Plastic Surgery Camp March 2010 (Nigeria)

Report by Chantal Moues

The team consists of:
Cees Spronk, leader of the team and plastic surgeon
Rob Niemeijer anesthesioloog
Geke Hoeksma anesthesieassistente
Fatima van Klaveren, operation assistant
Chantal Moues, trainee plastic surgeon

Turmoil

The prospect of going to Mangu, Nigeria is tempestuous to put it mildly because of the turmoil between farmers and landowners in Jos, Plateau State, 80 kilometres from Mangu, resulting in serious fights. One week before departure the Dutch Embassy informed us that the situation was stable, which later turned out to be temporary. One of the plastic surgeons, however, decides not to go so that five well trained team member remain who leave positively and eagerly on 6 March ready for action.

Quiet arrival

Everything has been arranged properly. On arrival our regular attendant, Kefas, guides us through Customs and takes us to our bus. Kefas has become an odd job man after he became a nurse: management, finances, guide, ward doctor and surgery are part of his job. After a cordial reception we balance the twelve suitcases dangerously on the back seat of the sponsored bus, carrying beautiful texts such as “Cocin hospital and rehabilitation Centre”. It should be replaced, but still manages to takes us along enormous potholes to a small cloiser where we spend the first night. The next day we leave for Mangu, a journey of 300 kilometres. Army and police roadblocks delay our journey somewhat, but we do not notice any turmoil. In the bus we realize how grateful the local population is.

Unpacking and getting started

There is no time to rest. Enthusiastically we go to the hospital, where patients are queuing, glad to see us. Together with local nurses, Kefas and a doctor Cees and Chantal screen 90 patients: 59 of them are placed on a list. Some patients are asked to return in November for a special treatment to their genitals to be carried out by the present doctor present then. Cees operated upon many patients earlier: some come for the second or even third operation.

During the first days of our stay a Nigerian orthopaedic surgeon from Jos joins us, the son of a former leprosy patient who was treated by Cees. He will treat a number of complicated trauma patients. An ophthalmologist from Jos also stays in the hospital in the first week. He treats two patients with complicated peri-orbital defects.

It is great to see that this small institute, initially meant for disadvantaged leprosy patients and handicapped children, has now become a multi-disciplinary hospital. Because of the productivity of international and national teams an eye-centre, extra nursing units and an HIV-centre were added. The limited possibility for diagnostic radiology definitely needs further improvement.

When the patients are screened the operation theatre is cleaned according to Dutch standards. The material brought with us is strategically put in cupboards. Unfortunately the autoclave, imported by Cees, still does not function. This week we decide to order a new one.

Till then the instruments had been cleaned in a small kettle on open fire. The air conditioning also malfunctions and the operation theatres should be improved. In the course of the week Cees develops his plans for a new operation complex. Sponsoring via Interplast, the Faridpur foundation and America might realize this new complex.

Operations

For nine operation days we have 59 patients. Age and seriousness of the disease determine the order in which we operate. In the first week we see another 18 patients who had to travel an enormous distance. Some of them come from the South coast of Nigeria, which is 400 kilometres. The first week patients who were seriously ill were operated upon, for instance the sixteen-year-old boy with circular burns on both legs.

He had been in hospital for six months without any operations. During the first operation we only cleaned the wounds and did some skin transplants. Then we gave blood transfusions. He was optimised after which we cleaned the wounds (under a regional blockade) that same week. One week later he had another operation. The necessary devices for further treatment were left behind together with instructions for the local doctors. We did 77opeartions: 9 schisms, 44 burn contractures and 24 other diseases.

Gratitude

Time flew. We worked hard to help many patients. Mentality in Nigerian is immense, notwithstanding the poverty. We felt welcome and protected in this turbulent time. There is clearly an upward spiral in the developments concerning the Cocin hospital run by local doctors and nurses who with international aid can achieve much for seriously burnt patients.
This is the answer to the general negative adagio that many Dutch people have: THIS IS NOT A DROP IN THE OCEAN, BUT AN ENTIRE TIDALWAVE!

Noordwijk, April 2010
Chantal Moues