KWENU! Our culture, our future

Book Review

Oseloka Obaze*

selonnes@aol.com

                                                                                   
Saturday, 15 April 2006

Letters to My Sisters

Plain Truths and Straightforward Advice from a Gynecologist

 Ngozi Osuagwu, M. D.

 (ISBN: 0977339815; Ben Bosah Books, New Albany, Ohio; 2006, pp.160; Price $16.95)

Available at: http://www.letterstomysisters.com

“Letters to My Sisters is preventive healthcare advocacy at its best.”

Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist opens with a mission statement of sorts; the all-too-familiar declaration heard frequently today in many doctors’ offices. “I was not content to practice medicine with a factory floor mentality just to make a buck. My primary mantra in my medical practice is to always treat every patient of mine as a sister, and I could not in good conscience treat patients as if they were objects in a production line.”

In Letters to My Sisters, Dr. Ngozi Osuagwu, through thirty intensely personalized letters to her patients, addresses various questions that focus on women’s medical issues. These include routine and complex questions that every patient would want to ask and expect their doctor to answer.

In the latter part of the book, Dr. Osuagwu offers synoptic discourse of various and common ailments that afflict women.  As a supplement, she provides the readers with information about websites and Internet addresses where further information can be garnered. Letters to My Sisters delves into an array of issues in a woman-to-woman and politely in-your-face fashion. As Dr. Osuagwu admitted on behalf of her fellow women, “We owe it to ourselves to become knowledgeable about our bodies and health.”

Overall, Dr. Osuagwu in a frank, oftentimes rather blunt manner addresses some of the everyday questions about medical, social and moral issues women raise with their doctors.  But the focus is the relations between an obstetrician/gynecologist and her patients.  The fact that she is also a woman makes most of Dr. Osuagwu’s responses introspective and thus invests them with added validity. A male OBGYN may not have ventured as far as Dr. Osuagwu did, or found the same courage in doling out the tough love, without being perceived as patronizing, if not politically incorrect or a misogynist.

I read through the 128-page advance readers’ copy of Letters to My Sisters in one sitting.  Navigating the book confirmed my long-held belief that irrespective of specialties, every physician is first and foremost a shrink. The gamut of issues dealt with by Dr. Osuagwu which include, female genitalia, fibrods, hormone replacement therapy, motivation, honesty, support, mymectomy, misplaced priority, balance, denial, depression, honesty, sexuality, physicians plight, frank communication, ectopic pregnancy, osteoporosis, STDs and UTI attest to this. Letters to My Sisters also grapples with many tangential issues currently in the social and political realm in an era Dr. Osuagwu refers to as one of “declining reimbursements, increasing costs, and the changing dynamics of medical practice” (p. ix)

This book is also laced with quotations, illustrations, and a poem - all anecdotal but also pertinent to the theme of the book. In effect, these accompanying sidebars give credence to the issues Dr. Osuagwu is discussing. They also have the subliminal impact of easing the reader’s mind and ability to traverse and grasp the many serious health issues being raised, including matters of life and death.  One quote that struck me as most apt, was by Harriet Beecher Stowe, “A woman’s health is her capital.” But then, a line from the poem “The One in The Glass,” speaks to the fact that one must take full responsibility of one’s health and life. Whilst we may be in denial or in need of second opinions, we must confront ourselves as the first step to overcoming any challenges. As the poem notes, “The one whose verdict counts most in your life, is the one staring back from the glass” (p.11). But in today’s demanding and confounding world, we all need a doctor, a shrink, a confidant, and psychoanalyst. This reality comes through clearly in Dr. Osuagwu letters. What is even more stark, is that this doctor-shrink or doctor-social-worker role, while inevitable in modern medical practice, is not one she and her other colleagues covet or are willing to play at all times.

Dr. Osuagwu also discusses the issue of “escapism” though she does no call it that.  In the letter to Elaine, she delves into the matter of “depression” but more importantly Elaine’s denials and dodging of much-needed counseling and her consistent effort to cunningly get her to prescribe antidepressants for her. In response, she tells Elaine,

I want to emphasize that you still need counseling. It is important to state clearly that I am not going to prescribe any more medicines for you until you see a psychologist or a psychiatrist…. My training allows me to recognize depression treat it on a short term or emergency basis, and then refer you to the appropriate mental health provider. . There are different forms of depression and only a specialist can recognize and develop a plan for properly managing your  care. (p. 27)

Shock therapy and benign brutality are said to be an occasional panacea just as much as a placebo would work for a hypochondriac. In the letter to Jaleen, Dr. Osuagwu cuts to the chase:

“You are fat! How else do you expect me to put it? I could employ avoidance by sugar-coating things and saying that you are too short for your weight.  But whom would I be fooling? You are 5’: 4”, weighing 300 pounds, and have a body mass index of 51. By definition, you are grossly obese, and I would be doing you an injustice if I did not say so… I am writing because I care.  I am not going to apologize for caring (p.30). 

