A powerful memoir told with such vivid detail and care. Thank you to NetGalley and the publisher for an advanced copy of the book.

A very powerful and gripping story that is difficult to read in some parts but worth sticking with. This is a first for me by the author and one I enjoyed and I would read more of their work. The book cover is eye-catching and appealing and would spark my interest if in a bookshop. Thank you very much to the author, publisher and Netgalley for this ARC.

Popular though they may be, there has often been something missing from the overseas medical memoirs and dramas I so hungrily consume. Rosamund Kendal’s Karma Suture and Angina Monologues are two of very few novels that hit the nail on the gritty metaphorical head; but then she went and became a popular author who branched out beyond the medical world, and I have since missed such relatability.

Far from fictional, Small by Small is Ike Anya’s memoir of the harshness and camaraderie of medical training in a country like mine: where sociopolitical upheaval actively, and often successfully, complicates the careers of medical hopefuls.

The author’s medical education takes place during the Nigerian democracy movement of the 1990s. It is impossible to summarise his journey without spoiling the entire memoir: anyway, the impact of Small by Small is not the factual background, but Anya’s candid retelling of the way first a student, and later a houseman (intern), lives and learns upon this background.

While Anya avoids sentimentality, there is a sense of kinship when – just five percent into his memoir – he recalls thinking,

“You don’t understand. I passed but some of my closest friends didn’t, people with whom I suffered through this last horrible year. You have no idea what it is like.”

That is something I recall vividly from my training: the feeling of being separated from the world by experiences they can never share. It matters not whether this separation is deemed real from the outside. The feeling is made real by being felt.

Some memoirs are full of flourish and wistfulness. The miracle of Small by Small is the author’s translation of the subconscious thought processes of the inexperienced medical student: the learning of a new language, the euphoria of being inducted into the cult of medicine.

There is no hyperbole when Anya writes of the long on-call hours, the failed resuscitations, the rush to save a person bleeding out from a gun shot wound. He tells bravely of the red tape, corruption, and abuse of power witnessed by the powerless trainee – the trainee that lives and learns and sometimes fails, the trainee that falls into depression (not in so many words), but gets up again.

Small by Small provides much-needed candour, and a touch of humour, to the medical community of the African continent. In short, it promises to be to Africa, what The House of God was to America*.

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Post-script: from a historic point of view, I learned much about Nigeria – my teaching about this country was mostly focussed on the Nigerian Civil War, rather than that which came after. The medical historian will read fondly of examples such as anaesthetists bag-ventilating patients for the duration of surgery (can you imagine?!), and patients’ relatives having to secure blood products prior to surgery.

* * *

* Ironically, I did not like The House of God! While also gritty and often stark, Small by Small is a book with plenty more class, and greater accuracy. Sorry not sorry to fans of the former: you do you, boo.

“𝘐 𝘸𝘪𝘭𝘭 𝘨𝘪𝘷𝘦 𝘮𝘺 𝘱𝘢𝘳𝘦𝘯𝘵𝘴 𝘵𝘩𝘦 𝘨𝘰𝘰𝘥 𝘯𝘦𝘸𝘴: 𝘵𝘩𝘦𝘪𝘳 𝘴𝘰𝘯 𝘪𝘴 𝘨𝘰𝘪𝘯𝘨 𝘵𝘰 𝘣𝘦 𝘢 𝘥𝘰𝘤𝘵𝘰𝘳, 𝘢𝘧𝘵𝘦𝘳 𝘢𝘭𝘭.”⁣
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This is memoir on becoming a doctor in 1990s in Nigeria.⁣
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Anya takes us on a journey.⁣
From childhood, school days, decisions and choices made along the way through to his days in Medical School till he becomes a full fledged doctor.⁣
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The many challenges and hurdles he faced and overcame,the time he nearly gave up among others.⁣
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He touches on the several change in government, coup d’état and protests that affected and impacted his journey on becoming.⁣
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Governance
Friendship
Education
Family
Health Care
Expectations
Disappointment
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This memoir is very informative and detailed.⁣
I enjoyed reading it and picked up a thing or two.⁣
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Thanks to NetGalley @netgalley and Sandstone Press @sandstonepress for this eARC.⁣
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“𝘌𝘷𝘦𝘳𝘺𝘵𝘩𝘪𝘯𝘨 𝘸𝘰𝘳𝘵𝘩𝘸𝘩𝘪𝘭𝘦 𝘪𝘴 𝘢𝘤𝘩𝘪𝘦𝘷𝘦𝘥 𝘭𝘪𝘵𝘵𝘭𝘦 𝘣𝘺 𝘭𝘪𝘵𝘵𝘭𝘦, 𝘪𝘯 𝘴𝘮𝘢𝘭𝘭 𝘪𝘯𝘤𝘳𝘦𝘮𝘦𝘯𝘵𝘢𝘭 𝘴𝘵𝘦𝘱𝘴.”

