Medical Mission with a difference: The changing face of surgical operations


We will occasionaly bring you a piece by a guest write Kingsley Obom-Egbulem. KC has been reporting on health issues for a few years and until recently was part of the JAAIDS team. He has earned our respect as one of a handful of science reporters that can separate the wheat from the chaff.

Enjoy his first piece for us…

By Kingsley Obom-Egbulem

How would you feel, if after going through several hassles including paying exorbitant medical bills for a colon cancer operation in the UK only to discover that the surgeon who operated on you is not just a Nigerian but a graduate of the famous University College Hospital,(UCH) Ibadan?

Not many people would find that funny. But it happens frequently and that has been the experience of Dr. Jimi Coker a Consultant General Surgeon and Coloproctologist.

Coker qualified as a doctor from the College of Medicine, University of Ibadan, in 1984. He went to the UK in 1987 for postgraduate training in general surgery. After completing his higher surgical training in North Trent and South Yorkshire, he was appointed Consultant Surgeon with specialist interest in colorectal surgery at Doncaster and Bassetlaw NHS Trust in 1999. In 1999, Coker joined the Tropical Health and Education Trust(THET) as surgical instructor with annual visits to Northern Ghana for basic and emergency surgical skills courses.

So, what has location got to do with the success of any surgical operation? Are Nigerian patients safer in the hands of foreign surgeons than that of Nigerian surgeons?

Dr. Coker says though certain variables such as the regulatory environment, economic and social status of the people, standards of care and practice and prevalent diseases has a huge role to play in the quality of surgical practice there are also basic component of surgery which plays even far greater role.

“The essential components of surgery which I believe contributes to the success of any surgical operation include good access and exposure to the part you want to operate upon, adequate blood supply, absence of tension, meticulous technique and above all ,good judgment on the part of the surgeon”.

Coker said some surgeries may be difficult if you are operating on parts of the body that are difficult to reach like in colorectal surgery in men. There is also the case of poor illumination which may even make it difficult to see very well what you intend to operate on. “Such cases call for good judgment in other to come out successful”, Says Coker.

But the advent of stapling in surgery has even made such difficult areas like the male colon during colon cancer operation easily accessible making it faster and safer.

“I believe any surgeon anywhere in the world, who can use stapling equipments shouldn’t have problems with colorectal surgery and any another surgery that has made easier by stapling and I must say thanks to Johnson and Johnson for this wonderful inoovation”.

Indeed surgeons in Nigeria have had their own share of the growing lack of confidence in anything Nigerian. The spate of failed surgeries sometimes due to poor judgment on the part of the surgeon or from other systemic factors have not also helped matters.

“I think some of our colleagues haven’t really done much to instill public confidence in Nigerian surgeons even though they are among the best in the world”, says Dr. Kunle Onakoya, an orthopedic surgeon and Group Medical Director, Lagoon Hospitals.

“We need to be seen to have raised the standards of our practice such that when you tell people they will require a surgery for any medical condition they will gladly go for it”.

And so, Nigerians continue to fly abroad for even minor surgeries that can be done here. The irony of the matter is that they are often operated upon by one of the many Nigerian surgeons who are making their marks across Europe and America. Jimi Coker is one of these Nigerians. And unlike many others, Coker visits Nigeria about three times a year on medical missions and capacity building for surgeons often paying his bills.

Last week, Coker was in town as a resource person for a 2 day training for surgeons on “Surgical Stapling”. The training which was held at the Lagoon Hospitals was organized by Johnson and Johnson in partnership with Lagoon Hospitals. Among the participants were ten surgeons and four theater assistant nurses.
Mr Jimi Coker….demonstrating

Despite been in existence for quite some time, surgical stapling techniques has only recently become available in the country and one of the aims of the workshop according to Onakoya is to help surgeons become more conversant with it both using animal models and in real life operations.

