Small by Small: Becoming a Doctor in 1990s’ Nigeria

Vivianne Ihekweazu (Lead Writer)

Since Ike Anya’s book, “Small by Small” called “a small miracle of a book” by Chimamanda Ngozi Adichie, was published in the summer of 2023, it has sparked discussions among the larger Nigeran diaspora. The book depicts the unique experience of many doctors studying medicine in Nigeria, thoughout the nineties. The recent publication of the Nigerian edition in 2024, by Masobe Books has made the book accessible to Nigerian readers, re-igniting discussions and experience sharing.
 
While “Small by Small” is a memoir, it is not a single story, but a collection of beautiful short stories capturing the journey to become a doctor in Nigeria. Making it through both the turbulent times of life on campus, juxtaposed against the turbulent times in the country. The experience of a medical education, prior to the widespread use of technology, has many common experiences shared around the world. These include the enormous amounts of material consumed, the experience of dissecting cadavers to learn about the different parts of the human anatomy and the unique student-doctor relationship in the clinical years. However, many stories in this book are unique to our setting in Nigeria.
 
Ike brilliantly narrates various events from his time in medical school in Nigeria. From the incredible adrenaline rush of the important “2nd MB” exams, where the trade and exchange of bones was a vital part of studying anatomy, to the camaraderie that develops among the class with each passing exam, to dealing with parental and societal expectations. The pressures and the pains, the joys and sadness and sometimes just the craziness of Nigeria in the nineties is described in beautiful written text that captures the reader’s imagination immersing them in the experience. Reading “Small by Small”, you are transported into the sights portrayed in vivid detail. One of Ike’s great skills is his detailed narration, often with sarcastic humour and vivid characters that paint a tapestry of stories that weave through the highs and lows of life as a medical student. Ike’s journey through medical school becomes more than just a story of academic pursuit, it is a vivid exploration of life’s ups and downs, of friendships forged through the shared struggles.
 
Universities have historically been at the heart of social and political activism, and the 1990s were likely the last time this was true in Nigeria. People often assumed that medical students were too preoccupied with academics to participate in activism. “Small by Small”, describes in detail how this was not the case, as medical students were at the forefront of many of Nigeria’s struggles during that time period.
 
Reading “Small by Small”, you cannot miss the references to Nsukka, the university town in southeastern Nigeria, described so beautifully in Chimamanda Adichie’s first best seller, Purple Hibiscus. Without revealing too much, it depicts its dusty red roads and hill clusters, highlighting the town’s role in the early stages of every doctor’s education at the University of Nigeria, where they spend their first year.
 
The book discusses the tremendous resilience that medical students show throughout their training to become medical doctors. This resilience is not uncommon among Nigeria’s current generation of medical professionals, who often have to work in difficult conditions. This is why the emigration of medical doctors is a growing concern in Nigeria. The incessant strikes, which often caused medical school to be delayed, the security issues on campus and when travelling to campus, and the financial resources required to study are challenges that every medical student has to deal with.
 
The question I would like to ask young Nigerians who read this book is, “Does it inspire or inhibit your aspirations to study medicine in Nigeria”? As the book is now available in bookshops in Nigeria, this is a question that can only be answered by those who have read the book. Aside from textbooks, there are not many books accessible to aspiring medical students that share the experience of becoming a medical doctor, therefore we recommend “Small by Small”, to anyone aspiring to make this journey. Yes, things may have changed since the 2000s, but many feelings, hopes and aspirations will remain the same.
 
Since the book’s release, there have been several discussions at readings and other events around the world. It has sparked conversations on the opportunities and challenges of a medical education, and well as the responsibilities that come with it. There are several Nigerian doctors and other medical professionals working in health facilities all over the world, but few have documented their experiences. So, this book fills that gap, providing not only a fascinating story but also an important record of one of the most different periods in Nigerian history, as well as the perspective of a doctor who lived through it.
 
More than anything else, the book, “Small by Small” inspires optimism, which is urgently needed in Nigeria. Finally, as Ike’s book elaborated on, the journey to becoming a doctor in Nigeria, is a gradual process, and, as the Igbo proverb goes “Nwayo nwayo ka-eji aracha ofe di oku”.