now? Well, I think there were less distractions then, but better opportunities now. For example if you wanted to write to a consultant in England, in my time, you would write a letter and wait a long time before you got a response, the letter may get missing on the way. But now you can just get on your phones and chat with anybody you want to.

There is a clichĂŠ among medical students stating that certain fields belong to people with a particular personality type for instance the friendly medical students end up being pediatricians. Do you believe this is true? Has your personality in anyway put you at an advantage as a Neurosurgeon? True! Pediatricians are mostly calm, easy going people. I think if you are not aggressive and patient you cannot be a surgeon, if you cannot stand more than 10 hours, you cannot do surgery. Yes your personality determines your specialty.

Were there ever times in your course of career when you wanted to give

AMSUL Digest 2014

We learnt of your recent international

awards, Congratulations sir! However, we would like to know what the secret to your success is. Secrets? I don't think it is any secret. It is exactly one year since I received the awards. At the time here, we were carrying out VP shunts for children with hydrocephalus, I started doing the endoscopic third ventriculotomy for people who didn't really need a shunt, it was less invasive. I think whatever you do, do it right, do RIGHT right! Some students are of the opinion that they do not need to struggle to get distinctions in their exams and are comfortable with just passing, after all, there is no '1st class' doctor. Other students on the other hand have the 'D' obsession. What's your take on this and does any of these equate to academic success. I spoke to one of my class mate

â&#x20AC;&#x153;When I do a surgery, I do it because I want to help people, but that is not the only reason why I do it...â&#x20AC;?

recently, and he said though in school we are of the same class, after then, you all become of different class. I think students who have the attitude for excellence carry it with them when they become doctors. People who just want to pass end up being doctors who just what to treat patients, they are never thorough. When I do a surgery, I do it because I want to help people, but that is not the only reason why I do it, also because doing my job makes me feel good, I am happy when I have just carried out a complex surgery and the patient is alive. The attitude you have towards your education now, is the attitude you have when you become doctors, you don't start developing it when you become doctors. Though now, you are all in the same class, after school, you all become of different class.

With the rapidly increasing brain drain in the country, and the fact that the Federal Government recently abruptly suspended the Residency program in the country only to reinstate in a few weeks later, what is your advice for undergraduate medical students in Nigeria? Brain drain? There would always be that issue, I think as Medical students you should have an open mind, if you wish to practice here or elsewhere, and you have the means, you should. About the residency program suspension, I think that was a wrong decision, I like to work with people that have some knowledge about the surgery, it would be more complicated if I worked with people who don't. But, the world is changing, a lot of our well trained doctors, are returning to work here, and people who have the opportunity are

moving to different parts of the world. I think, you should have an open mind. What does the future hold for budding medical practitioners in Nigeria? Well, before, the neurosurgery unit worked from 10am to 2pm during the week and if somebody was to be shot in the back on Friday night, he would not get attended to till 10am Monday morning, by that time he would have been almost dead, or dead. But now things have changed, we are carrying out complex procedures. Also, the national health insurance scheme if ever it gets done right would make life exciting for doctors, because they will have more money, to be able to do more things, and more facilities to express themselves.

AMSUL Digest 2014

“Do things at the right time, and you will find out that you can be whatever you want to be.”

Final words…. I know many people would wonder could they be whatever they want to be, especially when they see the challenges in our country, the first thing is believe you can have it. When I left school, I was telling a doctor I wanted to be a Neurosurgeon, he looked at me and said 'that is not possible', he gave me an idea that it was not possible, but I made up my mind that I will be what I wanted to be, and of course, God helped me. So I did not allow others to discourage me. Also, excellence comes from you, you have to decide to do the best you can do, I don't know what Holy book you read, but I know that even unbelievers want the best, how much more God. I tell people this, if you want a mechanic, do you want a Christian mechanic or a mechanic that can do the job? People are not looking for just a doctor that has

AMSUL Digest 2014

some faith, they are looking for someone who knows what he is doing, and the better if he has God to help him. Whatever we do, we shouldn't leave out the God factor, but we should strive for the best in what we do. If your motto is to do the best you can do, if you go to bed at night and ask yourself 'have I given my best today' and you can answer in the affirmative, I think you've done a good job. And for the next generation, I think the future is bright especially for people who are determined. I also know that many things in life is about timing, there is a time to be a student and a time to be a doctor, there is time for everything in life; if you don't get the timing right, you may be in trouble eventually. A ten year old boy passes WAEC, everybody would think him brilliant, a forty year old man passes WAEC,

everybody would wonder what he is doing at forty, it is not passing WAEC; it is the timing. If a sixteen year old girl get pregnant or a forty year old is not pregnant, people would shout, it is not the pregnancy, it is the timing. For medical students, you have time ahead of you; you should plan and make sure you don't miss the time. As much as possible within your power, pass your exams when you should, if you are going to do your house job do it early and move on, if you think of writing exams, write it early and move. If you become a consultant early, you have more time to space your family and do other things in life – politics or what have you. Do things at the right time, and you will find out that you can be whatever you want to be.



1st Runner Up, Oral Presentation, AMSUL Scientific Conference 2014

INTRODUCTION Commercial drivers are a recognized high-risk group for the transmission of HIV/AIDS and other STI'S due to their high level of social displacement and mobility, this occurs as a result of frequent exposure and engagement with female sex workers (FSW) in their garages or when en route. Due to the demands of their work, most stay away from their families for long periods of time especially longdistance bus drivers as well as truck and lorry drivers, some even have to pass the night in their garages in preparation for the next day's activity or during national petrol scarcity.1 Most of the commercial drivers fall into the World Health Organization recognized sexually active age group of 15-49years in which HIV prevalence is very high.2 A biological and behavioral survey carried out by the HIV/AIDS division of the Federal Ministry of Health to determine the prevalence of HIV infection among high risk groups and to evaluate trends over time showed that 7.7% of the drivers in the sample patronized commercial sex workers and 7.3% had casual partners. Prevalence of HIV among this group was 2.4%.3 Studies has shown some risk factors for HIV infection among this peculiar occupational group, namely lack of or partial treatment of STIs which has been identified as cofacilitators of transmission of HIV, High rates of extramarital affairs and multiple sexual relations, Engagement in unprotected and casual sex with FSW, drug abuse and traditional tattooing.1 This lifestyle of theirs puts them as

a recognized high-risk occupational group. The aim of this study was to assess factors influencing the practice of risky sexual behaviors among male drivers who work in motor parks in Mushin local government, Lagos state. MATERIALS AND METHOD Description of study area Mushin local government area (LGA) is a suburb area located in the heart of Lagos state the second fastest growing city in Africa. According to the state government, it has a population of 17.5 million and 20 Local Government Areas.4 Mushin is bounded in the North-west by Oshodi-Isolo local government, in the East by Shomolu local government, in the South by Surulere local government and in the North by Ikeja local government.5 The local government is made up of nineteen wards and three major communities namely Mushin, Ilupeju and Itire and according to the national population census in 2006 it had a population of 633,009.6 There are currently 19 wards in the local government, which are Alafin/Adeoyo, Alakara, Babalosha 1 and 2, Idiaraba, Idi-oro, Igbehin, Ilupeju, Ilupeju industrial, Kayode/Fadeyi, Mosholashi/agoro, Mushin/agewolara, Odo-eran, Oduselu/ola, Ojuwoye, Olateju, Onitire, Owodunni and Papa ajao, these wards have different socioeconomic structure and make up.

AMSUL Digest 2014

The commercial bus driver division of NURTW Mushin has 3 major divisions, Odeolowo, Mushin-Ajina and Itire. Study design This study was carried out using a cross-sectional descriptive design to determine the factors influencing the practice of risky sexual behaviors among male drivers who work in motor parks in Mushin local government, Lagos state Study population The study was carried out among National Union of Road Transport Workers, commercial bus drivers division in the various parks in Mushin local government area of Lagos state Sample size determination In determining the minimum sample size, Cochran's equation was used: n=z2pq/e2 z is the standard normal deviation/Confidence interval set at 1.96, which corresponds to 95% confidence limit. P is percentage of respondent who knew of ABC (Abstinence, Being faithful and Consistent condom use) as preventive measures against HIV/AIDS transmission in a previous study carried out among market men and women 82.2% = 0.8227 q = {1-P} = 1-0.822 = 0.178 e = precision value/degree of error acceptable usually set at 0.05 n = ([1.96]2 [0.822] [1-0.822])/ [0.05]2 = ([3.84] [0.822] [0.178])/ 0.0025 = 0.5619/0.0025 =225 Sampling methodology Random sampling method was used to select MushinAjina division. There are 13 parks/units in Mushin-Ajina namely, Mushin main garage 1 and 2, Palm avenue, Idi oparun 1 and 2, Onilegogoro, Idi-oro, Mushin-Obalende, Dakobiri, Kajola, Mushin total 1 and 2 and Pako junction. All the registered, available and willing drivers in the NURTW Mushin-Ajina division took part in the study Data collection tool Information was obtained from the respondents using an interviewer-administered structured questionnaire. The questionnaire was categorized into three sections; section A elicited the socio-demographic characteristics of the respondents; section B described respondent's smoking and drinking habits and section C describes the sexual practices of respondents. The questionnaire was pretested AMSUL Digest 2014

