In April 2005, I made my sixth trip to Nigeria, West Africa to participate as a medical volunteer. My particular project in Nigeria the past few trips has been to set up and administer diabetes-screening clinics at a number of hospitals around the country. This year my colleague Harlan Lahti, a pharmacist from Vancouver, British Columbia, and I set up clinics at Bauchi Specialist Hospital and Gombe Specialist Hospital, two state hospitals located in the eastern part of the country.
Practicing as both a clinical and natural pharmacist, I am always interested
in how professionals can better manage disease states with a more integrative
approach. This approach includes a successful balance of drug use with diet,
nutrition, exercise, supplements, and other complementary methods that help
the patient achieve a better sense of well-being. The concept is just as valid
in Nigeria as it is in the United States. Diabetes is a worldwide epidemic disease
and a very appropriate disease state to approach in this way.
For this special project in diabetes training, education, and
testing, we allocated more than two dozen FreeStyle and Accu-Chek
blood glucose monitors. Many of these valuable glucose monitors were donated
to me by Global Links, a Pittsburgh-based, charitable organization that
recovers surplus medical supplies, equipment, and furnishings in good condition
to redistribute to hospitals in third-world countries. We had to purchase the
glucose strips and lancets that were not generously donated by the manufacturers.
In addition to ancillary diabetes-testing equipment, we also took with us 5,000
doses of Metformin 500-mg tablets and about 4,000 glyburide tablets.
These were
all donated to the Chief Medical Director (CMD) of each hospital to distribute
to needy patients at no charge. Admittedly, the amount of diabetes medications
we could carry with us was miniscule compared to the need, but we had hoped
that each patient who had severe diabetes and could not afford to buy the needed
medication would at least be given a free supply for a month or two to get started
on the right track.
The Clinics
The opening day of our screening clinic at Bauchi Specialist Hospital
was met with fanfare and excitement. The local Nigerian radio station had previously
aired announcements regarding the free diabetes-screening clinic being set up
on the first Monday following our arrival. The response was unbelievable. Nearly
200-300 people showed up the first day and crammed into an outside tent structure
set up near the office of Chief Medical Director, Dr. Mohammed Bacu.
Before
we began the screening clinic, we had briefly trained a few doctors and pharmacists
who were very willing to assist us in screening the large number of patients.
The late morning was hot, nearly 100 degrees. Although the crowd was somewhat
orderly, everyone was clamoring to be first in line to have their finger pricked,
a blood sample taken, and a reading taken from the glucometer. Small record
cards were given to each patient so they could keep an account of their scores.
Many of the patients (ages 20-80) were getting their blood glucose
checked for the first time in their lives. I would estimate that about half
the crowd knew they were diabetics and were on medication or insulin, but about
half had no idea.
The screening proved invaluable to a high percentage of the
people. We made notes on the back of the record cards of those who registered
with high glucose readings, signaling them to see the doctor and go to the hospital
diabetes clinic the following day to get their free drugs. The screening went
very smoothly.
After we completed the screenings, we were whisked off to a new
section of the hospital that was, for the first time, designated the home of
The Diabetic Association of Nigeria (DAN). To my surprise, the hospital administration
asked me to cut the ribbon to dedicate the new section reserved for diabetes
training, testing, and education. A plaque was erected at the door of the new
clinic reading, “Dedicated by Dr. Dan T. Wagner, April 12, 2005.” I was quite
moved by the honor. After a photo session and an interview with local and national
Nigerian news media, we were taken on a tour of the rest of the hospital.
I had personally volunteered in this hospital eight years prior
to this trip. At that time the hospital was in dire straits: no running water,
poor sanitation, inadequate lighting, lack of medical equipment, and a hospital
pharmacy with many more empty shelves than ones filled with drugs and medications.
The positive changes the hospital had experienced since that time were truly
remarkable.
The roadways around the hospital were newly paved; the pharmacy
storeroom was better stocked with drugs; new wards had been built and adequately
equipped; and sanitation had greatly improved. The staff was well trained and
moral was high. This miraculous transformation of the hospital is due solely
to the caring efforts of the governor, His Excellency Ahmadu Adamu Mu’azu. Governor
Mu’azu is a man I have personally known since I began traveling to Nigeria eight
years earlier (before he was elected governor).