Thanks to NetGalley for the opportunity to read this memoir.
I loved it. Insightful and thought provoking. Although the time frame is the 1990's it shows the hardships this young man faced trying to be educated and attend medical school. The same challenges that exist in more affluent countries but with more examples of poor nutrition, housing and medical supplies than we in the UK could possibly recognise.
I do hope that Dr Anya goes on to write a "what happened next" volume sometime soon !

PR Gifted from @sandstonepress via @netgalley
A great read. The book brings us through the authors experience of medical school in Nigeria and his first year as a doctor in a hospital in Lagos during the 90s. At first I wasn’t sure this was anything unique, could be any medical students story, but as it went on, I did get the uniqueness. The delay in graduating as university closes down due to political turmoil, as an example. The most shocking aspect is how underresourced the hospital is - the doctors often write prescriptions to give to families to source and pay for supplies for their family member in hospital. I would’ve liked to know where the author is now, and how his career progressed - the acknowledgements suggest a break from the NHS, so I’m assuming in the UK now.

This is a Ike Anya's memoir about how he became a doctor in Nigeria in the 1990s.

This memoir was very informative and gives us insight into the unique issues facing the Nigerian healthcare system at the time, both financial and cultural (eg. language barriers).

I absolutely loved "Small by Smalll" by Ike Anya! This memoir is a beautifully written account of the author's journey to become a doctor in Nigeria during the 1990s.

Anya's writing is so engaging and heartfelt that I found myself completely absorbed in his story from the very first page. He shares not only the triumphs and challenges of his medical education but also the personal struggles and cultural nuances that he encountered along the way.

I was particularly struck by Anya's descriptions of the people he met during his medical training. His compassion and empathy for his patients shine through in his writing, and I was deeply moved by his dedication to providing the best care possible.

Another aspect of the book that I found particularly compelling was Anya's exploration of the complex issues facing the healthcare system in Nigeria. He doesn't shy away from discussing the challenges of providing medical care in a resource-limited setting, and he offers thoughtful insights into the ways in which healthcare can be improved in Nigeria and beyond.

Overall, "Small by Small" is a deeply inspiring and emotionally resonant memoir that I would highly recommend to anyone. Anya's writing is so powerful and engaging that I found myself cheering him on every step of the way. Whether you're interested in medicine, Nigerian culture, or simply a great story, this book is definitely worth reading.

I started reading this book not actually realising it was a memoir, I thought it was a brilliant novel. When I realised it was a medical memoir it made it so much better. As brits we constantly complain about the NHS, our educational system and our government. However I think this shows just how lucky we really are, and how easy we have it. I learnt so much reading this book, but also just really enjoyed reading ikes story.

This book is a really vivid and powerful memoir about Ike becoming a doctor in the late 80s, early 90s in Nigeria. The worldbuilding and writing is very inviting and sucks you in. He paints such vivid pictures of Lagos, Enugu and Nsukka.
Interspercing the English text with some Igbo sayings and sentences. The title comes from 'Okwa m da ezi unu, ife du m bu nkenta nke nta.'
Indeed she always does tell us that everything worthwhile is achieved little by little, in small incremental steps. Small by small, like inch by inch, mile by mile.
It was very informative on how medical school and hospitals ran and I learned a lot. Interweaving politics which affected him and his country was done is a very balanced and nuanced way.
He talks about his love of reading fiction, and the way he writes absolutely shows that. I recommend this book to anyone, but specifically people in the medical field around the world. It’s good to get a look and another perspective. 4.5 stars