Name of park/unit

No of registered drivers

Main garage 1 and 2


Palm avenue


Idi-oparun 1and 2












Mushin total 1 and 2


Pako junc on




in a similar motor park in another division. Method of data analysis Data entry and analysis was done using EPI Info version 7.0. The data was presented in tables and figures. Mean and standard deviation was computed for continuous variables while frequency tables were generated for categorical variables. Association between variables was determined using Chi square at p<0.05. Ethical consideration Ethical approval for the study was obtained from the Research and Ethics Committee of Lagos University Teaching Hospital. Permission was also obtained from the chairman of National Union of Road Transport Workers of each garage (unit). Written informed consent was also obtained from each respondent. Respondents were also assured of confidentiality of information provided by not requesting for their names and addresses. RESULTS The results showed that more of respondents were between the ages of 26-35 (34.75%). Mean age is 34.89+10.88. Most were Yoruba (88.56%), had a secondary education (63.14%), married (63.25%). 89.61% had only one wife and 88.96% lived with wife. About one-fifth (21.37%) of respondents smoked and of those who smoked, majority smoked less than 5 sticks per day 74.00%. A quarter (24.68%) of respondents smoked hemp or cannabis and majority of these were regular smokers (82.46%). Majority (59.72%) of respondents took alcohol, of which

65.95% were regular consumers. Of those who took beer, only 26.37% took more than 2 bottles. 26.95% of those who drink alcohol do so before having sex. More (42.61%) of respondents were 20 years and above at sexual debut. Mean age at sexual debut was 18.6+4.53. About a quarter (23.00%) had had sex with a partner 10 years younger and 9.33% with a partner 10 years older. 34.51% of respondents gave gifts or favors for sex and majority was to girlfriend (84.43%). 27.11% paid for sex and 86.44% paid money to sex workers for sex out of which 32.20% were regular at it. Majority of respondents had had concurrent sexual relations (60.43%). 44.21% of those married had extramarital affairs. Almost all respondents (91.90%) had sex in the last 3 months and of those who had sexual relations in the last 3 months, majority had one partner (50.23%) and had sexual relations with spouse (68.84%). 53.95% of those who had sex in the last week had it with their spouses. One-fifth (18.58%) took substance for sexual arousal and majority took drugs for arousal (47.62%). Each one of the respondents (100.00%) engaged in vaginal sex, 20.35% anal and 7.08% oral. This study shows that age affected age at sexual debut. More of the respondent below the age of 30 years had sexual debut before age 15 years (p=0.000). There's an association between age and practice of inter-generational sex, more of respondents below 30 years practiced intergenerational sex (p=0.013). Also, age affected payment for sex, as age increased, payment for sex reduced (p=0.003). It is shown that age affected engaging in concurrent sexual relations, increasing age results in decreasing concurrent sexual relations (p=0.024). There was an association between marital status and age at sexual debut. More of the single respondents had sexual debut before the age of 15 years (p=0.000). Also, marital status affected the practice of inter-generational sex. More of the single respondents practiced inter-generational sex (p=0.001). There's also a significant association between marital status and transactional sex. More of the single respondents paid for sex (p=0.000). Marital status affected ever having concurrent sexual relations. More of the single respondent had ever had concurrent sexual relations (p=0.004); a similar pattern is seen between marital status and current concurrent sexual relations, more of single respondents had current concurrent

relations (p=0.000). This study shows that cigarette smoking habit affected practice of inter-generational sex. More of those who smoked practice inter-generational sex (p=0.015). There's also an association between smoking and ever having concurrent sexual relations. More of respondents who smoked had ever had concurrent sexual relations (p=0.000); a similar pattern is seen between smoking cigarette and currently having concurrent sexual relations (p=0.003). Also, smoking cigarette affected engagement in anal sex, more of those who smoked engaged in anal sex (p=0.039) There's an association between smoking hemp and age at sexual debut. More of the respondents who smoked hemp had sexual debut before the age of 15 years (p=0.001). Also, there's an association between smoking hemp and practicing inter-generational sex. More of those who smoke hemp practiced inter-generational sex (p=0.043); similar association was seen between smoking hemp and transactional sex. More of those who smoked hemp paid for sex (p=0.004). There is also an association between smoking hemp and ever having concurrent sexual relations. More of those who smoked hemp had ever had concurrent sexual relations (p=0.000); similar pattern is also seen between smoking hemp and having current concurrent sexual relations (p=0.000). This study also shows that smoking hemp affected engagement in anal sex. More of those who smoked hemp engage in anal sex (p=0.004). This study shows that alcohol consumption affected practicing inter-generational sexual intercourse. More of the respondent who took alcohol practices intergenerational sex (p=0.010). Also, there's an association between alcohol consumption and payment for sex. More of those who took alcohol paid for sex (p=0.022). There's also an association between alcohol consumption and ever having concurrent sexual relations. More of the respondents who took alcohol had ever had multiple sexual relations running concurrently (p=0.000); similar association is seen between alcohol consumption and having current concurrent sexual relation. More of those who took alcohol had current concurrent sexual relations (p=0.000). Also, alcohol consumption is seen to have affect engagement in anal sex. More of the respondents who took alcohol practiced anal sex (p=0.010).

AMSUL Digest 2014



















Age at sexual debut (in years) n=230

Alcohol before sex

Age (years) n=236

Mean age34.89+10.88


Ethnic group n=236 Igbo









Level of educa on n=236 No formal


100.00% 80.00%











Ter ary














More than 1



Lives with wife n=154



Marital status n=236

Number of wives n=154 1

Table 1: Socio-Demographic Characteristics of Respondents Variables





Smokes cigare e n=234

0.00% Sex with partner 10 Sex with partner 10 years younger n=228 years older n=225

FIGURE 5: INTERGENERATIONAL SEX 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00%

Yes No

Paid for sex n=225

FIGURE 6 Frequency of paying for sex n=59

S cks per day n=50 Less than 5









Smokes hemp or cannabis n=231




Frequency of smoking hemp/cannabis n=57

Concurrent sexual relations




Non regular



Table 2: Smoking pattern Takes alcohol n=236

Frequency of alcohol consumption n=141


Gave gi s/favors for sex n=226

Currently sexual active

FIGURE 8 Extramarital affairs

FIGURE 10 Consumed substances for sexual arousal

AMSUL Digest 2014


FIGURE 13 DISCUSSION This study was done among commercial bus drivers belonging to Mushin-Ajina division of National Union of Road Transport Workers (NURTW) in Mushin Local Government Area of Lagos state. More of the respondents (34.75%) fell within the age range of 26-35 years with a mean age of 34.89+10.88. Majority of the respondents (88.56%) were Yoruba, 63.14% had a secondary school education and 65.25% were married. Among the married, 89.61% were in monogamous marriages and 88.96% lived with their wives. Consumption of alcohol and smoking of hemp was found to be commoner among the drivers in this study compared to the result of a study among intercity commercial divers in Ilorin, Kwara state in 2007 where less than a quarter consumed alcohol and only 3.9% smoked hemp.1 About 16.09% of the respondents had experienced sexual debut before the age of 15 years, higher than the result obtained in the 2008 National Demographic and Health survey where only 6% of men within the general population aged 15-24 reported sexual debut before age 15.8

About a quarter of the sexually active respondents (27.11%) paid for sex which is low compared to the 51.43% obtained among patients accessing treatment for STIs in a study carried out in 6 health facilities in urban Zvishavane, Zimbabwe in 2009.9 Majority of the respondents had been involved in concurrent multiple partnership (60.43%). Among the married respondents, 44.21% have had extramarital affairs. Majority of respondents (91.90%) were currently sexually active and among this group, about half (50.23%) had only one sexual partner. These results are higher than those obtained in a study carried out in Ilie town, Oshogbo, Nigeria among the adult population where only 23.7% of all respondents had multiple sexual relations running concurrently and 32.1% of those married engaged in extramarital affairs.10 About one-fifth of respondents (18.58%) consumed stimulants for sexual arousal among them 47.62% took drugs for sexual stimulation (8.47% of all respondents) which was higher compared to the result obtained in a study carried out among clients of commercial sex worker in Escuintla, Guatemala in which 2.2% of respondents took drugs just prior to sex. About a quarter (26.95%) of the respondents who take alcohol, do so before having sex (16.10% of all respondents) this is low when compared to findings of the study among clients of commercial sex workers mentioned above where 85.4% of respondents consumed alcohol just prior to sex.11 All the respondents engaged in vaginal sex, 20.35% in anal and 7.08% in oral which was close to the results obtained in a study carried out among sexually active male ruralurban immigrants in Shanghai, China in 2013 where all the sexually active respondents engaged in vaginal sex and 8.1% in oral sex however with regards to anal sex about one fifth of respondents in this study reported to participated in the act which is considerably higher than the 0.5% recorded among the Chinese.12 CONCLUSION This study carried out among commercial bus drivers under the National Union of Road Transport workers (NURTW), Mushin Lagos state revealed that one-fourth smoked cigarette and hemp and were regular smokers. Majority of respondents took alcohol, were regular consumers and about a quarter took alcohol before sex. More of the respondents were about 20 years and above at AMSUL Digest 2014

