Living the mission: medical assistance to Nigeria

AORN Journal,  Nov, 2007  by Jan Patterson

• E-mail
• Print
• Link

Volunteerism is synonymous with Tennessee, the "Volunteer State." In 2001, a perioperative nurse joined a group of Tennessee health care professionals who volunteered to give up their personal time off and fly 3,000 miles to perform surgery for impoverished people at a hospital in Nigeria. A surgeon and an anesthesiologist have coordinated and led this mission annually since 1998. Their rapport and mentorship have inspired many surgical residents, fellows, pathology residents, circulating nurses, first assistants, surgical technologists, and anesthesia care providers to donate their time and talents.

The Nigerian Christian Hospital is located between Aba and Ikot Ekpene in the southwestern Nigerian state of Abia. Since 1965, this 110-bed/cot compound has been supported in part through the International Health Care Foundation.' The hospital is accredited within Nigeria for family practice and maternity care. Care is given based on ability to pay and level of need. A total thyroidectomy, for example, costs the patient approximately $150, or about 18,500 Naira ($1 US = 124 Naira). In 2001, the facility employed six full-time Nigerian physicians and one British missionary surgeon.

Preparations for the 10-day mission began one year in advance. Many questions had to be addressed. Who was needed, and who would go? What jobs would they perform? Where would the supplies and suture materials come from? How would all of the personnel and equipment get to the intended destination safely? Discussing the mission's purpose--to act as advocates for the poor and sick through holistic care--gave the team direction. A commitment to the values of service to the poor, reverence, wisdom, dedication, and integrity would enable them to consistently provide the highest quality of care with the resources available to people living in circumstances foreign to the team members.

FACTS ABOUT NIGERIA

Nigeria has a geographical area equal to twice that of the state of California (2) and is the most populated country in Africa with 135,000,000 people; (2) one in every four Africans is Nigerian. (3) In 2005, Nigeria ranked ninth in world population. (4)

Sixty percent of the population lives below the poverty line. (2) Poverty, and specifically living "below the poverty line," is characterized by hunger, lack of shelter, and being unable to see a physician when one is ill. Poverty often means that people do not have access to schools and do not know how to read. (5) In Nigeria, only 68% of the population is literate. (2) Poverty results in powerlessness, lack of representation, and lack of freedom. (5)

[ILLUSTRATION OMITTED]

English is the official, government language, but hundreds of other languages and dialects are spoken. In 1960, Nigeria gained independence from British rule, but corruption and lack of infrastructure have slowed the development and progress of this nation) Decades of deterioration and neglect have taken their toll on public services such as health care delivery. Although it is the eighth leading oil producer in the world and a member of the Organization of Petroleum Exporting Countries (ie, OPEC), (6) Nigeria comes close to the bottom of almost every world development index. (7)

Malaria, HIV/AIDS, and tuberculosis pose impossible challenges to an already faltering public health system. The average life expectancy is less than 50 years. (2) Few Nigerians (ie, 63% in urban areas and 48% in rural areas) have access to primary health care. (8)

MAKING THE TRIP

The mission volunteers agreed to fund their own travel, medical, and living expenses. Travel cost each participant approximately $3,000; immunizations cost approximately $400; and medical expenses and living expenses totaled about $200 per person. A letter of invitation for each health care worker from a recognized agency within Nigeria was mandatory to enter the country. This letter explained where the health care worker would enter and when he or she would arrive. The letter also explained that the health care worker was not receiving any compensation for his or her services. Obtaining the required documentation took several months.

Fifteen people were scheduled to make the trip on November 6, 2001. After the September 11, 2001, terrorist attacks in the United States, however, only seven individuals made the trip: one surgeon, one anesthesiologist, two RN first assistants, one nurse anesthetist, one chief surgical resident, and one electrician.

The instrumentation and equipment that the team transported was loaned or donated from local hospitals, and the team also received donations from pharmaceutical and OR supply companies. These donations included electrosurgery units (ESUs); bipolar coagulation units; drape sheets; paper gowns; suture materials; waterless surgical hand scrub; sterile dressings; and medications including antibiotics, levothyroxine, anesthesia medications, sedatives, and analgesics.

The primary focus of the mission was to offer surgical treatments for any head and neck pathology, and the team brought supplies to perform approximately 60 head or neck procedures. This meant that each traveler was allowed to carry one personal piece of luggage and one piece of luggage for medical supplies. No supplies were sent ahead because supplies sent in previous years had been quarantined at the dock indefinitely, looted, or lost. Because travel had become more difficult after September 11, at each airport, all the supplies were x-rayed and many were opened and rummaged through. Medical instruments were scrutinized and thrown back in the bags without concern for damage or loss.