Physician Outlook

Global Health from Nigeria to Singapore - Having a knack for challenges


After studying medicine in France (Paris VI and Paris XII Universities), Brazil (Federal University of Rio de Janeiro), and the United States (The George Washington University), being an Assistant Professor in Tropical Diseases and Public Health at Paris VI University, Dr. Meunier practiced medicine as a private general practitioner in Lagos, Nigeria at a branch of the St Francis hospital (only European in this position) for one year and opened the first and only private practice on the island of Lifou, New Caledonia, for about 10,000 people for two years, then he worked, as a private general practitioner, at Gleneagles hospital and AsiaMedic in Singapore (only European in this position) for four years*.

The adjustment in New Caledonia was relatively easy, except for a typhoon, a dengue fever epidemic, and sometimes risky diving at night to capture sleeping lobsters. It was more difficult in Lagos during the rainy season with the ensuing flooded streets and avenues and monstrous traffic jams. In Singapore, the yearlong high level of humidity took some time to get used to. The smog coming from burning forests in Indonesia was a nuisance at one point. Fortunately, it lasted only a few days. The cultural shock was paradoxically greater in the city-state than elsewhere. There, the vast majority of my patients were French people whereas in Nigeria, they were locals in about 50% of the time (mainly Yorubas, Ibos, and Hausas) as well as in Lifou (about 90% Melanesians). I explain this apparent incongruence by various factors: 

- In an easy lifestyle the more negative aspects of human nature (gossip, jealousy, egocentrism, materialism, for example), tend to emerge. On the other hand, tougher milieus are more prone to stimulate more positive dimensions such as sincerity, solidarity, respect for others, and the search for meaningful entertainment to compensate for various hardships. 

- Opinion leaders and pillars of local communities exemplify certain types of behavior and are role models for predominant values 

- The unstoppable progression of consumerism in which the physician is a service provider more or less appreciated 

- The degradation of the doctor’s image, which is even worse now than it has been accelerated by COVID-19 

Patients’ Support 

The situation in Lifou was clear and simple: I was often the first and last medical resource on the island and my diagnosis was based only on anamnesis and clinical exam. It was humanly fascinating. 

By contrast in Singapore, in my setting MRI, Cat Scan, echography, blood tests etc., were readily available and at once. It was technically and scientifically fascinating. 

My relationship with specialists evolved. In Singapore sending a patient to a referee often meant losing him/her. It changed when I was granted admission privileges. 

One of the major gratifications proved to be the constant patient support. Sometimes, it came from surprising sources like the man who told me once in Lifou “We know that it’s the power you put in the pills you give that cures us”.  My conclusion was that the placebo effect had catalyzed the bactericidal or bacteriostatic action of the antibiotics! 

Depending on bureaucracy, getting paid was a nightmare for me in New Caledonia. In Nigeria, despite the absence of IT and computers, I had no such constraints at all. Ditto in Singapore except for legal obligations required by some embassies. 

The financial aspect was another very positive side of my experiences knowing that in Nigeria and Singapore doctors are free to set their own standards. The volume of patients also plays a role and in Lifou, I saw up to 72 patients in one day during the flu season. 

Striking Cases 

On the medical level, I dealt with some rare cases, like during the dengue fever epidemic or patients with ciguatera, pustulosis palmaris et plantaris or different presentations of scabies in children in New Caledonia; during the peaks of malaria in the rainy season and viral conjunctivitis (they called Apollo because the first wave occurred during the Apollo mission landing a man on the moon) in the dry season in Nigeria; SRAS in 2003 and the consequences of the Southeast Asia tsunami in 2004 in Singapore. 

Striking cases were quite a few. In Nigeria the ambassador with a lingering typhoid fever, which has not been previously diagnosed, the businessman stabbed three times in the thorax, in broad daylight when he was exiting his bank and came directly to my office with a partially severed right subclavian artery; the child who came out of a coma after I.V. quinine administration (this established my reputation!); In Lifou, the child I was seeing for the first time, who had a seizure on the table while I was examining him and died in a few seconds and the sadness of his funeral the following days. My neighbor who lived in a hut where I was making daily calls to inject him with morphine at the very last stage of his liver cancer. He died when I was on a break in Vanuatu. In the last couple of days, he had asked me if he could have a cold beer, which I granted promptly to the amazement of his surrounding family. In Singapore, the frequency and intensity of psychiatric and psychological disturbances, mostly among women. My clinical reports were published in Medical Progress on Hepatitis E as well as on  Restless Legs Syndrome and in The Singapore Medical Journal on CMV.            

Conclusion 

My pioneer adventures in New Caledonia and Singapore as well as my practice in Nigeria as a private general practitioner are etched in my memory as extreme emotional chapters ranging from acute stress to intense elation. They have at least two common points: A knack for challenges and a hatred for routine. 

*Later on I became the Director for International Corporate Affairs and Business Development for Stanford Hospital and Clinics. 

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