sexual debut. About a quarter had sex with a partner 10 years younger and one-tenth with a partner 10 years older. One-third gave gift/favors for sex and majority gave these to girlfriends. About a quarter paid for sex, mostly to commercial sex workers and most were regular customers. Most respondents had concurrent sex relations and about half of those married had extramarital affairs. Almost all respondents were currently sexually active and about half of respondents had more than a partner. One-fifth took substances for sexual arousal and majority took drugs for these. About one-fifth engaged in anal sex. More of the respondent below the age of 30 years had sexual debut before age 15 years and practiced intergenerational sex. Also, as age increased, payment for sex reduced. More of the single respondents practiced intergenerational sex, paid for sex and had current concurrent relation. More of those who smoked practice intergenerational sex, were multiple sexual relations and engaged in anal sex.More of the respondents who smoked cigarettehad sexual debutbefore the age of 15 years, practiced inter-generational sexual relations and paid/gave gifts for sex. More of those who smoked hemp paid for sex, had concurrent sexual relations and engaged in anal sex.More of the respondents who took alcohol practiced inter-generational sex, paid for sex, had multiple sexual relations and practiced anal sex. Determinants of participating in risky sexual behavior were age (young), marital status (single), drinking alcohol and smoking hemp Based on findings of this study, Awareness campaigns giving appropriate information about HIV/AIDS and STIs should be intensified on radio, television, newspapers and within motor parks. Training of peer educators among NURTW members who can ser ve as sources of information and referral for members.Banning of sale of alcohol and hemp in motor parks and provision of counseling services on substance abuse within motor parks REFERENCES 1) Olugbenga-Bello A.I, Oboro V.O, Parakoyi D.B, Akande T.M. Sexual Behavior of Intercity Commercial Drivers in Ilorin, Kwara state, Nigeria: Research Journal of Medical sciences. 2007; 1(5): 284-288. 2) World Health Organization. Data on the size of the HIV/AIDS epidemic: Data by WHO region. Available AMSUL Digest 2014 and Accessed on: 2014, February 8 3) Federal Ministry of Health (FMOH). Nigerian Integrated Biological and Behavioral Surveillance Survey 2010. 4) Lagos-Wikipedia, the free encyclopedia. Available from: Accessed on: 2014, April, 16. 5) Mushin-Lagos state government. Available from: Accessed on: 2014, April 16. 6) Adeoye B.E. Growth and development of Mushin local government area, Lagos state (1976-2003). May 2011 7) Lammers J, van Wijnbergon SJG, Willebrands D. Condom use, risk perception and HIV knowledge: a comparison among sexes in Nigeria. Dove Press Journal: HIV/AIDS-Research and Palliative Care 2013;5:283-293. DOI: 8) National Population Commission (NPC) [Nigeria] and ICF Macro. Nigerian Demographic and Health Survey 2008 Abuja, Nigeria: National Population Commission and ICF Macro. 9) Chadambuka A, Chimusoro A, Maradzika JC, Tshimanga M, Gombe NT, Shambira G. factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe 2007. African Health Science 2011;11(4):535-542. 10) Asekun-Olarinmoye E.O, Bamidele J.O, Olowu A.O, Odu O.O, Egbewale B.E, Amusan O.A. Sexual Risk Behavior and Risk Perception of HIV/AIDS among a Rural Adult Population in Southwestern Nigeria. Research of Journal of Medical sciences,2009;3(2):8089 11) Sabido M, Lahureta M, Montoliu A, Gonzalez V, Hernandez G, Giardina F et al. Human immunodeficiency virus, sexually transmitted infections and risk behaviors among clients of sex workers in Guatemala: Are they a bridge in human immunodeficiency virus transmission? Sexually Transmitted Disease 2011;38(8):735-742 12) Wu J, Wang K, Zhao R, Li Y, Zhou Y, Li Y et al. Male Rural-to-Urban Migrants and Risky Sexual Behavior: A Cross-Sectional Study in Shanghai, China Int. J. Environ. Res. Public Health 2014; 11:2846-2864.

Now That We Are Ebola-Free...


Things Nigeria Must Do To


Dr. Lawal Bakare Team Lead, Ebola Alert @bakarelawal

Nigeria is Ebola-free! That's something to be proud of. But it doesn't end there. We also want to ensure that we remain Ebola-free. Here are five things we need to do. Before we go into the five, though, we need to remember that we Nigerians must continue to empathise with our neighbouring countries still battling Ebola. We have had our own Ebola experience, and our victory is a victory for them too, because if we did it, they know they can also. Besides that, Nigeria must celebrate being Ebola-free for the sake of those who did everything to make this day possible. We must not forget that we lost lives, we marched in the rain, we moved in unison as a country. Now we will celebrate in style. But we will also remind ourselves what we have

learnt from all of this is that we can scale other national challenges, and how much work remains. And we must also remind ourselves that it is not over until it is over. And until it is indeed over, here are five things we need to maintain. 1. Prompt Reporting The Nigerian Ebola surveillance protocol is highly dependent on information. We have over 110 million active mobile subscribers and 54 million internet subscribers and widespread distribution of public and private primary healthcare centres nationwide. That is a huge amount of potential reporters. If we will remain Ebola-free, any suspicion of Ebola, whether by individuals or health facilities, must be immediately reported to health

AMSUL Digest 2014

authorities. The reporting channels are: Health facilities: Any health facility near you (especially governmentowned) Mobile toll-free hotline: 0800-32652-4357 (0800-EBOLA-HELP) Social Media: Twitter (@EbolaAlert), Web: Livechat on 2. High Environmental and Personal Hygiene Standards Ebola is a largely hygiene challenge, all the way from the source (fruit bats and monkey meats) to humanto-human transmission. To keep Nigeria Ebola-free, we need to sustain proper cooking of our food. Ebola is not the only infectious disease contracted through badly cooked food; typhoid, hookworm, cholera all can be prevented when our food are properly cooked with clean hands. Proper hand hygiene is all that is necessary to prevent many deadly infections: by handwashing, and where this is not feasible, by alcohol hand rubs (sanitizers). Maintaining sound environmental hygiene is indeed a reflection of our personal hygiene standards too. We must ensure that our personal and public spaces, are always sanitized and frequently decontaminated. Our homes, schools, offices, eateries, cinemas, churches, mosques, hospitals, public toilets are spaces that come together to make our lives convenient and beautiful; they are also points of potential infection when not properly cared for. We must make sure they do not become AMSUL Digest 2014

Dr. Ameyo Adadevoh problems to us. Whoever owns or is responsible for those spaces must do everything possible to ensure that appropriate materials and personnel required to achieve excellent environment hygiene are deployed to those places. 3. High Index of Suspicion for Ebola We know now how lucky we were that the late Patrick Sawyer was identified early at First Consultant Hospital. This is why we immortalize the late Dr Adadevoh, and why we remain grateful to the entire team at First Consultant: not only for their great sacrifice, but also for suspecting and reporting the case as early as they did. We need our healthcare providers to retain the same, if not higher, level of suspicion. We at Ebola Alert have developed a basic web application to guide you through Ebola case definition protocol, which you can find in the resources segment of the website at

A basic history is all we need to identify most Ebola suspect cases that present to health facilities; so they can be reported early, spread of Ebola can be prevented, and chances of survival for affected persons increased. In addition, ensure universal standard infection prevention control. Remember that clinical care requires us to guard ourselves and our patients from infectious diseases. Clinicians can help #KeepNigeriaEbolaFree if they remain extremely vigilant and #StayEbolaAlert. 4. Sustained Government Collaboration The Nigerian collaboration towards containing Ebola was a collective effort at all levels of government: federal, state, local governments and MDAs. Beside the health sector, the agriculture, technology, works and education sectors played key roles.





Ebola gave to us the opportunity to implement the Adelaide Statement on Health in All Policies, which highlights an inter-ministerial and inter-departmental approach to health. Health is our collective effort and as was evident in the Nigerian Ebola outbreak, the collective effort of federal, state and local governments can do great things. To #KeepNigeriaEbolaFree, we as a country must do everything to facilitate and sustain that healthy collaboration. Health is too crucial and resource-intense for us to leave our coordination to chance. This is partly why our healthcare system in Nigeria is structured to accommodate clear roles for a disease like Ebola. Now we need all actors at all levels of government to continue working together. We must also sustain this health sector awakening in tackling other disease burdens Nigeria is battling with.

