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EMMF:
Making a Difference in Nigeria
An open letter from Dr. Okeke
An Open Letter from Nlogha E. Okeke, MD, LMCC, FICS, FACS, FWACS -
Surgeon-in-Chief and Medical Director, Eastern Nigeria Medical Centre
The seed of establishing a private hospital
that could help improve the standards of medical practice in Nigeria was sown
in my mind by the late Dr. Samuel E. Onwu, the then Chief Medical Director in
the former Eastern Region of Nigeria, presently consisting of nine separate
States with a total population of 17 million.
This was in 1957 when he visited Boston where I was undergoing my
postgraduate surgical training (residency) in the Third Surgical Service of
Boston University. He challenged me to
promise him that I would build a hospital in Eastern Nigeria to demonstrate to
existing hospitals, especially government hospitals, higher standards of
medical practice. The hospital he
envisaged would cater to the poor. I
accepted this challenge before him prior to his returning to Nigeria.
Because of the implications of this
challenge, I started thereafter to discuss the project with my friends,
lecturers in Boston and the late Rt. Rev. Norman Nash, the Episcopal Bishop of
Massachusetts. By 1960, after I had
passed the American Surgical Board examination, the Nigerian - American
Hospital Foundation was formed. (I have
enclosed the brochure about this foundation.)
Prior to my leaving Boston for Nigeria towards the end of 1960, the
Foundation was able to raise large quantities of all types of medical equipment
and raised enough funds to ship these to Nigeria. On my return to Enugu (Nigeria), I presented my plan to the
Government of (the) Eastern Region of Nigeria.
After a thorough study of my programme, the Government leased to me an
11-acre site and stood surety for the 20,000 pounds I borrowed from a
Government owned bank on April 24, 1961, for the construction of the Eastern
Nigeria Medical Centre. In 1963, the
Premier of Eastern Nigeria, the late Dr. Michael I. Okpara, opened the hospital
to the public. On May 11, 1965, the
hospital was registered with the Federal Republic of Nigeria under the Land
(Perpetual Succession) Act, Cap 98 as a Voluntary Agency hospital. The registered Trustees of the hospital
were:
Dr. Samuel E. Onwu - The late Chief Medical Director of Eastern
Region of Nigeria
Prof. Kenneth Dike - The
late Vice Chancellor of Ibadan University
Mr. William Gordon - The then Director of United States
Information Service (USIS) in Enugu.
Chief James C. Okeke - who donated ophthalmology equipment still
in use in the Eye Clinic
Dr. Nlogha E. Okeke - Medical Director, Eastern Nigeria Medical
Centre
Mrs. Ifeoma E. Okeke, BS, MBA - Secretary and Director of Nursing
Services, Eastern Nigeria Medical Centre
Mr. Godwin E. Onyemelukwe - The late hospital administrator,
Eastern Nigeria Medical Centre
THE REGISTERED AIMS AND OBJECTIVES OF THE HOSPITAL
“To provide for all manner of people, a charitable non-profit
voluntary hospital to be established and managed at Enugu and know as Eastern
Nigeria Medical Centre.” (Official Charter of ENMC)
ASSISTANCE RECEIVED FOR THE HOSPITAL
1. The then West
German Government donated many hospital equipments.
2. The British
Government donated a blood bank.
3. Seven U.S. Foundations
donated different types of medical equipments.
One of the Foundations donated two sets of dental equipments.
4. The Nigerian
Tobacco Company donated many types of diagnostic equipment and an anesthesia
machine.
5. The Nigerian -
American Hospital Foundation donated beds, operating room equipment, maternity
and ward equipment including incubators.
6. The Canadian
Government sent a technician who was in charge of the diagnostic laboratory,
The young hospital really enjoyed broad sponsorship.
Before the U.S. Government made a decision
to send Peace Corp volunteers to Nigeria, I was invited to Washington, D.C., to
discuss the project. The hospital later
became a centre for treatment of all Peace Corp volunteers sent to
Nigeria. We trained two U.S. doctors
who took care of the Peace Corp volunteers in Eastern Nigeria.
