Medical missions have grown in relevance in Nigeria over the past 20 years. This is largely as a consequence of the failure of the health system to serve the poor. In the conventional sense, medical missions usually involve a group of physicians and other health workers travelling to a foreign country for the purpose of undertaking a special series of short term health interventions to improve the health and health care of a specific population. These are normally of short term duration and arranged around a health care facility. Although debate continues about the value of medical missions as a sustainable health improvement strategy, Pro Health International (PHI) offers a slightly different approach to medical missions. It seeks long term strategic partnerships and funding, intense preparation and significant post mission care. To find out more on about the benefits of these health missions to host communities, volunteers and society we decided to join Pro Health on their recent mission to Ehor, a town close to Benin City in Edo State. Here, Anja Choon gives a short summary of the mission and her experience as a PHI volunteer.
Pro Health International was founded by Dr. Iko Ibanga as a Christian, non-profit voluntary health care organization 23 years ago. Through mobilising volunteer doctors, nurses, pharmacists and other health care workers as well as support staff, the organization provides free health care during short medical missions. Services offered during missions include medical consultations, dental services, eye consultations, health promotion to increase awareness of important diseases and their risk factors, minor surgeries and pharmacy services, all free of charge to the clients. PHI’s focus is on helping the poor and underprivileged in rural settings. Originally starting with 3-4 medical missions a year, they now run 25-30 missions in a year in Nigeria, Ghana, Burkina Faso, Zambia, The Gambia, Mali, Niger, Burundi and Malawi. Over the years, they’ve carried out about 200 missions and reached many thousands of people.
The TY Danjuma Foundation provides funding for an average of three PHI missions every year, including a mission to Ehor from 6 to 12 July 2014, which I joint on behalf of Nigeria Health Watch. As I later found out, it was not the first visit of PHI to this particular town.
One week before the mission, PHI started to train health workers in the community, who would work alongside the volunteers. In addition, the local health workers were going to receive further training during the mission. This aspect of the mission, as well as future missions to this town, is meant to create a long-lasting positive impact on the quality of health care in Ehor.
The mission itself lasted for a week and was carried out by a total of 53 volunteers. Most of them came from different fields in the health sector, including doctors, dentists, nurses, pharmacists and medical laboratory scientists. There were also some students and people at various stages of training in the above professions, as well as a few volunteers that did not have a background in health.
In one week in Ehor, the volunteers on the mission attended to the various medical needs of about 1,500 clients. These included 1,401 clients who had a general consultation with a doctor and a total of 152 clients who consulted a dentist, of which 128 had a tooth extracted. The existence of a dental clinic as part of the mission must be highlighted given that dentistry is a relatively rare resource in Nigeria. The surgeons performed 52 operations during the week. The major surgeries were myomectomy (removal of fibroids), appendicectomy (removal of inflamed appendix), herniorrhaphy (repair of hernia), lipoma excision (removal of lipoma) and hydrocylectomy (repair of swelling of the scrotum). The consultations and surgeries were supported by medical technologists who carried out 493 tests in the lab, of which 193 involved counselling prior to administering HIV tests. In addition, the mission included pharmacy services and health promotion.
We started the first day in Edo State, as every other day with prayers and Bible study, which are an integral part of every PHI mission. For the PHI volunteers, mostly devout Christians, praising God and discussing how they can best give back to society is a joyful way to begin the day.
After prayer and breakfast, we took off to Ehor, where we immediately began to set up the healthcare centre. Lots of equipment had to be carried to the different buildings and banners put up to show the locations of consulting, health promotion, laboratory, pharmacy and surgery. Though some items were quite heavy, often requiring several people to move them, nobody complained. The team smiled and worked, knowing that their effort was going to make a positive impact in this community.
Setting up the place took most of the first day, so that we were not able to see many clients. Still, word of our arrival rapidly spread from mouth to mouth and, by the next morning and all other mornings of the project, we were greeted by a large crowd who had come for free medical services.
Thereafter, each day began with opening speeches, prayers and songs. After that, volunteers from the health promotion unit taught the community about HIV/AIDS, healthy diets and other health issues. They answered questions and quizzed their audience on these matters. They also performed some demonstrations, such as proper hand washing and how to prepare a meal with a powder called Tom-Brown, a mixture of corn, soya beans, groundnuts and crayfish, which they were going to share out later. The speeches, prayers and songs were followed by the distribution of patient slips, which were required before being seen by a doctor, dentist or health promoter.
Since I don’t have a background in health, I had been assigned to logistics, which meant making sure that all the hard working volunteers were fed, labelling patients’ slips and taking care of other non-medical issues. At the same time, I was visiting the other units, observing what was going on there, talking to both volunteers and clients and listening to conversations between these two, always taking notes and pictures for this report.