5. Sustained Community Action and Participation We can only #KeepNigeriaEbolaFree when we accept that our country and government need our participation to succeed. Community action is about individuals and communities getting actively involved in the decisionmaking process, especially where those decisions will affect their lives. The role of each individual, family, community and business, becomes more definitive by the day. Nigeria as a rich country needs every one of the 170 million who make up her human capital, individually and in organisations, to be actively involved in all issues concerning her survival. In the battle against Ebola, we must remember that we did not wait to be told everything; we stepped up and started solving our problems. Ebola Containment Trust Fund

rallied organized private sector to raise resources for the containment, Samsung, Tecno, Airtel, Etisalat, MTN, Total, Shell all put our monies where our mouths were. We supported government with information and donations, compliance and volunteering. Those in government worked round the clock to determine the right decisions in collaboration with our development partners. We worked as a country! Families complied, churches and mosques preached, transporters called for directives and implemented it, airlines changed protocols, travelers waited extra hours. That is how health gains are made. To sustain this new height and #KeepNigeriaEbolaFree, we must not lose our hold of these five things, and we shall see our country remain safer and healthier for it. To greater heights! AMSUL Digest 2014

The Association of Medical Students University of Lagos had its annual dinner and awards night on the 30th of September 2014 at the Dove Events Centre, FESTAC, Lagos. This yearâ&#x20AC;&#x2122;s event was a Masquerade Ball and we bring you exclusive pictures of the memorable occasion









Okonkwor Christian,300L MBBS and Abudu Kabirat,300L MBBS


nilag students are unserious! They don't know more than fashion! They like social events too much! Iâ&#x20AC;&#x2122;m sure as a student of the University Of Lagos, you have heard one of the above expressions, perhaps from a university student in another school. It is worse for students in the College of Medicine, University of Lagos, we are seen as unserious medical students, who have too much time on our hands. Well, let me corroborate that belief. Meet Fola David, reigning Mr.

Medilag (a yearly beauty pageant held in Medilag). He is a 400 level Medicine and Surgery student and he draws. Beautifully I must confess. His artwork rivals that of trained professionals and he draws portraits for people. he has somehow managed to balance his business of drawing and the 'hectic' nature of medical school. Next up is Towunmi Coker, a 600 level student of Medilag. She writes, wonderfully, and recently she organized a writing competition for secondary schools in Lagos with mouth watering prizes. Her writeups have been in newspapers, she

...despite all the biting comments, Unilag produces some of the best doctors in Nigeria and has the reputation of having one of the best medical schools in the country. AMSUL Digest 2014

Deji Odufuwa

Eazy Davidson

Towunmi Coker

Fola David runs a website, and she actively tries to push the writing community in Medilag. She manages to do all this with the extreme pressure of medical school. Not convinced, let us meet Deji Odufuwa, a 300 level medical student of Medilag. He is a fashion connoisseur, and a brilliant student. He also has a budding musical career. Dumbfounded? I’m not done yet, let’s meet Baju, the first runner up at the Mr. Universe pageant 2014. Amazed? Well, in between the hectic schedule of medical school, Baju finds the AMSUL Digest 2014

time to gym, take care of his body and don the panties that men wear during beauty pageants. By the way Baju is a 500 level student of Medicine and Surgery. Lastly, meet Eazy Davidson of the Eazy Davidson dance company, he is a 400 level student of… need I complete it? And yes, he runs a dance company. What do these people have in common? They are students of Medilag, they are students of the University of first choice and the nation's pride. They are the 'unserious' students who

don't know more than modeling, dancing, writing, drawing and of course fashion! So how do they manage it. Afterall , despite all the biting comments, Unilag produces some of the best doctors in Nigeria and has the reputation of having one of the best medical schools in the country. So how come with the tough academic environment that picks only the best minds in the country, these people still find time to do what they do. Well the answer is simple. They have the Lagos advantage. The advantage of being in the foremost city in Nigeria nay Africa. Fashion trends start in Lagos, everything in Nigeria starts in Lagos, and so despite their busy nature, students of Unilag have the opportunity of exposure which allows them to explore other passions and talents they possess outside their chosen course of study. Some people might think that makes us unserious, but the truth is that, it doesn't. We live in a Nigeria where jobs are difficult to come by. After graduation, instead of trekking the streets of Lagos in search of a job, these 'unserious' students of the University Of Lagos can easily fall back on their talents or side businesses. After all we are being encouraged to be job creators and

“We live in a Nigeria where jobs are difficult to come by. After graduation, instead of trekking the streets of Lagos in search of a job, these 'unserious' students of the University Of Lagos can easily fall back on their talents or side businesses.”

'unserious' student of UNILAG is a world class graduate, because the world is shifting towards talent. There is so much saturation in the world today, that the only people that make it to the top are those who are creative. Those who think outside the box. The world is filled with the conventional, and is always enthralled when confronted with the unconventional. After all, Frank Netter was a Surgeon and a wonderful artist, the writer of

Sherlock Holmes, Sir Arthur Conan Doyle was a doctor also. In conclusion, The Lagos advantage as I would like to call it can only be gotten in College of Medicine, University of Lagos. Why? In the College, there is so much going on that challenges you. When you see how much your senior colleagues have achieved, get to attend one seminar after another, numerous health week symposia, you realise that you are not surrounded by

people that conform to the 'typical medical student' image. So while they excel in their medical profession, they excel outside it as well. Business, fashion, writing, what ever it is. The world wants good doctors but, it is in need of special doctors. Doctors that dare to challenge themselves and gain more than just an MBBS degree after six years. The students and graduates of this College are at the top of that list.

We have amongst our alumni movers and shakers of various spheres of life

Dr. Matilda Kerry Prof C.O Onyebuchi-Chukwu

Dr. Ajibayo Adeyeye

Dr. Olajide Idris

The current Minister Of Health, under whose expertise Nigeria fought and won the Ebola war

Majority Leader Lagos State House Of Assembly

Current Commisioner for Health, Lagos State

Most Beautiful Girl in Nigeria(2000) Cervical Health Campaign activist & President of the George KerryLife Foundation.

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We met up with the MD of Multishield HMO, Lagos and we ask about his thoughts on financing healthcare in Nigeria.

Please, sir can you introduce yourself?

How would you define the current health sector in Nigeria?

Well, my name is Leke Oshunuiyi. I'm a 1982 graduate of the great rival of your institution, the senior rival (laughs) – the University College Hospital and the Medical School University of Ibadan. Since I graduated I have remained in private practice because I have always thought that the problem in medicine was not manpower. I've always believed that the problem is funding, and for three decades and more I have continued to be proven right, and as we go along with this interview you will realize why I say I have been proven right – that the issue is funding rather than manpower or even infrastructure because it is the funding that ties everything together.

At the risk of sounding condescending, I would say it is hyper-fragmented. That's the word I will use with all the connotations that go with that word: hyperfragmented! I'll just leave it that way so that my colleagues would not be up in arms against me.

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So with where we are right now, what hopes do you have for the current health sector in Nigeria? To start with, there is no such thing as free health. If a politician mounts the rostrum and says to you 'I will give you free health', he is not saying the truth because somebody has to pay. Let us look at examples all over the

world of where health systems work and don't work; and what are the cost implications. Let us look at the UK- the budget for the 2013 National Health Service (NHS) was a sum in excess of £120 billion or over $200 billion (roughly £2,000 per inhabitant per annum). To put that in perspective, the UK has a population of about 6o million people, with pipe-borne water, no malaria, little or no HIV/AIDS or Sickle-cell anaemia. In Nigeria, we are about 3 times that figure, no universal pipe borne water, poor maternal and infant mortality indices, illiteracy and the likes. Now, the entire country of Nigeria budgets $30 billion annually. Our entire budget, with 3 times the population and its attendant problems is one-sixth of the UK's health budget.

“...there has to be a mechanism whereby people are paying into the pool, so that at any given time, the healthy are paying for the sick. That is the only thing that is sustainable”

Now, the World Health Assembly in I think 2005 asked member states to adopt methods of health risk pooling and health risk sharing to prevent people from catastrophic health expenditure. What does that mean? You have a gateman who earns maybe N30,000 a month or N360,000 a year. One night, his son develops an abdominal pain, his only child, they rush him to the nearby health centre, and they say he has appendicitis. Surgery is N150, 000. That is at least 40% of his annual salary is required else the child dies. This is not a fable or a confabulation, it is real life story. How does he pay? So, that brings us to the issues of Health funding and what the World Health Assembly was proposing was a method whereby people do

not have to pay at the point of service. It is a contributory scheme, people call it health insurance or managed care, whatever you term it. But, there has to be a mechanism whereby people are paying into the pool, so that at any given time, the healthy are paying for the sick. That is the only thing that is sustainable, that will allow us to lift from this hyper-fragmented state to a more cohesive health system. People must learn that they need to pay towards their own health care for the evil day that surely cometh to all man – the day they fall ill. Currently, what type of insurance do we have available in Nigeria? There are two basic schemes running in Nigeria. There is the public sector firm driven by the

NHIS which has maybe about 3 million people registered – largely comprised of Federal civil servants and their dependants: 1 wife and 4 children up to a maximum of 18 years. Then, we have the Private scheme which has been tailor-made. You can actually more or less ask for what you want and the plan can be designed. The private health insurance scheme has not fully worked because they are not mandatory. Some flaws exist in the NHIS Act number 35 of 1999. There was no compelling clause in the Act. There is a clause in that Act which says that “anyone who employs ten or more individuals or any company that employs ten or more may subscribe to the scheme”, it was supposed to read “shall subscribe to the scheme” but some AMSUL Digest 2014

...“look let us have a scheme whereby people can pay for their insurance policy by text, by airtime”. clever or some unkind person changed that word 'shall' to 'may' and that more or less ruined the Act as there was no compelling law, it was optional. So, it's been an Act without a solid backbone and we've tried to work with it. It's been difficult but most of what we've done regarding legislative amendment from 1999 has been to change that word 'may' back to 'shall'.

scheme whereby people can pay for their insurance policy by text, by airtime”. That is already being rolled out and managed by a financial service aggregator company. Currently, MTN says they will take N5 from my phone every day for mobile health insurance. Do you think that is sustainable?

profit in excess of what they paid for. They have revenue estimated over 4-5 Billion Naira a day. This thing, the president is going to launch it and we hope that after a while there will be a law that will ensure that most people subscribe to one health insurance scheme or the other.

