By Sila Ogidi
What day is it?
And the month?
What about the year? What year is it?
That is one of many simple mental status tests Dr. Onyeka Okonkwo, a 31-year-old Nigerian, performs on patients such as the 82-year-old man she attended to on her rounds yesterday at Jefferson University Hospital in Philadelphia.
Right before her rounds she arrives at 8:30 a.m., late to her regular morning debriefing from the overnight staff. She stands out in the crowd of white laboratory coats and blue scrubs in her green and white color-block dress and smart blazer. Her pager is attached to her left boot and her legs are shifting –she is restless and eager to begin the day.
Four months is a short time to have many of the managerial responsibilities Dr. Okonkwo has at the teaching hospital. In addition to seeing patients, she manages the daily routines of the staff, organizes the curriculum for residents, coordinates faculty research and is currently in the process of recruiting new members of staff. She doesn’t hate it, but it is different. She is comfortable getting to work using taxicabs, trains and buses- means of transportation that a middle class family living in Nigeria rarely use.
In a tiny, tucked away bar and restaurant near the Philadelphia Museum of Art Okonkwo orders an amaretto sour and begins to casually stroll through memory lane and how she came to find herself in this city 10 miles away from her previous home and 7,000 miles away from the country of her birth. Life happens differently in Philadelphia. Then again, few things can be said to have any similarity to living and working in New York City.
Working in New York City as a faculty member at New York University and a doctor in the Veterans Affairs Hospital, she prided herself on having become accustomed to the cramped spaces and fast-paced life that only a place such as New York City can offer.
Between the fancy restaurants and the $1,000-a-month apartments for rent, Okonkwo had no problems fitting in and even carrying on a long distance relationship with current husband, Francis Chiejine who lived in Philadelphia. Before NYU, Okonkwo had been a student at Columbia Medical School after her graduation from Howard University in Washington D.C. in 2003.
“I was so angry that the first year of medical school was pass/fail,” said Okonkwo “I really wanted to show how smart I was.” That was a statement she came to regret very quickly into her first year. It amazed her to see all the other people who graduated from their various institutions and considered themselves to be the best. She often recalls one of her peers whom she described to “simply roll out of bed and know everything.” It was people like that who showed her just how success happens differently, as she struggled countless nights to read and memorize medical books and concepts.
“I’m so surprised you’re a doctor,” she recalled her mother saying “I always thought you would end up a journalist or something.
At a co-ed college
Being biology major and classical studies minor at Howard meant that medical school was really all Okonkwo saw as the end goal after college. One of her greatest regrets in college was not knowing that she could major in anything and still go to medical school. However, if she didn’t study biology she wouldn’t have spent many days in the computer lab and in turn she wouldn’t have met her college boyfriend — a strapping young Nigerian, Uche Nwamara who was a combined classical studies and history major. It didn’t necessarily help that her older brother also attended Howard at that time and lived in the same dorm as her and her boyfriend.
“Where were you last night?” her brother yelled, “I came looking for you at 1a.m.!”
It never occurred to Okonkwo that leaving her room to watch movies till they fell asleep in her boyfriend’s room could look suspicious to an older brother who still thought his sister innocent. The reality was that she was indeed innocent.
“Our awkwardness brought us together,” admitted Okonkwo because attending Howard University alongside her older brother was the first of many things in her life.
When she was four years old her parents talked of traveling to England for a short holiday and since nobody told her otherwise, Okonkwo assumed she was going with them. She played hide-and-seek with her three brothers and one sister while making mental notes of all the things she needed to get ready for the trip. Okonkwo had never been outside of Lagos state in Nigeria before, aside from the bi-annual trips to her local village in Delta state located in the south east of the country and only an eight-hour drive from home. She was excited and thrilled at the chance to experience something new. Alas, with nowhere left to hide during her game, she found herself hiding behind a curtain, which got stepped on a little too hard. The iron rod supporting the curtain crashed down on her small frame and immediately medical attention was needed.
Moments later the situation is calm and her mother comes into the room to inform her of a change in plans.
“Now that you are hurt you can’t travel with us anymore.”
No one told Okonkwo she was never going on that trip to begin with.
She eventually moved on to the Federal Government Girls College in Benin which was a school deemed worthy only for students who excelled in their Common Entrance exam –a standardized test in Nigeria for primary school students to enter secondary school. Having passed her Common Entrance exam with flying colors, Okonkwo was afforded the luxury of attending a government boarding school in Benin state, which then was believed to be better than any private institution.