On the third day, I met two clients who were waiting for their consultations. One was an older man, about 75, who wanted to see a doctor because of pains following a surgery in the lower abdomen. The surgery and a follow-up check had been carried out at the University of Benin Teaching Hospital (UBTH). He told me he was happy he didn’t have to travel to Benin this time, especially as he had had good experience with PHI in the past.
The other client was a 17 year old boy, waiting for his turn at the dentist. He didn’t talk much and didn’t smile at all as he was in pain from one of his teeth. In the past, he had had another tooth removed, and I imagine his mind was all on the treatment. I could feel his pain. When I talked to him again a few hours later, he told me that the dentist had seen him and instructed him to come back another day during the mission. It was late afternoon, and we were about to round off.
The following day, I joined one of the doctors in the consultation room. His first client was a middle-aged man, who complained about a headache that had been going and coming for the past few months. He didn’t have vision problems, he hadn’t fainted but his blood pressure had been on the high side during a check-up the month before. He mentioned some tablets that had been prescribed to him after that check-up. Another measurement indicated severe hypertension. Hence, the doctor started to ask questions about his client’s life style, such as diet, smoking and stress factors, and advised on how to reduce risk factors for hypertension. In addition, after a third measurement two days later that also showed a high blood pressure, the doctor wrote a prescription for drugs treating hypertension, which the client was able to collect from the PHI pharmacy for free.
The next client was a teenage girl, 12 years of age and a SS1 student in secondary school. All she wanted was to find out her blood group. Sympathising with her curiosity, the doctor sent her to the lab for a blood test.
Then, an older woman arrived. It soon became clear that she didn’t speak much English, while the doctor did not speak any of the local languages. The woman’s daughter, who was seeing another doctor in the same consultation room, rushed over, translated for a while before she returned for her own consultation. Another translator had equally little time. It’s not surprising that the doctor was still not sure of his client’s medical history after about twenty minutes of consultation. She had mentioned urine in the blood, vomiting for some days, coughing for the past three months and many more symptoms. The doctor tried to find out why his client hadn’t gone to the hospital earlier but didn’t succeed in extracting that information. In the end, he wasn’t even sure about the blood in the urine because the client and her translators changed it to dark but not reddish urine. This incident highlighted the challenges of rural medical practice in Nigeria to me.
I left in the middle of the older woman’s consultation and moved over to join the health promotion team, where one of three health promoters was seeing clients. While I was there, four women brought their small children. The health promoter talked to the mothers to enquire about the family’s living conditions. She also took notes on the children’s appearance and measured their height and weight. Many of the children were malnourished according to the health promoter, who encouraged these mothers to give their children a balanced diet and breastfeed the babies exclusively until six months of age. She also stressed the importance of keeping one’s house and children clean and letting the children sleep under a mosquito net. At the end, each woman received a pack of anti-septic soap and a pack of the nutrient powder that the health promoters had used during the cooking demonstration in the morning.
My final stop that day was the dental clinic, where the dentist removed the tooth of a small girl, who was sitting on her mother’s lap. Her older sister had already undergone the same procedure. One of the volunteers lamented that clients do not come for treatment in time; hence the affected teeth were often beyond repair. Furthermore, PHI does not have the means to do fillings. I was told volunteers can refer the client for such a treatment, but unfortunately many clients are unable to afford it and will opt for a tooth extraction instead.
Another limitation of the medical mission was its short duration of just a week. It meant that many people who sought medical consultation were not attended to. There were a lot of complaints, even emotional blackmail and raised voices. On one occasion someone came to the logistics room to demand, with lots of drama, to be given a patient slip, when we had exhausted all the consulting opportunities for the day.
I enjoyed the week with PHI very much. It was hard work, and the days were long. We got up by 5.30 in the morning and often didn’t make it to bed till midnight, exhausted. At the same time, it was lots of fun. I really enjoyed the company of my fellow volunteers. To them, Pro Health is more than just a temporary and unpaid job; it is a family.
The wonderful people I met include final year dentistry student Linda Iheme, medical laboratory scientist Chibuike Alagboso, personal transformation coach Christopher Agina, OR nurse Magdalene Omenyi, pharmacist Godwin Attawodi, dentist Eghe Aihie, doctor Kingsley Lasing and doctor Femi Owagbemi. My roommate Sola Obajimi and her fiancé Christopher Njoku, whom she met during a PHI medical mission, both started as volunteers but are now employed with PHI. When I talked to them and the current volunteers about why they participated in PHI medical missions, one reason was mentioned over and over again: the wish to help those in need in the name of Jesus.
It would be great if medical missions like the ones carried out by PHI were not necessary, if every Nigerian had access to basic health care, free at the point of care. It would be great if there was no need for an organisation like PHI, but sadly, this is not the case and likely to remain so for the foreseeable future.
After the large conference on universal health care that held in Abuja earlier in the year, little seems to have changed. The few services in government hospitals have come to a standstill as the strike by doctors enters its 4th week.