So how do you think we can expand this coverage?

Don't you think people would get tired?

As medical students/ intending medical practitioners, is there any role we have to play in the whole concept of Universal health provision?

Under the leadership of Dr. Femi Thomas, the Executive Secretary of the NHIS, there is an agreement with all the mobile networks: Airtel, Glo, Etisalat and MTN who have over a hundred million people enrolled. He said, “look let us have a

You know when the mobile phone networks came in 1999, people said “it can't work; I'm not going to bid”. Most companies bided 287 million dollars, and within two years they had made their money back. Every year now, MTN makes a declared

I usually take medical students when they come to my hospital in Obalende and I always make sure I tell them, “Today I'm not going to discuss cardiology or neurology with you, and I'm going to tell you something that has made many of

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It's not N5, N35!

our members unhappy.” I tell them, “I had a friend, who was working with us, who was forced to take a Molue bus because he didn't have a car, so he stayed at the back so that no one would see him. One of his patients had spotted him and said '’Doctor, I've paid for you in front o!' Real life story! Everybody was now looking back to see the doctor that cannot pay his transport fare.” The public expects doctors to be so wealthy, but they are not ready to pay these same doctors. In my private hospital, I have seen patients come and say “Doctor, I no get money o! In fact, na you go give us transport money go home and you go treat us free” The quality of intellect that goes into the profession is phenomenal. The best boys, the best girls in every generation are just moved

into medicine and I regret to inform you that often times their minds go to waste because the country does not have the installed capacity to utilize this kind of brainpower. So we see our people go abroad and excel. We really need a huge boost in funding in healthcare for us to enjoy the gains of healthcare. We need to be advocates of health insurance, until healthcare- the biggest industry in the land, finds its feet!

don't really have to do medicine.” So he did economics at Manchester. My wife is a fellow of the Royal College of Obstetricians and Gynecologists, and practices in the UK. My hobbies include writing, reading, swimming and cycling. Thank you for sharing your time with us, we are indeed grateful Its my pleasure.

Sir, on a lighter note, please tell us a little more about your family. I have 2 children. One is a medical student, Kings' College, London; she's in her third year. She's my second child. My first child asked me when he was 16 if he really had to do medicine, I said “No! You AMSUL Digest 2014



here are different dimensions of a doctor's personality. How you handle stress, what gives you satisfaction, and fulfillment, how you interact with your peers etc. Discovering your personality type means identifying your distinctive attributes, values and affinities, and finding the natural comfort zone where your time preferences lie as a physician. From our first year in medical school, almost all students would have already started asking themselves questions relating to what medical specialty specifically suits or fits them. Many researchers have also tried to find out what personalities are better adapted to their various medical AMSUL Digest 2014

specialties as Surgery, Internal medicine, Family medicine, Dermatology, Neurology etc. One of the systems developed to specifically do this is the MyersBriggs Type Indicator (MBTI). The Myers-Briggs Type Indicator was developed in the 1950s by Isabel Briggs Myers and Katherine Briggs and has become the most popular and widely used psychological test in the world. The MBTI can help medical students to choose the right specialty for their personalities and temperaments. The test enables you to learn more about how you perceive and judge others, whether in an occupational or social situation. It identifies your strengths and weaknesses, and shows whether you value autonomy or prefer interdependence.


4. Judgment (J) versus

According to the theory behind the MBTI, every individual falls into one of 16 types of personality. These personality types are derived from the four main indices of the MBTI. Each index represents one of the four basic preferences (described by Jung) about how every individual perceives and processes external stimuli and then uses that information to make some kind of cognitive judgment. As part of one's overall personality, this judgment guides behavioral preferences in any situation involving other people—like colleagues or patients. The four dimensions measured by the MBTI are:

Perception (P): How do you order your life? What kind of environment makes you the most comfortable? This index describes how a person deals with the outside world. Those who prefer judgment are

1. Extroversion (E)

2. Sensing (S) versus

3. Thinking (T) versus

serious, time‐conscious

versus Introversion (I): How do you relate to others? Where do you best derive your energy—from yourself or from others? Introverts prefer to focus their interest and energy on an inner world of ideas, impressions, and reactions. Being introverted does not mean being asocial. Instead, introverts prefer interactions with greater focus and depth, with others who are also good listeners and who think before they act or speak. Extroverts, on the other hand, derive their energy from external stimuli and tend to focus their interest on the outside world. They prefer dealing with facts, objects, and actions. Not all extroverts are the life of the party, however. They simply prefer being engaged in many things at once, with lots of expression, impulsivity, and thinking out loud.

Intuition (N): What kinds of stimuli do you prefer when collecting, processing, and remembering information? Sensors are the ones who are drawn to the hard, immediate facts of life—practical details and evidence that can be taken in through one of the five senses. They are sensible,

Feeling (F): How do you make decisions and come to conclusions? This index concerns the kind of judgment you trust when you need to make a decision. Thinkers make their decisions impersonally, based mainly on objective data that makes sense to them. As analytical people motivated by achievement, they always consider the logical consequences of their decisions. Unlike thinkers, Feelers rely on personal, subjective feelings in their decisions. As empathetic, compassionate, and sensitive people, they take the time to consider how their decision might affect others. Feelers like pleasing others and tend to get their feelings hurt rather easily.

individuals who live by schedules. They like things orderly, planned, and controlled. Judgers need a world of structure and predictability to have a sense of control over their environment and to be their most organized and productive. Judgers work hard, make decisions quickly and decisively, and sometimes can be closed minded. On the other hand, Perceivers are much more open minded, relaxed, and nonconforming. They are much more aware of ideas, events, and things. Their flexibility and spontaneity, however, can sometimes lead to irresponsibility. Although judgers need to finish projects and settle all issues, perceivers tend to gather information in a leisurely way before making a final decision. Perceivers prefer to experience as much of the world as possible, so they like to keep their options open and are most comfortable adapting.

matter‐of‐fact people who look at the reality of the world around them, rely on prior experiences, and take things literally. Intuitives, on the other hand, look beyond the facts and evidence for meanings, possibilities, connections, and relationships. They are more imaginative and creative people who like to see the big picture and abstract concepts. Using intuition often means relying on a hunch or gut feeling rather than past experience. They eschew facts for theories and look beyond simply the obvious.

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MEDICAL SPECIALTIES BY TEMPERAMENT According to the theory behind the MBTI, personality type indicates an innate preference (similar to hand dominance) toward one of the two poles in each index, meaning that a person is probably never a 100% introvert, but may lie closer to the introversion pole (the dominant or

leading process) on a continuum scale, while still having some qualities of extroversion (which in this case would be considered the nondominant or auxiliary trait). When you take the MBTI, you receive a score t h a t s h o w s t h e s t re n g t h a n d consistency of your natural tendency

in each of these four dimensions. It is the interplay between the four poles that ultimately gives us our individual personality and temperament. Thus, the test classifies you as one of 16 different personality types' combinations: INTP, ESTJ, ENFJ, ISTP, and so on.

