Hospitals in the bush

[naijababe]

Since 1983, surgeons working in rural Ibarapa district of Oyo state, have done over 11,900 surgeries armed with nothing but the most the most basic and sometimes unthought-of equipment.

Dr Oluyombo Awojobi is one of four general surgeons who coopted some junior colleagues in rural-urban slum practice to form the Association of Rural Surgical Practitioners of Nigeria with 14 foundation members in 2008.

Last week, he picked up an award for rural-based health workforce achievers on behalf of the association for its work where there are no doctors.

Five more awards were offered to healthworkers in similar circumstance in different rural areas and urban slums around the country: Deborah Badu, a junior community health extension worker for her work helping build an outreach programme to cover 18 villages in Fuka Munya, Niger; and Yagana Wali, chief nursing officer of a 20-bed clinic providing antenatal care, immunisation and community empowerment in rural Borno.

Others are Zulai Sani, a community health extension worker in Machina, Yobe; and the National Primary Healthcare Development Agency for its Midwifery Services Scheme which has dispersed nearly 2,500 midwives since 2009.

The awards were presented by the federal health ministry and its development partners, including UKAID, USAID, the Carter Centre, PATHS II and others.

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Inspired by war

Delivering healthcare to millions of patients in rural areas remains difficult, but few healthworkers are stepping up to the plate—and fewer still are being recognised for it.

After training at University College Hospital, Ibadan, Dr Awojobi became a rural surgeon in 1983 in Eruwa, where he started rural practice on land provided by the locals.

Apart from a first trip overseas in 1995—12 years after becoming a rural surgeon and 20 years after becoming a medical officer—he did his entire training in Nigeria, inspired by the notion that his world-renowned teachers could train their kind at home and a confidence that he could one day hold a lecture using only materials homegrown in Ibarapa district "with no foreign influence whatsoever," he once said in a guest lecture on rural surgery at Olabisi Onabano University.

The third inspiration was something called the Red Devil, a Biafran tank deployed in battle from Aba, where it was made, until it got stuck at Ore during the Civil War.

"I had inspected the disabled Land Rover-turned-battle tank at Ore and concluded that Nigerians could solve all their problems with little or no external help," Awojobi said.

But a surgery practice in the bush faced problems of water supply, electricity, sewage disposal and getting basic equipment.

Public water supply was unreliable, a 90,000-litre overhead reservoir couldn't provide water round the clock and the hospital used "bowls and buckets for most part of the day," he remembered.

The rural surgery overcame its water problems by harvesting rainwater using extra reservoirs and wells and pumping it through the hospital so it doesn't depend on municipal supply today.

It also dammed a section of a stream that runs through the clinic and populated the dam with fish to control mosquitoes.

One of two generators installed in 1970 broke down eight years later and its parts were cannibalised to maintain the second. And a 5KVA generator the clinic bought for N6,000 from operation fees and an appeal fund provided essential lighting but couldn't power the x-ray machine.

The doctors have gone around lighting problems today by constructing the clinic's new site with large windows "so that natural lighting is adequate to perform surgery in the daytime," according to Awojobi. Good ventilation removes the need for fans and airconditioners.

The clinic still uses inverters to power itself from direct voltage of car batteries, and is hoping one of its own will give it the solar panels it needs.