From Benin to the USA with Dr. Samuel Nwaobi

Michael Akande
600L Medicine& Surgery
University of Ibadan

Please, can you introduce yourself to us?
I am Dr. Samuel Ogechukwuka Nwaobi. I’m a resident physician here in Georgia, United States of America. I graduated from the University of Benin in 2016 and am now doing a residency in Family Medicine. So that is a short introduction about me. 

Thank you very much for that.

So, what was school like for you at the University of Benin (UniBen)? How was the medical training?
The one thing I would say that the medical training in UniBen, and most Nigerian schools, provides you is perseverance—that’s the word I would use. You have a lot of information thrown at you which you have to master. You have lecturers that help you, but most of the time, you have to learn how to master most of those topics, or systems, on your own. So, it teaches you how to be self-sufficient and a fast learner. It has deficiencies, definitely, but it also builds you up as a person, ready to be a doctor.

That is apart from the fact that it takes your time—because of the numerous strikes, you don’t know when you’re going to graduate. It almost seems like you get two extra years when you sign up for medical school in Nigeria. You’re bound to have at least two strikes every year. So, I think that is a major problem. Apart from that, I’d say it provides you with a platform to be a sponge. A sponge, being that you absorb stuff quite well; it teaches you how to learn and learn very fast.

How would you compare the medical training over there to that of UniBen, in general?
There’s one thing I want to dispel because I hear it a lot. I’m a very honest person—I don’t do the whole political statement or whatever. I think we need to get over that statement we keep making that “In Nigeria, we have the best doctors in the world” or “The stuff we learn in Nigeria, we can take it anywhere in the world”. Let me tell you the truth: we have a whole lot of stuff and no application. Zero. So, you have a lot of knowledge because you’ve crammed a lot of stuff, you’ve learnt a lot on your own, but don’t have the standard of care. I was never a ‘crammer’. I tried to learn stuff, which I did in medical school, but guess what? It’s still a little bit slow. 

You are still slow when you get into another system because you are not used to the available tests. You don’t really know what the standard of care is. These are the little differences. You begin to realise that what they tell you about a lot of those cases you saw in your textbooks—”Oh, this is highfalutin stuff you will never see in your life”—is a lie. They happen every day. The question is, do we stress ourselves enough to find the diagnosis in our community, or we just decide to give them drugs for malaria and typhoid? Because once you can’t diagnose something, it is malaria and typhoid. Malaria – 2+, Typhoid – high titre.

Secondly, when it comes to actually doing stuff with equipment, you know you are not so sharp. Some things like medical records—those are things that kind of slow you down, but as I said, one of the benefits of Nigeria, or our medical schools generally, is that they teach you how to be a sponge. So, you don’t get angry but persevere through the fact that you do not know. You become a sponge, that is, you open your brain—very open, very fast—so you learn a lot in a very short time. And that’s why they say Nigerian doctors are the best. Not because our stuff is greater than another person’s stuff, but because we learn faster and use it better.

You have a Master’s degree in public health right now. Why did you choose to have a master’s in public health and also go for a residency programme?
Oh, I will say it was two-fold. There were a couple of things I saw in the past that kind of changed my perspective of medicine. Clinical medicine is very important. A lot of times in medical school, I was like “stuff is very important”, “how many differentials” and all that. But then, you realise that you can only treat one patient at a time and you see, the world is moving fast. I realised this pretty early. Everybody has different aspirations but for me, being a medical doctor is not just enough.

I guess the coronavirus pandemic has shown that. I wanted the soft skills that would help me in terms of policy implementation, research and preventive health. I wanted an alternative pathway for myself, in which I could merge Medicine and Public Health, and this degree was one of the fastest or one of the best I could get in. It ties into Medicine and, at the same time, is something that 20 years down the line you can consult—you can decide to cut down on your clinical hours and do more consulting for multilateral organisations. It gives you variety, in terms of your career choices, apart from helping the community.