Introverted– Sensing–Thinking– Judging (ISTJ)

Introverted– Sensing–Feeling– Judging (ISFJ)

Introverted– Sensing–Thinking– Perceptive (ISTP)

Introverted– Sensing–Feeling– Perceptive (ISFP)

Dermatology Obstetrics & Gynecology Family Practice Orthopedic Surgery Urology

Anesthesiology Ophthalmology General Practice Family Practice Pediatrics

Otolaryngology Anesthesiology General Practice Ophthalmology Radiology

Anesthesiology General Practice Family Practice Thoracic Surgery Urology

Introverted– Intuitive–Feeling– Judging (INFJ)

Introverted– Intuitive–Thinking– Judging (INTJ)

Introverted– Intuitive–Feeling– Perceptive (INFP)

Introverted– Intuitive–Thinking– Perceptive (INTP)

Psychiatry Internal Medicine Thoracic Surgery General Surgery Pathology

Internal Medicine Anesthesiology Psychiatry Pathology Neurology

Psychiatry Cardiology Neurology Dermatology Pathology

Thoracic Surgery Neurology Pathology Psychiatry Cardiology

Extroverted– Sensing–Feeling– Perceptive (ESFP)

Extroverted– Sensing–Thinking– Perceptive (ESTP)

Extroverted– Sensing–Thinking– Judging (ESTJ)

Extroverted– Sensing–Feeling– Judging (ESFJ)

Obstetrics & Gynecology General Practice General Surgery Orthopedic Surgery Pediatrics

Internal Medicine Orthopedic Surgery Otolaryngology General Practice Pediatrics

Obstetrics & Gynecology Orthopedic Surgery Ophthalmology Thoracic Surgery General Surgery

Orthopedic Surgery General Surgery Dermatology Family Practice Radiology

Extroverted– Intuitive–Feeling– Perceptive (ENFP)

Extroverted– Intuitive–Thinking– Perceptive (ENTP)

Extroverted– Intuitive–Feeling– Judging (ENFJ)

Extroverted– Intuitive–Thinking– Judging (ENTJ)

Psychiatry Dermatology Otolaryngology Pediatrics

Otolaryngology Psychiatry Radiology Pediatrics Pathology

Thoracic Surgery Dermatology Psychiatry Ophthalmology Radiology

Thoracic Surgery Internal Medicine Neurology Cardiology Urology

Source: Data adapted from: McCaulley, M.H. The Myers Longitudinal Medical Study (Monograph II).Gainesville, Fla: Center for Applications of Psychological Type; 1977. Adapted from: Personality Type and Medical Specialty (Excerpt from” The ultimate guide to choosing a medical specialty”) By Brian Freeman, MD Resident in Anesthesiology and Critical Care, University of Chicago Hospitals Chicago, Illinois.

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INTRODUCTION The first consultation with a client is the beginning of a doctor-client relationship. It is thus of major importance to conduct this in a correct and proper way. [1] Effective doctor-client communication is a central clinical function in building a therapeutic doctor-client relationship, which is the heart and art of medicine and is important in the delivery of high-quality health care. [2] Much client dissatisfaction and many complaints are due to breakdown in the doctor-client relationship. [2] Despite disputes in literature on the tension between evidence-based medicine and client-centered medicine, clients' views on what constitutes high quality of doctor-client communication are seldom an explicit topic for research. [3] Clinicians, educators, researchers, and policy advocates generally agree that a more active and autonomous role for clients in the doctor-client relationship is necessary to address health care needs. [4]

To identify clients' priorities in a doctor-client relationship of clients attending out-patient clinic at Randle General Hospital.  To assess clients' satisfaction of their doctor-client relationship in clients attending out-patient clinic at Randle General Hospital.  To identify factors affecting a doctor-client relationship in clients attending out-patient clinic at Randle General Hospital.

MATERIALS AND METHODS The study location used for this research was Randle General Hospital, Surulere, Lagos. TYPE OF STUDY This was a descriptive cross-sectional study.

GENERAL OBJECTIVE  To assess clients' perception of a doctor-client relationship.

STUDY POPULATION Study population was clients attending out-patient clinics at Randle General Hospital and would include: General Out-patient clinic, Ante-natal clinic, Paediatrics clinic and Dental clinic.

SPECIFIC OBJECTIVES  To assess clients' attitude toward doctor-client relationship in clients attending out-patient clinic at Randle General Hospital.

SAMPLING TECHNIQUE Multi-stage sampling technique was used.  Step 1: All clinics assessing out-patients were AMSUL Digest 2014

chosen.  Step 2: A proportionate fraction of clients were selected in each clinic using the clinic's daily average attendance in proportion to the total sample size.  Step 3: Clients in each clinic were sampled using the simple random sampling technique. 

SAMPLING SIZE DETERMINATION The formula used in calculating the sample size was: n = (z2pq)/ d2 A sample size of 273 was gotten which was shared amongst the clinics according to the fraction of clients attending their clinic. DATA COLLECTION Data was collected by means of self-administered questionnaires. The questionnaire was made up of 4 sections: Socio-demographics, Clients' attitude, Clients' priorities and Clients' satisfaction. The questionnaire was adapted from a study done at Ife and analysed using Epi info software versions 3.5.1 and 7 and Microsoft Office Excel spreadsheet. [5]

Fig 1: A graph showing Clients' Attitude About half of the clients 151 (58.5%) felt in control of their management, 164 (63.6%) clients would like to be in control of their management. Majority of clients felt their doctor helped them take control of their management 248 (92.2%) and they 249 (92.2%) have a good partnership with their doctor.

ETHICAL CONSIDERATION Ethical consideration was sought from the Lagos University Teaching Hospital 's (LUTH) Ethical Committee Body. Permission and consent were got from the Medical Director of Randle General Hospital. Permission and verbal consent were also taken from each client before they were given the questionnaires to fill. Fig 2: Graph showing Clients' Priorities RESULTS Majority of the respondents were between the ages of 20-39 (68.5%), the lowest age being 1 and the highest being 77. The mean age was 26.6 ±14.1years. There were more female respondents, 209 (76.3%) than male respondents, 65 (23.7%), more Yoruba respondents, 153 (55.8%) than other tribes. Most respondents were Christians, 205 (74.8%) and married, 213 (78%). Majority had a tertiary education, 188 (70.9%) and about two-thirds earned less than 50,000 naira monthly.

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Respect 239 (89.7%), Consent 212 (82.8%), Shared responsibility of care 221 (84.4%), Reassurance/Support 229 (88.4%), Good prescription 248 (93.9%) were of high priority to the clients. Clients prioritized Doctor's listening skills 234 (88.7%), Doctor being polite 239 (90.0%), Doctor being friendly 241 (90.1%) over Having the same mother tongue as the doctor 112 (43.2%) and Seeing the same doctor at every visit 123 (47.0%). Association between clients who like to ask a lot of questions about their illness and the doctor giving all information about illness the client expected was

significant at p < 0.0001. There was positive association between clients' attitude and overall satisfaction with encounter with the doctor in the doctor-client relationship (Fisher exact of 0.0496). Clients who already feel in control of the management/care of illness, doctor helping clients take control of their management and clients having good partnership with doctor are positively associated with scale of satisfaction (Fisher exact of 0.0321, 0.0012 and 0.0005 respectively). There was however no statistical significance in the association between clients who would like to be in control of the management of their illness/care and scale of satisfaction (Fisher exact of 0.1309).

Fig 3: Other factors affecting clients' satisfaction Association between client understanding illness better after seeing doctor, client who felt they had enough time with the doctor and client's trust in doctor and overall grading of client satisfaction were statistically significant at p= 0.0007, p= 0.0026 and p<<0.0001 respectively.

Nearly all the clients 266 (97.08%) were satisfied with their doctor-client relationship asides 8 (2.92%) clients. CONCLUSION Clients in this study generally had a positive attitude 95.26% towards the doctor-client relationship. The study also proved that clients' attitude towards the relationship influenced clients' satisfaction. Clients' priorities in this study included: -Doctor's listening skills 234 (88.7%) -Doctor being polite 239 (90.0%) -Doctor being friendly 241 (90.1%) -Respect 239 (89.7%) -Consent 212 (82.8%) -Shared responsibility of care 221 (84.4%) -Reassurance/Support 229 (88.4%) -Good prescription 248 (93.9%) Clients at Randle General Hospital were majorly satisfied with their relationship with their doctor having a percentage as high as 97.08%. Factors that were shown to affect a doctor-client relationship include clients' attitude, priorities and satisfaction (trust, consultation time, clients' understanding of the illness after consultation). REFERENCES 1) Terpstra O T. On doctor-client relationship and feedback interventions. Perspect Med Educ. 2012; 1(4): 159â&#x20AC;&#x201C;161. 2) Ha J F, Longnecker N. Doctor-Client Communication: A Review. Ochsner J. 2010; 10(1): 38â&#x20AC;&#x201C;43. 3) Butalid L, Verhaak P F M, Boeije H R, Bensing J M. Clients' views on changes in doctor-client communication between 1982 and 2001: a mixedmethods study. BMC FamPract.2012; 13: 80. 4) Peck B M. Age-Related Differences in Doctor-Client Interaction and Client Satisfaction. CurrGerontolGeriatr Res. 2011 (2011), Article ID 137492, 10 pages. 5) Kuteyi A E A, Bello I S, Olaleye T M, Ayeni I O, Amedi M I. Determinants of patient satisfaction with physician interaction: a cross-sectional survey at the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria. SA Fam Pract. 2010; 52(6):557-562.