The hospital facilities were used by the
World Health Organization (WHO) for the treatment of children suffering from
malnutrition. Bags of powdered milk and
vitamins were supplied to us for treatment of these children. The milk and vitamins were given out free to
the mothers of children whenever they brought their children to be examined and
treated. We were also responsible for
the medical treatment of the U.S. Consulate staff in Enugu including the USIS
staff. We also treated the staff of the
British High Commission and the Israeli companies in Eastern Nigeria.
CONTRIBUTIONS BY THE (NIGERIAN) GOVERNMENT
Apart from guaranteeing the building loan,
the government gave grants to the hospital to cover doctors and nurses
salaries. Some of the Honourable
Ministers of the Eastern Region Government gave personal voluntary donations
towards the completion of the buildings of the hospital.
U.S. DOCTORS THAT WORKED AT THE MEDICAL CENTRE
The first dentist that opened the Dental
Clinic was a lady dentist from the U.S.A. who worked here until the beginning
of the civil war in Nigeria. Between
1963 and 1965 we had groups of doctors and nurses who volunteered and came in
every summer to work here so that our own staff could go on leave. A retired radiologist from the U.S.A.
volunteered his services and worked here for two years. We had also other staff from the U.S.A. viz:
two physicians, who worked here for two years.
One of them is Dr. Terence Hardly, practicing at Jefferson County
Medical Centre, Louisville, KY. His
wife Susan also worked with us as a nurse supervisor. They gave very committed service to the hospital. Before the onset of the Nigerian Civil War,
we had twelve expatriate specialist doctors who worked here. During this period, we could not accommodate
all patients who came to the hospital.
THE PATIENTS SEEN IN THE OUTPATIENT DEPTARTMDENT AND PATIENTS
ADMITTED INTO THE HOSPITAL
From 1963 to 1966, the number of patients
seen in the outpatient department was over 300 daily. The Emergency department was very busy from 2 P.M. to 8 A.M.
daily. The hospital enjoyed full bed
occupancies totaling ninety-eight beds for paediatrics, maternity, surgical and
medical cases. We had to refer cases to
other hospitals for admission. During
this period, we were regarded by the public as the best equipped and managed
hospital with a good cadre of medical specialists compared to other local hospitals. This was gratifying because the late Dr.
Onwu’s challenge, earlier mentioned, was met by the hospital.
In 1965, the Government of Eastern Nigeria
appointed me the Chairman to start a University Teaching Hospital in
Enugu. The Eastern Nigeria Medical
Centre, the Government General Hospital and the Park Lane Government Hospital
were the three hospitals that constituted the Teaching Hospital until a
permanent site could be chosen and built up as a Teaching Hospital. With the onset of the Nigerian civil war
(1967), Enugu was evacuated. After the
civil war (1970), the Government General Hospital was developed into the
present University of Nigeria Teaching Hospital - Enugu. From 1989 to 1993, I served as the Chairman
of a Task Force to complete the building of the Teaching Hospital at the new
site.
THE FATE OF THE EASTERN NIGERIA MEDICAL CENTRE AFTER THE CIVIL WAR
IN NIGERIA, 1970.
At the end of the civil war, the old
Anambra State Government forcibly occupied the Eastern Nigeria Medical Center
and turned it into a psychiatric hospital.
All our efforts to retrieve our equipment and documents from the
hospital failed. The hospital was
misused, and all the equipment was looted.
In response to my appeal, the then Head of
State, General Olusegun Obasanjo ordered the Military Governor here in Enugu to
vacate the hospital and to hand it back to me.
We took back the hospital from the State Ministry of Health in November,
1976. The Government could not account
for any of the medical equipment in the hospital. All the charts on patients and research records we accumulated
since 1963 were burnt. All our efforts
went painfully down the drain. The
buildings were in a deplorable condition.
The toilets were blocked, and the toilet seats and covers vandalized. We spent more money to rehabilitate the
hospital than the amount used to build it.
We had to start from scratch. We
were able to employ expatriate medical consultants to head each department in
the hospital. We received voluntary
contributions from friends and relatives.
The Presiding Bishop’s Fund for World Relief, New York, donated a blood
bank and a portable ultrasound machine to us.