A boarding school at 9
In other parts of the world it sounds like a horrific thing to send a child to boarding school at the age of nine. In Nigeria, however, such a practice is common in the hopes of teaching the children independence at a young age. Her time went from horrible to glorious in a span of six years. She started out being teased and hazed by seniors to eventually taking on the role herself and eventually making lifelong friends with the girls there. It was her first time away from home and was about to be the stepping-stone to a much bigger plan fate had in store for her.
Okonkwo graduated in 1998 at the top of her class and with her brother already attending Howard University, she knew what school she was applying to in the United States.
She did not, however, head to America right away. Instead, her parents insisted she stay home and re-take WAEC, West African Examination Council, which Nigerians refer to as the national exam to finish high school, which is the equivalent of SATs here. She was not worried because she had no need to take the exam, her parents just wanted to keep her occupied before she went out of Nigeria for the first time in her life in 1999.
The United States brought for Okonkwo a whole host of new experiences that she never imagined. Unlike her siblings who are loud and outspoken and unafraid of making mistakes, Okonkwo approaches life strategically and meticulously. Her earliest memory of being in the United States was a trip to McDonalds. Prior to going to the fast food restaurant, she looked up the prices online and got the exact change for the item she planned to order. Everything is going well until she gets there and realized that people get taxed.
“That’ll be $1.69, please.”
-Excuse me? I’ll get something from the dollar menu then!
That was the first and last time she made that mistake. She blended into the environment so well that moving from a single-sex high school to a co-ed college where living with boys in the same buildings meant showering in the same bathroom and living in the same dorm as your boyfriend and brother.
Having been here for 15 years and counting, she has struck a delicate balance between earning respect as an African in the workplace and in her social life. At work, few African coworkers who make an effort to socialize for the simple fact that they are all African surround her. She often struggles to socialize for fear that she might come off as a snob and at the same time maintain a professional stance as a superior in her workplace.
“I am proud of you,” said an African-American patient she had the pleasure of taking on at the hospital. She couldn’t tell if it was because she was black or because she was African or both. She didn’t even know whether or not he knew where she was from, but whatever she was, it mattered to him.
She sat in the restaurant and thought about her future with Francis and the new house they bought and plan to move into before the end of the year. Marriage means family and family means having a stable home. For Okonkwo, that home is in Philadelphia.
“You love Nigeria the way you love a drunken uncle” is often how she views her homeland. While there are many reasons to love Nigeria as she admits that you will never meet anyone like a Nigerian, she is saddened at the fact that her choice to live here means she won’t have her children grow up around their relatives, she recognizes that Nigeria has nothing to offer her professionally. Nigeria can be a place where money is to be made in the world of medicine, but Okonkwo fears that her skills will not be put to good use in the country.
At home in Lagos
In the summer of 2003, Okonkwo worked at the General Hospital in Lagos and saw the two worlds that operate parallel to one another in Nigeria. The one she grew up in was filled with private hospitals and doctor-centered service where the service you received was based on what the doctor decided was best and not necessarily what was best for you. She recalled in the government hospital seeing women with their children suffering from jaundice fight for the one lamp in the room to put their children under when the electricity came on because no generators are available during power outages that happen multiple times on a daily basis.
“Hospitals here are focused on patients and patient-centered care,” she argues “In Nigeria it’s all about the doctor who is in charge.”
Back in her office tucked away in a corner on the 7th floor is her password-protected office with nothing more than an L-shaped desk and a tiny closet for coats just for her and fellow Doctor Satya. In the room the two computers flash signs as reminders for the values and standards Jefferson University Hospital because hospitals are a business and it’s all about writing those notes as detailed as possible so that the insurance companies can pay as much as possible.
She does not speak at the debriefings often and when she does, her voice is low and her words are well thought through and delivered with such precision that no can judge or question her. Yet somehow, her feet still shift under the semi-circular nurses’ desk and her coat and bag are tossed on the side to the next to another one of those flashing computers in the hallway. As red and green light starts going off during the meeting and associated with it is a loud beeping sound. It goes on for about 45 seconds and nobody on the 7th floor of the hospital pays any attention to it.
Okonkwo is eager to get coffee from the nearest Dunkin’ Donuts to begin her long day of candidate reviews and rounds until 7p.m.
It was going to be a long day and she needed to be awake for it after having more fun than she expected the annual holiday party the night before.