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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:

 

a)

An ophthalmologist

b)

An obstetrician-gynecologist

c)

A dentist

d)

A radiologist

e)

Two full-time surgeons

f)

An anesthesiologist

g)

Two internists

h)

A pediatrician

i)

A psychiatrist

 

 

 

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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