Fig 4: Pie chart showing Clients' satisfaction AMSUL Digest 2014

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egin by ironing a black skirt, place three chiffon blouses before you, ask your roommates' advice, two would pick the flower-patterned one and the last the blue. Take a look at the blue colored blouse and at your very stylish pretty roommate, doesn't she sometimes remind you of 'The Crush'. His shirt, his tie, his trousers and the way they are so nicely cut; laugh or should I say giggle, lest your roommates think you crazy. The reason you want to giggle is you have just remembered the day you stared at him long and hard, the day he maybe had noticed you for your AMSUL Digest 2014

long stares, the day he wore what you call the grey and black themed outfit â&#x20AC;&#x201C; black shirt, grey pants, black tie, grey socks, black shoes. You have sometimes wondered if maybe you were staring because you wanted to recreate the look with a grey necktie, but you know it is because you think you are in love. You have a long day ahead, so you should decide to go with stylish roommate, so you iron the blue blouse, checking repeatedly to ensure the iron is not too hot and would not burn your blouse. Take out the flexi rods from the 100% human hair you had bought at the wholesale shop along Akoka

road, apply your face powder, gently run the eyeliner and draw your eyebrows, look in the mirror and tell yourself the eyebrow was not properly done, try to make it better and finish with that Cherry Red Lipstick you have gotten to reward yourself for a job well done in your professional examination. Pick your new Black leather wristwatch, tell yourself you need to get a brown and later a blue wristwatch, the time is 7:15 am, Pick your brown messenger bag, put in your Morbid Anatomy notebook and your Pharmacology too; hurriedly eat the 'fresh bread' and sardine and gulp water down your

“It all started with how he shocked you with a very impressive attendance at classes, how he never seemed to miss a day, and the only day he wasn't in class, you had found out it was because he had a terrible fever and was vomiting“ throat. The time at this point is 7:45am, you don't want to be locked out of class, so put in your earpiece, place your songs on shuffle while your phone picks 'I Choose You' to start the walk to class, throw in a gum to chew for fresh breath and say in a loud voice “have a nice day people”. Get to class to find him sitting with an empty seat beside him, this doesn't usually happen so say to yourself “My lucky day!” walk up to him and ask “anybody here?”, he will shake his head and then in a happy state you would sit down on his left, your body seeming to appreciate the empty space beside your crush for the past one year. It all started with how he shocked you with a very impressive attendance at classes, how he never

seemed to miss a day, and the only day he wasn't in class, you had found out it was because he had a terrible fever and was vomiting. How he had friends, so many even, a lot of them in the female gender, maybe because of his good looks, his straight shoulders, his handsome side profile, and yet how he knew how to draw the line between play and serious. You watched him read in class

everyday of the year and how it had seemed like he went through the Professional examination effortlessly, he sometimes reminds you of your Secondary School Chemistry teacher's favorite quote “Make Hay while the Sun shines”. Just before the class begins, she comes and sits beside him on his right and you then would realize that she too was having a lucky day. You would think to yourself “the AMSUL Digest 2014

thief was on the Left of the Savior” or how those on the right of the Savior will supposedly be allowed into Heaven at judgment and you ask yourself if really it is your lucky day. So while you tell yourself that you have to come off smarter, stronger, more attractive, so you watch him closely and tell yourself to say “I like your socks” but then you think not to, asking yourself if you would come off as shallow or too jumpy, then she says “I really like your socks, very unique!” He smiles and replies “Thank you”. And like you are losing out on this conversation you tell yourself to come up with something better, should I say “I don't see boys in school wear this”, but then you know it is a lie, you have seen Femi, Ibrahim and Kelechi on something similar. Her loud squirrel like voice disturbs your thinking with “I don't see boys in school wear this, this is a first” He looks at her and then says “Actually we are a lot, I ordered same with a few of my friends” And without thinking lest Miss. Rival steal your line, she must be some kind of dark mind reader; you say “Happy Socks right?” “What is that?” she says laughing out loud, “Of course the socks are cool but using happy, geez girl!” He smiles at her and says “Actually she is right, ordered them off Happy Socks, they've got some real cool stuff.” You start to do a summersault in your head but Mr. Morbid man with a pot belly comes in and stops your happy moment, you wish you had more minutes to say some more AMSUL Digest 2014

stuff, you force yourself to listen and take notes in class, after all you must come off as a Smart girl, strong and attractive. It is hard to concentrate in class, you keep looking at his book, while he takes notes, he seems to be understanding the class and just as Mr. Morbid man with the pot belly is done, you turn to ask him what exactly Amylodoisis is about, as you really do not understand. He smiles and starts to explain, you should remind yourself about the lesson you learnt from the movie “Think Like a Man”, and you try to pay attention to what he says so you can contribute smart, rather than look at his gorgeous face. He explains very nicely and ask you questions to ensure you got it all. And while he is done he stands to leave with his friend who is really dark, you hope that by some miracle you could continue where you stopped, maybe after the next class, only for the Class rep, to come ruin your moments with the announcement that the next class had been cancelled, so you ask yourself if you should stay back and pretend to read. But the pressed feeling that just came on, telling you 'go to your hostel' is a better option. You do not notice when he comes up beside you as you walk to the hostel, “So how do you know about Happy Socks”, and then somehow you feel relax even though you are hoping your bladder do not feel the same and leak urine, “Hello! Meet me the Internet Surfing addict!”, you say with a huge smile on your face. It is usually the first time they

notice you, and then the next thing is a walk in school at night, you would think it is a whole new scenery, you want to do it over and over again, explore new areas and maybe one day go out on a daydate. He would smile at you in class and sometimes text you saying 'your blue blouse is pretty' or 'the flowerpatterned blouse makes you look younger' or how he admires your problem solving skills. Then he would get on one knee one night just at the corner of the long road and ask “Would you be my girlfriend?” Laughing out loud, and covering your face repeatedly, trying to say “yes” yet acting all calm, you would know that indeed you Have fallen in love with a Medical Student. And then that one night you would sit in bed and wonder how it all happened, first your patience, then your good taste that you would not settle for less, that you wanted the best of them all, the Medical student that was more. This morning, yet again you pick out a black skirt and three blouses and you are asking yourself how you ever wondered how those doctors married a doctor, and then it just might have been that they knew just How to Fall in Love with a Medical Student.

JOMICH FIT Phone no: Twitter: Email:

08183117677 @jomich_fit

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Will You Practice Medicine In Nigeria Upon Graduation? Why?

AMSUL Twitter conversations. WILL YOU PRACTICE MEDICINE IN NIGERIA UPON GRADUATION? WHY? 5pm-8pm Sept 19th & 20th.

Good evening twittersphere. So much for #AMSULspeaks right? This is (y)our moment. Vox populi...vox dei.

@AMSUL_UNILAG I'm definitely practicing in Nigeria. I've never seen myself anywhere else. #AMSULspeaks

4 dose of us dat can easily run, pls let us do so, nd 4 dose of dat can't easily run, pls lets hustle so dat we can easily run. #AMSULSpeaks

From what I know, health insurance is gaining momentum. We need health information. And then a better economy. #AMSULSpeaks

If u really wanna appreciate medicine as a profession, u need to leave dis country. Where LUTH cant provide enough beds #AMSULSpeaks

At least when all the doctors leave, all the nurses are willing and ready to do their jobs. #AMSULSpeaks

The problem wit the health sector is a complication of the national problems. This sector can't solely be transformed. #AMSULSpeaks

The grass is greener where you water it. #AMSULspeaks Lool. Goan fetch "@kudoMD: No water in LUTH, literally. "@D_CHYKE:The grass is greener where you water it.#AMSULspeaks

Naija gives you almost free medical education and you go use it for the US or UK. I think that's unfair. #AMSULspeaks U don't av to practice abroad to b successful. @AlikoDangote amongst others proved that Greener pasture is not a location #AMSULspeaks

AMSUL Digest 2014

I call it idiocy if you have the means to leave “@RickyBlaise: #AMSULspeaks ..for y'all dat plan 2 stay here..I admire your patriotism.”

@AMSUL_UNILAG My heart goes out to those bold enough to stay. God be with you! As for me... #AMSULspeaks @AMSUL_UNILAG Some people already have their parent's hospitals to take over when they're done...forming #AMSULspeaks The odds say..NO!"@crazzzyninjaa: Is Nigeria that system? cc @AMSUL_UNILAG "@kudoMD: ! "@sayrusty: Go where the system works #AMSULspeaks""

Regardless of how luxurious any pay package might be, it's perceived that it hardly equals the overall output of a physician. #AMSULspeaks

@AMSUL_UNILAG africa needs her own to help build a stable and healthy continent.

@AMSUL_UNILAG the recent ebola crisis shows how much we can achieve if we stay back and work as a team"

"Brain drain. Go away. Come again in your latter days. After mediocres have ruined the system." #AMSULspeaks

Government woke up one morning and sacked doctors like Christmas turkey waiting to be that not enough cue? #AMSULspeaks

@Tohsean @AMSUL_UNILAG @akenny_O if we all stay, will things change? U think the problem is us leaving?