Secondly, it took me a while to make the decision that I wanted to do family medicine. I was one of those people who, in medical school, everybody must have expected that I was going to be maybe a Cardiologist. I love internal medicine. I love family medicine. I love, love them equally. So, public health is something that I felt ties into Family Medicine and Community Health. Family Medicine and Public Health have close ties in terms of trying to keep the population healthy. So, I think that was one reason why.

How did you go about the process of getting a Master’s degree? Where did you run the MPH programme?
I did my MPH at Georgia Southern University in Statesboro, Georgia, but the funny thing is, I wasn’t really into it. You know how you are like “Yeah! I want a public health degree but not like I want to do it now”. Then, I had some time, and I was like “You know what, let me just try”. So, I practised for the GRE for about two months. I applied, wrote the exam and scored well. I applied to a couple of schools—six if I’m not mistaken. I got admission offers from Emory Rollins School of Public Health, Georgia Southern and another school—that’s why sometimes in life you just have to try stuff.

And of course, like every medical person, you grow up hearing about Emory, Johns Hopkins and I was thinking I was going to go to Emory. But lo and behold, I got a scholarship from Georgia Southern, which was more than the scholarship from Emory, and I also got a job offer from them. So I went to school for free. And I think, inasmuch as Emory was a dream school for me, just because I had that welcoming environment, got paid every month and tuition was covered, I decided to go to Georgia Southern, and it was a good experience.

While working for them and also schooling, was it stressful? And how were you able to cope?
Yeah, it was stressful and was more like a graduate assistantship. I was working 20 hours a week, and at the same time, I was schooling full-time. Also, at the same time, I was completing my board exams for USLME. So I wrote my USLME exams while I was doing my master’s.

People laugh at me because I have small eyes. I tell them that that’s the reason I have small eyes. I have strained my eyes so much in the past two years you; but, jokes apart, it was a stressful process. Would I advise someone else to go through the same path I did? Honestly, if you can avoid it, avoid it. The reason I’m saying so is that you need to be super determined and super ready for the stress. A master’s in the US is not like a master’s in Nigeria, no offence, where you go to school for like three or two days. This one is a whole lot of work: you have tests and assignments to complete every week. So, it’s stressful, and if you think you want to combine your exams, you have to really think and ask yourself—Am I disciplined enough to go through this pathway? 

So why did you choose to do it that way? What fueled your decision?
I am someone who likes to take the road less travelled.

I like to go through known routes, but for me, sometimes, the hardest route gives the best rewards. I am not saying I like to stress myself unnecessarily, but one, I wanted to do things on time because things change. Sometimes we treat time like it’s a tool but no, time owns us most of the time, and that is the honest truth. You can’t control time; time is going, irrespective of whether you decide you want to sleep or not. So, I decided I wanted to get done with my board exams as soon as possible. Most people usually wait till after their masters to take the exam, which is fine. That’s why I said it’s all about “Man know thyself”. You know yourself, you must know what works for you. My path may not be your path, so you have to ask yourself: Can I do this? Is this something that I can do? Is this something that sits right with my spirit, or my work ethic? I was hoping I could begin my residency immediately I finished my masters, and I was lucky enough to achieve that.

To backtrack a little bit. When did you graduate, and what did you do between graduation and when you left Nigeria?
So, I graduated in 2016 and was lucky to get housemanship in Warri. I started my internship towards the end of 2016, and after the whole internship, I realised it wasn’t the way I wanted to practice medicine. I was one of those people who never wanted to leave Nigeria. I was really involved in student politics. I was president of my school association, University of Benin Medical Students’ Association (UBEMSA). I was also South-South Chairman of Caucus of Nigerian Medical Students’ Association. But at some point, I wasn’t really happy with what I was doing in the hospital and I wanted something more. Then, I didn’t know what that ‘more’ was going to be. And as I said, I applied for a master’s not because I thought I was going to get it.

So, immediately after my house job, I got started on the process, got my admission and then in 2018, I began my master’s in Public Health in the US. 