“I believe we can’t afford not to align the quality of Surgical practice in Nigeria with global standards and that is why Lagoon Hospital , in partnership with Johnson and Johnson, is organizing this workshop. I must add that Johnson & Johnson has been a willing partner in the training of surgeons and other operating room personnel and has consistently made both technical and human resources available in this regard. “

Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds, and also to reconnect the ends of the bowels or other such organ after parts of it has been excised .
Stapling is much faster than using sutures, and also more accurate and consistent. In bowel and lung surgery, staples are primarily used because staple lines are less likely to leak blood, air or bowel contents.

“The devices are also used to dissect the bowel and the surrounding structures for example in tumor or cervical surgery. After the diseased part of the bowel is resected, the two adjoining ends are brought together and stapled. This part of the operation had conventionally been done by stitching the two ends together using sutures. Using staples ensures that the procedure is faster, of a much greater integrity and far less likely to leak” Onakoya emphasized.

According to statistics, the entire procedure using staples has lower morbidity than conventional approach.

Surgical conditions are defined as “conditions that require suture, incision, excision, manipulation, or other invasive procedures that usually, but not always, require local, regional, or general anesthesia .

Surgical conditions constitute a substantial burden of disease. But how equipped are surgeons especially in developing countries to deal with this burden? Not a few Nigerians who travel abroad for surgical operations would be interested in the answers to this poser.

Truth is ,despite its importance, the place of Surgical conditions has been described as one of the “neglected diseases” disproport
ionately affecting the world’s poorest people. In the absence of health insurance, very few people can afford the quality of surgical operations they need even if it is available. So they settle for what is available which is often a game of chance. Nigerians are not left out in this game of chance.

So in the absence of the requisite skills, a surgical operation can go awry.

Professor Ade Elebute, Chairman, Hygeia Nigeria Limited himself an operating physician believe that one way to keep the standards of surgical practice high is to have as many formal training as possible for surgeons.

“Ordinarily surgeons are trained by apprenticeship or by word of mouth .But this form of training hasn’t been adequate so far. Surgical training shouldn’t be left to whims and chances. We should train surgeons not just by word of mouth but by seeing them do things with their hands”, he says.Mr Jimi Coker….demonstrating

While the advent of surgical stapling and availability of requisite skills in its handling portends greater confidence in Nigerian surgeons the non reusable nature of the equipment may stand on the way of access or affordability.

Mr Coker in Theatre

Mr. Gbenga Olatunji, Team Head, Johnson and Johnson said Johnson and Johnson at the moment have not found substantial evidence to support the sterilization of the equipment after use “hence we insist it is non-reusable”.

This was a major source of concern to most participating surgeons at the training especially those from public hospitals who have to deal with poor patients on a daily basis most of them needing surgical operations they can’t afford.

The issue of cost and affordability of staples soon opened another critical albeit sore point in Nigeria’s healthcare sector where in lies the antidote to lack of access to quality health care by poor Nigerians.

As if waiting to hammer home a long held feeling of disappointment Professor Elebute retorted: “one major tragedy that happened to medical care in Nigeria was the protest by doctors when the proposal for health insurance was made by Dr. Majokodunmi in the 60’s.The Nigerian Medical Association(NMA) fought against health insurance as at that time, we won the fight but it was a tragic win”.

Continuing, Elebute added that “the doctors were ignorant and could not wait to understand what they were fighting and protesting against and they say my people perish for lack knowledge, that lack of knowledge is costing us so much today”.

Elebute said that no country currently making meaningful headway in its health care sector anywhere in the world has done so without health insurance for its citizens adding that until all Nigerians can be covered by health insurance, the issue of affordability will always impede access to quality health care and by implication result in needless deaths.

While Nigerians continue to battle with implementing its national health insurance policy, Lagoon Hospital and Johnson & Johnson seems to be playing its role and that is: investing in building capacity of surgeons in Nigeria to make surgery safer, easier and less painful. Since this training is free of charge it should affect the cost of surgeries done here. But how sustainable that can be depends entirely on Nigeria and Nigerians.

Kingsley Obom-Egbulem is Executive Director and Chief Creative Officer, Health Communication and Development Initiative(HCDI) email contact is

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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