Leighton Hospital Team, Eruwa, Nigeria

JULY 2010

This year we had a relatively large team comprising a consultant surgeon (Magdi Hanafy), consultant anaesthetist (Andy George), operating department practitioner (Paula Hynes), surgical registrar (Nicola Eardley), two senior scrub practitioners (John Pickering and Ginny Long), and a senior ward nurse (Michelle Hawkes).

We met early in the morning of Saturday 24th July and loaded a minibus with numerous boxes and bags of medical supplies and luggage before travelling to Manchester Airport. British Airways had opened a counter especially for us and our luggage which made checking in very straightforward. We flew to Heathrow Airport and then from Heathrow to Lagos. On our arrival we were greeted warmly at the airport by Dr Yombo Awojobi. He helped us to upload all of our luggage on to another minibus and then we went to a hotel to spend the night before our journey to Eruwa the following morning.

We woke early and set off for Eruwa straight after breakfast. When we arrived we were shown to our accommodation, where we unpacked. We then went to the hospital and unpacked our medical supplies to enable us to start work promptly the next morning. During that afternoon we had the opportunity to observe Dr Awojobe perform a Caesarian Section, assisted by Christina, a medical student on her elective from the University of Sheffield. We were extremely grateful to both Dr Awojobe and his patient for this experience. Later in the day Dr Awojobi took us to see the developments to the area since our last visit before we sat down to dinner. We were very impressed at the work that had happened and his plans for the future.

We awoke on Monday morning after a night of being serenaded by frogs! We had breakfast and went to the clinic where we started seeing the patients. We would examine them, mark them and give them identification wrist bands. We treated eight patients on that day with large and small hernias and one with a hydrocoele. Most had local anaesthesia but some had spinal anaesthesia for repair of the larger hernias. The experience of Ginny and John was apparent in the way that they set up instruments and equipment, ensuring a high turnover of patients. Everything went smoothly and we finished relatively early because there were no more patients for us on that day, mainly due to the heavy rain. As last year, Karim, Dr Awojobe s theatre assistant, helped in organising the patients and the staff and to him we are very grateful.

On Tuesday morning we started with a ward round, reviewing any of the patients who had stayed over night. Karim brought us many more patients, young and old, and we had another busy day. Andy and Paula were fantastic given that there was no scope for performing a standard general anaesthetic as would be routine in the UK, taking everything in their stride. Today, and for the rest of the week, we had with us Sayo Idowu, a young Nigerian surgeon who was keen to learn more about hernia repair. He was a good student and by the end of the week he was pleased to be able to perform hernia repairs from start to finish.

Community, Eruwa, Nigeria
Community, Eruwa, Nigeria

The following day we had a long list of patients for us to see and operate upon. Whilst we were busy operating, Michelle took good care of all the patients on the ward giving medication, changing dressings and helping with personal care. She got to know every patient very well and her quiet hard work did not go unnoticed.

Thursday turned out to be a more eventful day than we were hoping for. Unlike here in the UK, when patients are seen we know very little about any co-morbidity. Risks of the hernia versus risks of the anaesthetic/surgery have to be weighed up. We decided to cancel a man with a recurrent inguinal hernia who claimed to be 110 years old as we felt that the risk of surgery was likely to be too great to him. The next patient was a 75 year old lady with a recurrent femoral hernia. We decided that she should have surgery but after anaesthesia she became unresponsive and hyoptensive. She required a period of cardio-pulmonary resuscitation and IV adrenaline before her blood pressure improved and she regained consciousness. She recovered well and was admitted to the ward for close observation overnight. It goes without saying that we were extremely pleased to see her looking well the following morning.

After performing the last few cases, we packed our belongings and started the long journey back home. We all came away with a feeling of wanting to do more to try to help to support Dr Awojobe s efforts for the local people. As a result John Pickering is hoping to arrange funding from BMI Healthcare to provide solar panels for the hospital in order to be able to generate electricity with the aim to have enough electricity to run an autoclave. The team have also discussed raising funds for an oxygen concentrator which would mean that more patients would have access to supplementary oxygen. We are all extremely gratefully to Dr Awojobe who once again made us feel very welcome and gave us a bit of an insight into surgery in Africa.

Nicola Eardley 
SpR in General Surgery