Gradually, both the inpatients and outpatients increased. By 1985, we saw over 20,000 patients in the
outpatient department. All the hospital
beds were fully occupied. Often we
could not accommodate all patients needing admission. From 1984, the Nigerian economy started to go sour. The full effect could be felt from
1990. Many companies could not pay for
treatment of their staff. Villagers
could not pay for medical treatment.
MAJOR PROBLEMS CURRENTLY FACING MOST NIGERIAN HOSPITALS
1. Inability of
Patients to Pay Their Medical Bills:
There is a high unemployment rate, and
Nigeria is adjudged the second to the last country with the lowest per capita
income in spite of its oil wealth. Many
of the citizens have an annual income of US$250. This has led to patients coming to the hospitals in the terminal
stages of illness after trying at home all types of medications and prayer
houses.
2. Lack of Diagnostic
Equipments:
This has adversely affected the treatment
of patients. Presently, in the various
Eastern group of States with a population of 17 million, we have no functioning
C.T. scanner. If we are able to get one
here, we will get patients from all parts of Nigeria. Attached to this letter is the complete list of equipments we
need (See Appendix A).
All the above problems are badly affecting the effectiveness of
the Eastern Nigeria Medical Centre.
3. Inability to
Secure Medical Specialists
Prior to 1985, the Eastern Nigeria Medical Centre had the
following types of medical specialists in the various departments. These were:
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a) |
An ophthalmologist |
b) |
An obstetrician-gynecologist |
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c) |
A dentist |
d) |
A radiologist |
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e) |
Two full-time surgeons |
f) |
An anesthesiologist |
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g) |
Two internists |
h) |
A pediatrician |
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i) |
A psychiatrist |
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Presently, we have a surgeon (Dr. Okeke) and
an anesthesiologist (Dr.Uchefuna) on full-time basis. The other medical specialists are on a part-time basis.
Most come to the hospital two to three times a week, mostly in the
evenings. This has adversely reduced
the number of patients who come to the hospital. To improve our services, since we cannot fully finance such
needed service, we need medical staff who can come to work here as
missionaries. It is mostly in Roman
Catholic hospitals in Nigeria that one finds medical expatriate missionary doctors.
If any Foundation can donate U.S.$5,000
per month or U.S. $60,000 per year, we will be able to employ five Nigerian
specialists on a full time basis in different fields of medicine. Some of the Middle East countries are
attracting Nigerian specialists who work there as they are well paid in U.S.
dollars and given free accommodations and also granted annual paid
vacations. The benefits include also
free round trip airfare to Nigeria and back to their stations. If we can raise US$1000 per month as salary,
we will be able to employ Nigerian consultants to work full time here. We need consultants in the following
departments: Internal Medicine,
Radiology, Obstetrics/Gynecology, Ophthalmology and General Surgery.
Because of the standard of medical practice
in our hospital, we were the first private hospital in Nigeria approved by the
Dental and Medical Council in Nigeria to train two interns every year.
I think it is important to mention that
90% of our patients come from the rural areas surrounding Enugu.
4. Addressing the
Shortage of Patients: The Hospital
Fellowship Progamme
When the hospital was returned to our
control in 1976, we started a nondenominational Christian fellowship
programme. All the staff of the hospital
and ambulatory admitted patients attend the fellowship programme every
morning. All admitted nonambulatory
patients are visited for fellowship at the bedside by representatives of the
fellowship programme. Some patients and
their relatives have publicly accepted Jesus Christ right here in the
hospital. Some have attributed their
recovery to prayers of intercession received here. This is one of the most encouraging programmes in the
hospital. Many hospitals presently are
starved for patients because of the poor economy, but we still get patients
from villages and towns. We thank
God. This is all due to God’s support
of the hospital.
FUTURE PLANS FOR THE HOSPITAL
At present, only the affluent can afford to travel overseas for
treatment and for many diagnostic sevices.
Our aim is to turn the hospital into a major diagnostic centre in the
Eastern part of Nigeria. To achieve
this goal, we need the basic equipment shown below:
C.T. Scanner
Radiotherapy unit
Mammographic X-ray machine
A diagnostic X-ray machine capable of
carrying out all radiographic diagnostic procedures.