After school, you won the Graduate Research Poster Award. You also graduated as a member of the Honour Society and with a perfect CGPA. How did you feel achieving all that? I, for one, felt intimidated.
Yeah. To be honest, I haven’t been more fruitful in my life than in the past 6 – 8 months. I would say grateful because sometimes we take things for granted. I’ll be honest. When I was in medical school, I read to pass exams; like, I would just pass. It makes you lose sight of the struggle.

And this time around, it was a different educational system. Not like I had the greatest social support or all the friends around me or something. I had work; I was doing something different from regular medicine. I was in public health, which is quite different—there are some things that they don’t teach you in medical school—and I was reading for my boards at the same time. So, it was really emotional for me getting all these accolades. I was excited, but most importantly, I was thankful to God. I was thankful for the opportunity because I knew the stress I went through. I was sleeping three, four hours every night because I had to study, go to work, go to my master’s class. So, yeah, I was really excited about the opportunity. Felt good.

Something to add to your life story about how you pushed and came out with something great.

While you were planning to leave Nigeria, did you have any financial difficulties you had to overcome?
Here’s the thing I tell people. If you know you want to travel abroad, you have to make that decision at 400/500 level. The earlier you make the decision, the better. The reason is you have to start thinking about what direction you are going to take. Am I going to the UK? Am I going to the US? When you make that decision, you try to have an idea about the financial outlay. When you have an idea about the financial outlay, you can ask yourself—Is this something that I could see through, or is it something that I need to raise a ton of money for? Because a bunch of us, including myself, we all got scholarships while we were in medical school. I know that I used mine to buy BlackBerry phones at that time—you know, as a fresh boy—or iPhone or whatever and before you know it, there’s a new one out there.

So you have to make sure that you make the decision early and have a financial plan for yourself while you’re going to school. For instance, if you had saved your scholarships, maybe like two or three of them, it takes you a very long way in terms of paying for exams and all that. For me, I found some difficulty, definitely, in the exam process, but the good thing was I had some savings and investments. These are what kind of helped me. 

So, save some money, plan yourself well, and you must know the financial outlay because the worst thing you can do to yourself is to start a journey, then get to a point and realise that you never even carried the tools you needed for the journey, but you are already midway through.

The US is a very expensive pathway. I don’t know if I would have been able to do this if I didn’t get a scholarship and wasn’t getting paid every month. That was how I was able to manage my way through. I know not everyone is going to have that opportunity so I won’t sell you a rosy tale and tell you it’s cheap, but it’s something you can do. It should cost somewhere around 5 million Naira. Might be around 4 million, but I’m putting extra on top because of account deficit and other things one can’t account for. Let’s just say it’s around 4 million that you need for the full process.

Alright. Whoever wants to take that pathway can start planning towards that amount.
You can save some during house job if you don’t buy a car. 

As a black immigrant in the US, do people look down on you? Any issues with racism? We hear about it a lot, especially during this period.
So, this is what I would say. There’s racism everywhere. I haven’t personally experienced outright racism. I have seen some people who have implicit bias, but you owe it to your race, to wherever you come from, to be better than the narrative. People will naturally look down on you because you’re black and because you have an accent. So, being a black doctor with an accent is “double wahala”.

The beauty about everything is, when you know what that person is already thinking about you, it gives you an edge. So because I know that you already think that I probably don’t know much, I have to make sure that I’m the best at what I’m doing. Proper manners. Proper bedside etiquette with patients. And in my short time here, it has really helped me because my patients always give good feedback like “that Nigerian doctor is awesome”. “He’s the one I want to see”. And I’m the youngest on the team. I’m not trying to brag or anything. The reason I do that is that, unlike some other physicians from here, I have a lot to prove—to myself, for my country, for my race. It won’t be nice if I’m the black Nigerian doctor who did not treat you well at the hospital. So, I have not experienced racism directly, but I have experienced implicit bias. Some people just are racist, not because they want to be racist, but because it’s all they know.

Since you left Nigeria, have you ever come back? And how often do you visit?
Luckily, I was back earlier this year but, unfortunately, it was cut short by coronavirus. I didn’t spend as long a time as I was going to spend. I spent very few days and had to go back before the closing of the airports, and I got trapped with you guys and Buhari. No offence. They are doing a good job, but I just had to run back.