We should however bear in mind that the health system may be better off if we all stayed. #AMSULSpeaks

Exactly, the way the health sector is right now, all of us leaving is just a recipe for disaster waiting to happen. #AMSULspeaks

@BeautifulFeet_ #AMSULspeaks...the backup gen to a prominent medical school is down and u expect its graduates to be passionate about it

@akenny_O I keep believing that I'm a Nigerian for a reason. That reason is to make change and that I will. #AMSULspeaks

Medicine has lost its prestige in Nigeria, so why practice medicine here #amsulspeaks"

AMSUL Digest 2014



he strong relationship between physical activity and health has become so important and apparent, that it is almost impossible to talk about one without mentioning the other. Sportsmen and athletes, professionals or amateurs, need to be at optimal physical conditions in order to deliver optimum performances. However, physical fitness and the prevention and treatment of injuries are, to a large extent, the responsibilities of practitioners of sports medicine. Sports medicine, hence, is a multidisciplinary sub-speciality of medicine which deals with health promotion for the general population, by stimulating a physically active lifestyle and diagnosis, treatment, prevention and rehabilitation following injuries or illnesses from participation AMSUL Digest 2014




physical activities, exercises and sport at all levels. Being a relatively broad aspect of medicine, sports medicine has various specialization areas. Below are some of the more mainstream specialties: SPORTS PHYSICIAN/SURGEON Sports medicine physicians have specialized training in the field in medicine that deals with sport or exercise-related injuries. Their primary focus is on the diagnosis, treatment and prevention of injuries that occur during sports and other physical activity. Most primary care sports medicine doctors complete a three-year primary medicine residency after medical school. Many then choose a fellowship in sports medicine for specialized training. An orthopedic surgery residency leads to a career as an orthopedic surgeon, many of whom

- Bababunmi Mayowa, 500L MBBS

treat athletes. PHYSICAL THERAPIST Physical therapists, PTs, help injured or ill people improve their movement and manage their pain. They treat a variety of injuries but many specialize in the care and treatment of sports injuries. Those who focus on sports medicine and orthopedics work with both recreational and professional athletes. Physical Therapists are in demand and will be for some time. These therapists are often an important part of rehabilitation and treatment of patients with chronic conditions or injuries. PTs usually have a four-year degree, but many schools now offer an entry-level Master of Physical Therapy option. SPORTS PSYCHOLOGIST Sports psychology is a growing

Dr. Eva Carneiro

M.Sc Sports Medicine Team Doctor Chelsea F.C.

profession and many athletes seek the services of psychologists, trainers and coaches who can help them with the mental aspects of sports training. Elite athletes, professionals and Olympians all have tremendous physical skills. However, research has shown that at these levels, mental training skills (focus, relaxation, goal-setting and reducing anxiety) are critical in separating the winner from the first runner-up. More recently, recreational athletes have come to discover that the mental training benefits them as well. Motivation, concentration and focus are helpful for anyone wanting to achieve a goal, whether it is sports related or not. A psychologist is an

individual who has completed graduate training in the field of psychology and is licensed by a specific state. In some countries, individuals with a Master's Degree can become licensed psychologists while in other countries, a Doctorate Degree is required. A sport psychologist is a psychologist with expertise in pearformance enhancement through the use of psychological skills training, issues that are specific to the psychological well-being of athletes, working with the organizations and systems that are present in sport settings and social and developmental factors that influence sport participation

competitive and recreational athletes, onsite and during travel. Primary responsibilities include counseling individuals and groups on daily nutrition for performance and health;translating the latest scientific evidence into practical sports nutrition recommendations; tracking and documenting outcomes of nutrition services, serving as a food and nutrition resource for coaches, trainers, and parents; providing sports nutrition education for health/wellness programs, athletic teams, and community groups; and maintaining professional competency and skills required for professional practice.



NUTRITIONIST Dietitians and nutritionists are experts in food and nutrition. They advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal. Sports dietitians and nutritionists counsel patients on nutrition issues in relation to athletic performance. The Sports dietitian provides individual and group/team nutrition counseling and education to enhance the performance of

TRAINER (CAT) The Certified Athletic Trainer is a highly educated and skilled professional specializing in athletic health care. In cooperation with physicians and other allied health personnel, the athletic trainer functions as an integral member of the athletic health care team in secondary schools, colleges and universities, sports medicine clinics, professional sports programs and other

athletic health care settings. Athletic trainers specialize in preventing, diagnosing, and treating muscle and bone injuries and illnesses. Certified athletic trainers have, at minimum, a Bachelor's Degree, usually in athletic training, health, physical education or exercise science. In addition, athletic trainers study human anatomy, human physiology, biomechanics, exercise physiology, athletic training, nutrition and psychology/counseling. Certified athletic trainers also participate in extensive clinical affiliations with athletic teams under appropriate supervision. Many athletic trainers work in educational settings, such as colleges or universities. Others work in physicians' offices or for professional sports teams.

HIGHEST PAID Median pay (as of 2012 according to US beaureau of Labor statistics)

Sports Physician/Surgeon: $187,200 per year Physical Therapist: $79,860 per year Sports Psychologist: $69,280 per year Sports Dietitian: $55,240 per year Certified Athletic Trainer: $42,690 per year

AMSUL Digest 2014




by Cassandra Ikegbune -

2. GO RETRO Vintage is still definitely all the rave! Especially the print shirts. They're different, striking, comfortable, and is a sure way to add life to any outfit! But make sure to tone it down by not wearing a loud skirt or pant.

3. MIX IT UP! You start with one print, layer on another and another depending on how brave you are. Although I must admit that Its a bit tricky, you might miss it and end up looking like a walking clash on prints. Uhh, not a pretty sight I tell you. I'll give you a cheat tip here, start with stripes or polka dots, they always make a good blank sheet.

Although these are guaranteed to make you look stylish and of course stand out, be warned that it might also attract a bit of unwanted attention. Unwanted if you're like me who tries to avoid being quizzed in front of AMSUL Digest 2014

Photo Credit:

Photo Credit:

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1. ALL TIED UP Because who says ties are only for boys huh? and I never heard there's a rule against girls wearing ties to school. I once rocked a bow tie to clinic and my senior registrar gave me thumbs up.


hiffon shirt, Midi/mini skirt and flats? Medical student, Yes we know but that doesn't really have to be you, not all the time anyways. We all know the medical school dress code can be a bit strict/rigid but good news is you don't have to wear the same plain ol' 'med student' uniform and the key is in spicing up your 'corporate' outfit. I'll be sharing three ways to still stay stylish, and look unique while not breaking any of the med school dress code rules. Let's Dig in

Photo Credit:



everyone in a ward round so Yes! you also have to be able to move stuff so you don't appear bright on the outside but stony dull on percussion!!!






hey come in different shapes and sizes, different patterns, and different colours and designs. They could be outrageously long or moderately short, very fat, or cutely slim. Their colours are even more variable, they could be simply coloured, perfectly suiting a cool calm and collected setting or personality. On the other hand, they could be very richly coloured and wild, making all things bright and beautiful. Variety, that's where their beauty lies; the vintage ties. The new cool from the old school. Part of their beauty also lies in the fact that they are hardly selective. A patterned tie will go with a colour present in the pattern, no matter how insignificant the colour is in the pattern. This means that they can go with almost any colour since a patterned tie usually has almost every colour. And yes, a patterned or stripped tie can go with a patterned or stripped shirt. Just make sure you know how to do colour maths. The rule is making sure it looks pleasing to the eye. However, too many patterns or patterns of the same size would make you a clown! It is a common trend, especially in female fashion, for something from the old school to return as cool. The afros, Ray Ban Shades, jump trousers, etc are all examples. The vintage ties have a very popular notoriety for always making comebacks. Since they first appeared in the 19th century, they've been known to come and go like the Abiku of Yoruba folklore. Initially, when these ties started making the rounds, they were greeted with much resentment probably because of their size and eye-confusing colours. They were considered too old school. I'm sure even you wondered then what was attractive about the same ties your ancestors wore. But with the appearance of more and more designs, and more people wearing them, their popularity soared, and people have come to appreciate the beauty that they are. Today, if you wear a tie in CMUL, and it's not Vintage, you're old school and definitely not cool. AMSUL Digest 2014

LETâ&#x20AC;&#x2122;S HAVE SOME



A pun is a joke exploiting the different possible meanings of a word or the fact that

I didn't have the faintest idea as to why I passed out.

I once had insomnia so bad I was awake until it dawned on me.

Organ donors put their heart into it.

Break a bone today and you will feel hurt to marrow.

there are words that sound alike but have different meanings Did you hear about the guy whose whole left side was cut off? He's all right now. There was a sign on the lawn at a drug rehab center that said 'Keep off the Grass'.

The painter was hospitalized due to too many strokes. After having a knee dislocated and an elbow fractured in two bathrom brawls, Bradley should have learned to stay away from those joints.

The patient decided against an organ transplant. Instead, he changed his mind. He was wheeled into the operating room, and then had a change of heart.

I was going to buy a book on phobias, but I was afraid it wouldn't help me.

My friend had amnesia and couldn't remember how to walk up the stairs, so I had to go back and teach him step by step.

I once heard a joke about amnesia but I forgot how it goes.

Being crushed by large objects can be very depressing.

I always believed my body was a prison for me. I was right, in biology I learnt they were made of cells.

I was arrested after my therapist suggested I take something for my kleptomania.

I had some back trouble, but it's all behind me now.

Never lie to an x-ray technician. They can see right through you.

I probably have blind spots, but I don't see them. An unusual medical book is one which has no appendix.

I have a fear of needles. They really get under my skin. Deafness is getting to be quite a problem for me lately. I never thought I'd hear myself say that.

People have many misconceptions about pregnancy.

Next time your doctor is examining you, listen attentively, he might just be cracking a punny joke. Medical practitioners aren't boring after all.

AMSUL Digest 2014
















































NAICOM/CA/AD/2009/872 NAICOM/CA/AD/2009/872

Breaking The Silence