Since his election victory five
years ago, he has transformed Bauchi into a “flower in the desert” by vastly
improving the schools, the roads, the libraries, the hospitals, and the general
infrastructure of the state. Considering Nigeria is a country with many, many
poor people, it is comforting to know that in a few of the 36 states government
leaders are committed to improving the health care of the people. Bauchi Specialist
Hospital is now a model for all of Nigeria.
After a very successful diabetes-screening clinic at Bauchi, we
were off to Gombe Specialist Hospital, located about three hours east of Bauchi.
The topography along the way was dry savannah. For the first time we saw huge,
ancient acacia trees dotting the landscape. The few rivers that the well-paved
highway bridged over were dry as a bone. The rainy season comes to Nigeria during
late April and early May, and lasts up to three months. It will not rain the
remaining nine months of the year. We were probably one to two weeks away from
the rains.
Gombe Specialist Hospital is located in the middle of the crowded
and dusty city of Gombe. Much like Bauchi, the governor and deputy governor
of this eastern state are very progressive. They are spending millions of Nigerian
naira (one U.S. dollar equals about 135 nira) to improve the infrastructure.
There is also a genuine commitment to the betterment of the hospital. I had
been to this hospital on my initial trip to Nigeria over eight years ago, and
the changes have been miraculous.
We had planned a two-day diabetes-screening clinic at the hospital,
but because of the kind (but forceful) persuasion of the deputy governor (His
Excellency Atiku Abubaker), we agreed to perform a three-day clinic. It went
extremely well. The assistance afforded us by resident physicians, pharmacists,
and nurses was gratifying. Each morning we arrived to find hundreds of people
waiting outside in the hot sun, eager to get into the clinic to get their blood
glucose taken, along with their weight and blood pressure.
We decided to meticulously record data on each patient we serviced.
We recorded their age, weight, blood glucose number, and whether or not they
knew they were diabetics. It was interesting to review the results of hundreds
of patients. Generally, we discovered a higher-than-normal rate of adult-onset
diabetes (NIDDM), especially in men in their 30’s and 40’s. It would be premature
to establish what the main cause could be. I suspect that they have a predisposition
to diabetes from heredity; however, their diets are high in starch (mainly from
potatoes and cassava), with a lack of vegetables, higher-than-normal sugar use,
and most disconcerting, a heavy consumption of sugar-laced soft drinks, including
Coca-Cola and Fanta.
Keep in mind that in any third-world country (I imagine
even in our own country), you would rarely drink tap water. So if they can afford
it, many people will buy purified bottled water. But it is disturbing to discover
that bottled water in Nigeria is actually more expensive than Coca-Cola. Many
Nigerians consume 2-8 bottles of soft drinks a day. There is little doubt in
my mind that this practice is a contributing factor to the high incidence of
diabetes.
It was very helpful to the team of doctors, nurses, and pharmacists
at Gombe Specialty Hospital that we were able to leave behind a dozen meters
and hundreds of glucose strips and lancets. Nigerian hospitals do not have access
to such technology, so screening patients before surgery, screening women in
labor, or just identifying those patients with diabetes is extremely difficult.
In the end, we had the professional and personal satisfaction
of knowing our team saved lives. Since the inception of our diabetes program
four years ago, no patient has died of ketoacidosis or diabetic coma in the
hospitals where we have instituted a screening clinic. This is solely because
the hospitals now have the means to identify patients at risk for diabetes.
This is truly what our medical mission is all about.
Brand Development Manager of DeeDoo Nigeria, Erdoo Apeh, revealed this while briefing newsmen as part of the organisation’s activities to mark 2012 World Diabetes Day Awareness Campaign today.
She said this year’s theme, Protect our Future, was apt in view of rising cases of people living with diabetes and deaths arising from complications of the disease.
Apeh said: “Diabetes is an emerging epidemic that can be linked to obesity, physical inactivity and diet; those most frequently affected are aged between 35 and 64.
“Diabetes can damage the heart, blood vessels, eyes, kidneys and nerves.
“Nigerians are at risk of having the disease because of their life style, eating habits and nonchalant attitude towards comprehensive and routine medical check-ups, hence this awareness campaign.”
Erdoo further noted that as part of its social responsibilities, her organisation would take the campaign to some schools in Benue State, where provision of customised educational materials on the disease, it’s management and medical advises would be distributed free to the pupils.
She said: “We hope that this awareness campaign would go a long way in sensitising our children who are our future to start developing habits which would ensure healthy lifestyle now and for the rest of their lives.”
Source: Vanguard news Nov. 2012
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