Retiring from the NHS in July 1992 at the age of 65 I let it be known that I was available for short term appointments in the mission field. Previous comparable experience had been in Hong Kong in the early 60's. I was approached by Dr Carling of the Sudan United Mission (Action Partners) and appointed as a locum for two months to Vom Hospital in Central Plateau State, Northern Nigeria. Built in the early 60's, the hospital was subsequently taken over by the state government, allowed to run down and then vested under the control of the local church, the Church of Christ in Nigeria. The secretary of that church was my employer. The financial arrangements were simple; pay your own fares and living expenses! Accommodation was provided.
Only three wards were open; male, female and children. The hospital was run by three resident Nigerian doctors and one dentist. What they lacked in skill they made up for by dedication and enthusiasm and their life style was a credit to their faith. The result was that I was to become a surgical jack of all trades. My first surgical role was to assist a resident doing his first open prostatectomy!
The hospital and adjacent buildings were of excellent design, but in poor state of repair. Wash basins and flushing toilets were often out of order. Relatives camped round the wards. There was no shortage of water, but the electricity supply failed from time to time. Laboratory facilities included simple haematology and bacteriology, but no chemistry or histology. There was no blood bank as such, which meant that in emergency cases donors needed to be identified amongst the relatives, a time consuming process, especially as there was no available plasma expander.
The hospital day started with prayers at 7.30, followed by ward rounds, with an attempt to get to the out-patients by 10.30. On Tuesdays and Thursdays operating lists started at about 9.30. As there is no such thing as a "free" medical service, all hospitals and clinics are competitively priced. Vom was fairly inexpensive, but like any "private" hospital, depends upon elective surgery to pay its way. "Bad debts" were common, so that some months only a proportion of the staff's salary could be paid. Emergency admissions were common, especially as the government medical service was disrupted by strikes. Investigations needed to be paid for in advance so that there was often delay before urgent treatment could be started.
The majority of emergency surgical cases arose in women with life threatening complications of labour, or miscarriage. Women are reluctant to be confined in hospital, but when complications arise are admitted late. Obstructed labour, with a dead baby and possibly ruptured uterus, is a common event. Other emergency admissions arise from road traffic accidents, as well as complications of intestinal disease. Fever and diarrhoea are the commonest reasons for seeking medical advice in West Africa. Tropical diseases were not part of my previous experience. My appointment partly overlapped that of Dr Alistair Coles, who had recently become an MRCP and offered immensely valuable opinions on problems of hypertension and renal failure, as well as having the practical skill of inserting needles into the veins of "collapsed" patients.
Well trained technicians provided anaesthesia. The methods available were spinal, local, i.v. Ketamine or Ether through an EMO machine, with Thiopentone induction. The provision of a new theatre light during my appointment was a big improvement. Gowns were in a poor state of repair. Most operations were "covered" by antibiotics, but the infection rate was high. However, it was remarkable how successful the combination of intravenous fluids and antibiotics could prove in severely ill patients.
Nigerian society is vibrant and friendly. European visitors are made very welcome. The short visit was rewarding as providing an insight into another culture and the problems facing the local church.
Only three wards were open; male, female and children. The hospital was run by three resident Nigerian doctors and one dentist. What they lacked in skill they made up for by dedication and enthusiasm and their life style was a credit to their faith. The result was that I was to become a surgical jack of all trades. My first surgical role was to assist a resident doing his first open prostatectomy!
The hospital and adjacent buildings were of excellent design, but in poor state of repair. Wash basins and flushing toilets were often out of order. Relatives camped round the wards. There was no shortage of water, but the electricity supply failed from time to time. Laboratory facilities included simple haematology and bacteriology, but no chemistry or histology. There was no blood bank as such, which meant that in emergency cases donors needed to be identified amongst the relatives, a time consuming process, especially as there was no available plasma expander.
The hospital day started with prayers at 7.30, followed by ward rounds, with an attempt to get to the out-patients by 10.30. On Tuesdays and Thursdays operating lists started at about 9.30. As there is no such thing as a "free" medical service, all hospitals and clinics are competitively priced. Vom was fairly inexpensive, but like any "private" hospital, depends upon elective surgery to pay its way. "Bad debts" were common, so that some months only a proportion of the staff's salary could be paid. Emergency admissions were common, especially as the government medical service was disrupted by strikes. Investigations needed to be paid for in advance so that there was often delay before urgent treatment could be started.
The majority of emergency surgical cases arose in women with life threatening complications of labour, or miscarriage. Women are reluctant to be confined in hospital, but when complications arise are admitted late. Obstructed labour, with a dead baby and possibly ruptured uterus, is a common event. Other emergency admissions arise from road traffic accidents, as well as complications of intestinal disease. Fever and diarrhoea are the commonest reasons for seeking medical advice in West Africa. Tropical diseases were not part of my previous experience. My appointment partly overlapped that of Dr Alistair Coles, who had recently become an MRCP and offered immensely valuable opinions on problems of hypertension and renal failure, as well as having the practical skill of inserting needles into the veins of "collapsed" patients.
Well trained technicians provided anaesthesia. The methods available were spinal, local, i.v. Ketamine or Ether through an EMO machine, with Thiopentone induction. The provision of a new theatre light during my appointment was a big improvement. Gowns were in a poor state of repair. Most operations were "covered" by antibiotics, but the infection rate was high. However, it was remarkable how successful the combination of intravenous fluids and antibiotics could prove in severely ill patients.
Nigerian society is vibrant and friendly. European visitors are made very welcome. The short visit was rewarding as providing an insight into another culture and the problems facing the local church.