The letter to Rickie is a classic case of how doctors become conflicted and unintended confessors. At issue here, is the paternity of Rickie’s child. The doctor has been let into the secret that James Rickie’s companion might not be the father of the child.  Rickie is not telling and is holding out.  Dr. Osuagwu has other concerns both moral and medical. She is also acutely aware of her obligation to her patient. Putting a good face to it all, she takes a stand:

 “I don’t know why I’m writing you. Maybe it’s because I feel so guilty and I’m trying not to view myself as an accomplice. Or maybe it’s because I believe that as adults we must deal with consequences of our actions…. I guess I wanted you to know that I don’t agree [with] how you are handling this issue with respect to the determination of the child’s paternity, but I will stand by you. You are my patient and your welfare is my priority” (p.48)

Without meaning to devalue the other letters, which dealt with strict medical issues, my favorite letters are the ones that dealt with values, which invariable will always impact on our health. They include; the letters to Bridget on “direction”, to Carmen on “balance.” to Petrie on “misplaced priority,” and to Lansing on “motivation.”  But the letter of choice was the one addressed to Lila on “frank communication.”  If there is one individual that we interact with routinely, that needs to be told the truth, it is one’s doctor. Failure to do so is fraught with imponderables. But we know too well that full disclosure from patients cannot be assumed.

Dr. Osuagwu put it all in a nutshell:

You did not come to my office to be judged, and I want it to be clear that I am not making any judgement on your choices. My primarily responsibility is to take care of your healthcare needs. However, if we are going to continue our patient-doctor relationship, it has to be one based on open and frank communications.  ..If we cannot have a relationship where I can get your complete history, I may miss a diagnosis and get into trouble.   Unless you assure me that you are being forthright, you may have to look for a new physician. (p.90)

The letter to Lila represented Dr. Osuagwu’s renascent moment.

This book is vital for the medical and social issues it attempts to address. However conspicuously absent either by choice or by compulsion, is the challenge of treating patients who are uninsured.   Dr. Osuagwu certainly cannot deny not having been drawn into the conflict of her rights and entitlements for work done versus her Hippocratic Oath to treat those under her charge regardless of whether or not they can afford to pay for her services.  Hence, it is surprising that she glossed over the issue of rising medical malpractice insurance especially for those in OBGYN. Whilst she referenced her awareness that there are some “forty-four million uninsured people in the United States” (p. vii) she inexplicably omitted the confounding and tortured tales of healthcare delivery and uninsured and ‘insuranceless’ patients, especially indigent immigrants.  These are serious issues for medical practitioners that cannot be wished away no matter how hard we try.  Any doctor who has not encountered this vexatious conflict must be practicing medicine on Mars.

I also found curious, the absence of the diversity one would customarily expect from a census of patients of an OBGYN like Dr. Osuagwu, who is female, black, and obviously a child of a first or second-generation immigrant. While I note and respect her disclaimer about the names being used “fictitiously” and recognize some of the addressees – Tonisha, Jaleen, Lansing, and Shakira  --  as unquestionably African American, the rest of her patients seem to be mainstream and WASP, except for Hawa.  Where are the immigrants? Glaringly absent also, are traditional Hispanic names. This in not awfully important in the context of the book’s theme, but they are nevertheless noteworthy in the framework of promoting diversity and universality.

Letters to My Sisters is preventive healthcare advocacy at its best. The book is a hard-nosed unstinting advocacy for routine medical checkups. It is a charming narrative, told firsthand from the unvarnished perspective of an insider and in a dazzling, delightful, and personalized this-is-made-especially-for-you style. As a quick reference book, it is foremostly educative, informative, splendidly but inoffensively graphic and brutally frank. It deals with everything you needed to know, but was too scared or too shy to ask. As a preventive health tool, it is prophylactic, diagnostic, palliative, and pragmatic. It needs to be said, however, that Letters to My Sisters is by no means an alternative or a substitute to care from a licensed medical professional. 

Because this book is conversational in structure, it is easily readable. If this male and very squeamish reader could read, understand and indeed enjoy this book, then I believe that other readers especially women will do so too. The letters consist of one side of a dialogue while the reader’s mindset, spontaneous internalized reactions and questions form as the rebuttal flip side of the dialogue. The end product is a sense of having had a ‘house call’ from ones doctor, during which the patient and the doctor engage in an animated, intimate and more importantly, friendly discourse on matters of mutual interest. Ann Plato’s quote at page 61 said it all: “To remove ignorance is an important part of benevolence”.

Letters to My Sisters (which is due in the bookstores on 28 April) is worth keeping handy. Also it may be worth giving a copy to a loved one, a teenage daughter, or niece. As Dr. Osuagwu opined, “this book is primarily about preventive health and comprehensive education, and it will be deemed to be successful if one person finds it useful.”

I concur!

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*Mr. Oseloka Obaze, an aspiring writer, is a member of the Kwenu.com Book Review Forum, which is dedicated to the promotion of books with Igbo and Afrocentric themes.   He is also a supporting Member of the African Writers Endowment (AWE).   From 1999 to 2005 he served on the editorial board of INYEAKA, the journal of Songhai Charities, Inc., a New Jersey community-based charity founded and run by Nigerians based in New York Tri-state area in the United States, first as its founding Publisher and later as the Editor-At-Large.  He is also on the editorial board of The Amaka Gazette, the journal of the Christ the King College, Onitsha Alumni Association in America.  His collection of poems, “Regarscent Past: A Collection of Poems” was among the top three finalists in the poetry category in the African Writers Endowment Publishing Grant Program for 2004.  He reviews books and arts strictly as a hobby. 

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