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EMMF:
Making a Difference in Nigeria
A site visit to the Eastern Nigeria Medical Centre
SITE VISIT
Thomas E.
Williams, M.D., Executive Director of Episcopal Medical Missions Foundation
(EMMF), and Peggy Williams, RNC (Public Health) visited the city of Enugu,
Nigeria, at the invitation of Nlogha E. Okeke, M.D., Medical Director and
Surgeon-in-Chief, Eastern Nigeria Medical Centre. during the dates of Jan.
15-21, 2000.
The Purpose of
the visit was to inspect the Eastern Nigeria Medical Centre (ENMC), 30, Amaigbo
Lane, P.O. Box 38, Uwani, Enugu and to discuss with the medical staff the needs
of the Centre.
Preparation: The condition of the Eastern Nigeria Medical
Centre (ENMC) and the plight of the people of Nigeria were first brought to the
attention of EMMF by The Rev. Daniel F. Crowley, Assistant Rector of St. John’s
Episcopal Church in Ellicott City, Maryland, and some Nigerian expatriates and
others who have experience with the conditions in Nigeria in general and with
the ENMC in particular: The Rev. Canon
Dr. Edmund Ilogu, Christian N. Nwankwo,
Jr., M.D., M.P.H., Drs. Peter and Lois Wilson, The Rev. Canon Jerome O.
Nwagbaraocha, Dr. Manny C. Aniebonam, Ephraim E. Oduche, Mr. and Mrs. Chike
Erike, Dr. Okey R. Mbadugha, and Sonni Aribiah. They formed the core of an informal group called “Friends of
ENMC” and over a span of 12 months met three times with Dr. Williams and once
with Dr. and Mrs. Okeke, to review the current status of ENMC and to plan the
visit of a representative of EMMF to conduct a site visit and needs assessment
at the Enugu facility. Both
site-visitors are active in foreign missions and have current diphtheria, tetanus,
polio, influenza, and hepatitis A and B vaccinations. For this visit they received vaccinations for yellow fever and
typhoid fever. Cloroquine-resistent
falciparum malaria is endemic to Nigeria.
Malaria chemoprophylaxis was mefloquine HCl. Visitors should be aware that Dengue Fever is endemic and
should wear appropriate clothing and mosquito repellent.
Travel: Visas are required and may be obtained from
the Embassy of the Federal Republic of Nigeria, 2201 M Street, NW, Washington,
DC. An application is required and can
be faxed to the recipient by calling the embassy at (202) 986-8400 and (202)
822-1522. The application requires a
passport-sized photo and must be accompanied by the visitor’s passport, a copy
of a letter from the host in Nigeria, and a copy of a round-trip ticket. The embassy staff is cooperative and will
accept the application by Federal Express.
There are daily flights to Murtala Muhammed Airport in Lagos from
Europe, and the airport is served by Lufthansa (United Airlines), KLM, and Air
Italia among others. There are no US
carriers to Nigeria. The site-visitors
began their trip at 4:30 PM on Thursday, January 13, 2000, and flew on United
Airlines from San Antonio to Chicago and on to Frankfurt where they transferred
to Lufthansa for a non-stop flight to Lagos, arriving at 8PM on the following
day. They were met at the airport by
Dr. Okeke and escorted to the Sheraton Hotel-Lagos where they stayed
overnight. (It is recommended that
visitors read the latest State Department advisory available on the internet
before traveling to Nigeria and register at the American Services Center of the
U.S. Embassy, 2 Eleke Crescent, Victoria Island in Lagos before traveling into
the interior of the country. The
following morning, Saturday, January 15, 2000, they flew to Enugu on
"local carrier EAS Airlines. They
were met by Mrs. Okeke and escorted to Valley-Inn Guest House, 4 Chime Lane,
G.R.A. (off Abakaliki Road), phone (011) 234-42-257-471, fax (011)
234-42-254-286. The rooms are
air-conditioned with window units. TV
(dish satellite) was provided.