Laser ophthalmologic equipment to enable
us to surgically treat cases of glaucoma, cataract and pterygium.
We desire that this hospital will become a
center of excellence for the diagnosis and treatment of glaucoma. Once we can mobilise the necessary equipment
and staff, the hospital will be able to depend on its own resources.
The incidence of carcinoma of the
prostate, breast, colon and uterus is common in Nigeria. A radiotherapy unit is needed for treatment
of advanced cases. Only the very
wealthy families can afford treatment overseases. If we have a C.T. scanner, then it will be possible to thoroughly
evaluate cases seen here in Nigeria.
UPDATING MEDICAL KNOWLEDGE SEMINARS
Following the opening of this hospital to
the public in 1963, we paid attention to having a well-equipped medical library
to serve the needs of doctors and professional staff. We subscribed to forty different medical journals and subscribed
to pediatric, surgical, medical, obstetrics-gynecological cassettes
yearly. Once a year, we organised
seminars in which we chose specialists from all parts of Nigeria to present
papers at the seminar. We underwrote
their traveling and hotel expenses in Enugu.
This we did to encourage participation.
The first seminar on carcinoma in West Africans was held in this
hospital. During the civil war, we lost
all the papers on the seminars held here.
Due to the downturn in the Nigerian economy, we cannot now afford the
money to subscribe to medical journals and cassettes. Of course we stopped the sponsorship of seminars very long ago
due to cost constraints. One of the
deficiencies in medical educyaion and training of doctors in Nigeria is the
updating of their medical knowledge.
REESTABLISHING THE NIGERIAN - AMERICAN HOSPITAL FOUNDATION
The old Nigerian-American Hospital
Foundation is no longer functioning. It
is very important to form a new and very active Nigerian - American Hospital Foundation
in the USA under the Episcopalian Church.
May I offer some suggestions with regards to the membership of the Board
of the Foundation and an Advisory Committee?
I. Foundation Board Members - Nine in
Number
1. The Bishop or any
other person nominated by the Bishop of Maryland.
2. The Rev. Daniel F.
Crowley
3. Mrs. Ona O. Orike,
Esq. - she is a registered practising attorney in Uniondale, New York, as the
Secretary to the Foundation.
4. Two
representatives of the Episcopal Medical Missions Foundation.
5. Mrs. Ifeoma Eunice
Okeke, Graduate of Simmons College, Boston, and Suffolk University, MBA.
6. Robert Gauthier-
Vice President General Services, St. Luke’s Hospital, 101 Page Street, New
Bedford, MA 02740
7. Mr. Reuben Mbadiwe
Okongwo - Pharmacist, 1055 Tremont Street,
Boston, MA 02120
8. N.E. Okeke, M.D.
II. Membership of the Advisory Committee to
the Board
1. Chuddy Nwachukwu,
MD, FACS, a Nigerian Surgeon in California.
Jasmine Avenue, Culver City, CA
90232
2. Rev. Prof. Canon Ilogu, Anglican
Priest, resident in Maryland
3. Dr. Okey Mbadugha, BUCKS, P.O. Box
1632, New Brunswick, NJ 08903.
Other members to
be chosen by the Board.
I am suggesting that the Foundation, when
established, will in the future sponsor the establishment of bi-annual seminars
in Enugu. The speakers will come from
well-known medical specialists from the U.S.
The papers and discussions at the seminars will be on cassettes to be
sold to doctors in Nigeria. This will
contribute immensely towards updating the medical knowledge of doctors and
medical students in Nigeria.
Mrs. Okeke and I are ready any day we are
called to speak to different groups under the Episcopal Medical Missions
Foundation and to organise and establish the Nigerian - American Hospital
Foundation or any other name acceptable to the board members. The formation of a tax deductible foundation
would facilitate fund-raising since any donations may be tax deductible.
We pray for God’s guidance in considering the above proposals.
Yours sincerely,
-Signed-
Nlogha E. Okeke, MD, FACS
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