Outside work, what are your favourite things to do in the US?
Mheeeenn! Let me just put it this way, anything you want to do in the US, you can do it. The question is, do you have time for them? Are you ready financially for all the fun activities? The only thing the US doesn’t have is that sense of friends you have at home. You don’t get that here—that’s one thing I miss. My guys, my classmates, guys that I hang out with. I don’t have them here. So I think that’s just the only thing.

How easy was it for you to get comfortable over there? Were you able to meet people on time?
Well, I would attribute that to my political background. Let me put it that way. One thing being involved in volunteering in Nigeria or politics does for you is that it teaches you how to be friends with people who do not share the same ideology, people who do not share the same mindset with you. So, you learn how to accept differences, look for where you have common ground and form friendships because the truth is that most of these people are so different from you. What they like for fun is different from what you like for fun. What you know as fun is different from what they know as fun. So, it takes you a while to bridge the cultures and, I’ll be honest, it’s not everybody you can make friends with here in the US. Some people don’t care about that. You’ll find some people if you are outgoing or can hold conversations—you easily form some friendships. It might not be as tight as the friendships you had in Nigeria, but you can definitely make friends.

There are many people here that want to know more about Nigeria; they want to know more about where you come from. They are genuinely trying to know about you and not being colonial or something. Some might make a few mistakes; some might make assumptions. Don’t get angry; just use that as an opportunity to educate them.

If you were not to practise in the US, what other choices would you have made?
If not the US, I definitely would have gone to make some money in the UK. The UK has been a blessing to Nigerian doctors. Not that it’s easy, but it’s easier to get into the UK than the US. If I wasn’t going to the US, now that’d be my second option. 

There are also many of my friends and classmates there.

How many years does your family medicine programme run for?
Yeah, so residency is three years. I am in my first year, so I have three years to go or two and a half years. Anyhow you look at it. Then, you finish and become an attending—same thing as being a consultant in Nigeria. 

So you’ll pull that off in three years? Seven years after you leave school, you’ll become a consultant? Some people would still be residents in Nigeria.
That is the beauty of the US residency system—it’s not so long. I might do a fellowship after the residency, or I might not. Still depends.

For the USMLE, there are ranks on how easy it is to get into a particular field. Is it the same way for public health programmes?
Yes. At the top of the food chain is epidemiology. If you remember your community health, the five pillars of community health or something like that. In the US, the top of that list is Epidemiology and Biostatistics, which is what I did. You earn the highest, and it is usually very difficult to get into. Then, you have Health Policy. They write policy papers for government, institute health programmes, health insurances and other things. Then, you have Environmental Health. Environmental Health deals with air pollution and water pollution, allergies, occupational health, safety, antibiotic resistance, microorganisms and so on. Then you have Community Health and others along the way. Epidemiology and Biostatistics are the hardest, and the rest follow.

Generally, how do you feel about your journey so far in these academic pursuits? Are you happy with what you’ve done so far? Do you feel there are more things you’d like to achieve out there?
If you feel you’ve achieved everything, then you shouldn’t even be living anymore. So you should never get comfortable with where you are. For me, I always look for what’s the next opportunity. I’m not saying that I’m a dream chaser or I’m always on the road looking for work, but there is a place I want to be at and I’m hoping to get there.

Am I happy about the journey I’ve taken? I would say yes. I’m happy about the outcome mainly. The journey itself hasn’t been easy—it has been humbling. The reason being that you come from a background where you are like a king in a small pond or a small lake or whatever, and getting somewhere else, you realise you are like an ant there. Both in terms of knowledge and the things you have to learn. So, it has been a character-building experience for me in terms of humility. Humbling myself to learn, listening more and being more purposeful with my time. That’s the one thing I would just say. It’s been a learning curve, and I’m happy where I am right now.

That’s what matters—being happy on your journey.

Thank you very much! This was an interesting and enlightening interview.

You are welcome.

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