Programming included CNN (European edition). Plumbing was adequate. Water pressure and electricity were
intermittent. This bed and breakfast
also has a full restaurant with excellent food. (The owner is Wilda M. Okeke, RDA, an American who is married to
Dr. Okeke’s twin brother.) All ground
transportation was provided by Dr. Okeke so that no experience was had with
taxis or buses.
Climate:
The climate is tropical, i.e. hot and humid.
Daily Itinerary While in Enugu, Nigeria
Sunday, January 16, 2000
Attended Sunday
service (Morning Prayer) at The Cathedral Church of the Good Shepherd, Achi
Street, Independence Layout, Enugu, The Very Rev. Chike Nwizu, Provost. Attendance estimated at 500-600, music
provided by an electronic band, a Hammond organ, and ‘The Glorious Singers’, a
22-person choir (Ikechukwo Igbokwe, President, and Hyacienth Ogbu, Music
Director). Service from the English
prayer book of ?1628. Homiles were given by the Provost and by the Diocesan Bishop
of Enugu, The Rt. Revd. Dr. Emmanuel O. Chukwuma. The service lasted 4 hours.
Observed parishioners receiving their pledge boxes, received an official
Cathedral Church calendar for a ‘donation’ of $20, and watched a parishioner
present a goat for his alms. After the
service, were introduced to the Provost and Bishop by the Okeke’s and confirmed
that we had an appointment with the Bishop the following morning. Signed the Cathedral guest book and noticed
that The Rev. E.A. ‘Tad’ Bordenave, III, Director of Anglican Frontier Missions
(AFM), had also signed the guest book in the fall of 1999. (His newsletter of September 8, 1999
indicated that he was receiving immunizations in order to prepare for a trip to
Nigeria where he planned to visit with five bishops [Makurdi, Sokoto, Enugu,
Maiduguri, and Lokoja] there who, in partnership with AFM, want to begin
sending Nigerian missionaries to the Islamic countries of North Africa.)
Monday, January 17, 2000
Interview with Bishop Chukwuma, Diocese of
Enugu
Escorted to the
Eastern Nigeria Medical Centre by Dr. Okeke.
Arrived at the compound to find the hospital staff in Morning Prayer led
by Mrs. Okeke in the Commons.
Thereafter joined the housestaff on morning ward rounds in a women’s
ward and post-partum. Left the hospital
for our appointment with Bishop Chukwuma at Bishop’s House, Christ Church
Compound. Found the Bishop in
consultation with another Bishop and with Dr. Luke Umeh, FFAN, manager of the
agriculture division of the African Development Bank. Were ushered into the Bishop’s study where we described the lay
ministry of EMMF and explained our purpose for being in Enugu. Discussed the need to receive the Bishop’s
endorsement of our activities in Enugu which he indicated he would fax to Houston
when he returned from a trip that he was making that morning. Also requested routing and bank
identification information of his London account in order that EMMF might send
funds there for the Bishop to transfer to ENMC. The Bishop indicated that he would fax that information as
well. During the audience with the
Bishop we were often interrupted by phone calls from government officials
throughout Africa seeking his advice and consultation on issues ranging from
foreign debts to the AIDS epidemic. Completed the interview and retired outside for photos with the
Bishop. Lunch at Valley-Inn Guest House
and then returned to ENMC for interviews with department heads.
Dr. S. Ike, Head, Department of Internal
Medicine
Dr. Ike attends at ENMC on Monday,
Wednesday, and Friday of each week. He
is on call at home for ER consultations.
The most prevalent disease that he treats at ENMC is malaria which
clinically presents with headache, fever and pallor. Patients often understand the symptoms and treat themselves with
over-the-counter (OTC) medications e.g. Maloxine (pyremethamine and
sulfamethoxazole) or fancidar. Tylenol
and other analgesics are also available OTC.
Diagnosis usually requires CBC, ESR, and a thick prep. Most likely form is m. falciparum. WHO has a malaria lab in Enugu for rapid
diagnosis of m. vivax and m. malariae. Treatment is usually initiated with chloroquine injection or
orally (if the patient can afford it).
Second choice is fancidar; we are beginning to see chloroquine-resistant
m. falciparum.. If no response within 48 hours he uses third-line
treatment such as halofancrine p.o., followed by artesuccinate IV (costly) and
lastly quinine IV. When asked about the
use of mefloquine for choloroquine-resistant m. falciparum, he professed
to know of the medication but had little experience with the drug because of
its expense. Hypertension is also
prevalent among the patients at ENMC.
He follows WHO guidelines for the diagnosis which requires two
readings. For readings >140/90 (essential
hypertension) he prescribes anti-anxiolitics and no additional table salt. If >180/120 he admits to the hospital for
CBC, UA to rule out nephritis, BUN, Cr., CXR, and EKG and 2-D ECHO. Care is individualized and may involve the
use of alpha blockers (prazosine), ACE inhibitors (lisinotror), calcium channel blockers with furosemide, or
nifedipine.
Dr. Obiakor, Professor of
Otorhinolaryngology, Teaching Hospital, Enugu
Most common
diseases encountered include sinus and ear infections with mastoiditis. Requires either plain x-rays or CT
scan. Tomograms are not available in
Enugu.
Estimates that
there are 300 cases/year of laryngeal cancer in his referral area. Usually presents late with
lymphadenopathy. Only treatment is XRT
and that is not available in Enugu - only in Ibadan. To adequately diagnose laryngeal cancer, ENMC needs equipment to
perform direct laryngosocopy which is not currently available i.e. a
laryngoscope, biopsy instruments, and light source. Bronchoscopy is available but the only instrument available is a
rigid scope, and he would like a flexible one.
Cleft palates are
repaired not by ENT specialists but by maxillofacial surgeons who are only
available at the teaching hospital, Enugu.
Atresia of the auditory canal is treated
by him. He performs plastic surgery.
For the diagnosis
of deafness, audiometry is not available and audiometry technicians are not
available. Speech and hearing
consultations are available at the School for the Deaf that is 2-3 hours away
from Enugu. Hearing aids are not common
due to their expense.
Dr. Maduka-Okafor, Head, Department of
Ophthalmology
Dr. Maduka-Okafor is called for
consultations regarding about 100 cataracts per year of which 70% are senile
cataracts and 30% are associated with diabetes. There are approximately 100 cases of glaucoma, per year. Macular degeneration and retinal detachments
are best treated with laser therapy, but this is not currently available. Refractory errors are diagnosed with a box
of lenses and fitting markers.
Dr. Okoye-Uzu, Head, Department of
Dentistry
Dr. Okoye-Uzu
performs routine extractions and fillings with old equipment and not enough
sets to carry on an efficient practice.
Bridge and crown work is available from other dentists in Enugu. Dr. Okoye-Uzu would like to perform this
technique but would require a technologist to assist in making the
prostheses. Dental assistants in
Nigeria do not perform this procedure.
Dental hygienists are trained in Enugu.
Acute traumatic injuries are referred to a maxillofacial surgeon who
also attends at ENMC for tumor cases and mandibular recessions.
Dr. Onyeama, Head, Department of
Psychiatry
Dr. Onyeama
consultants at ENMC two or three times a week.
There is a psychiatric hospital in Enugu. The primary psychiatric illnesses he sees are depression, anxiety
disorders, affect disorders, and schizophrenia. Post-partum depression is also seen. For psychotic disorders, the patients are admitted to the
psychiatric hospital for electro-convulsive treatments. Major drugs used include tricyclic
antidepressants, prozac, haloperidon, trifluperazone, and chlorpromazine. The latter three drugs are usually too
expensive for routine use. Psychiatric
services at ENMC are hampered by the lack of psychiatric nurses, social workers
(only available at the local psychiatric hospital), and psychiatric
technologists. The service needs better
organization, Journal of Psychiatry, and funds to attend psychiatry meetings in
Africa where members of the Menninger Clinic from the US are often invited
speakers.
Tuesday, January 18, 2000
Escorted to the
ENMC by Dr. Okeke for a full day of interviews with key members of the hospital
staff, discussions with department heads and house staff, and inspection of the
laboratory, X-Ray Department, and operating theater.
Dr. Uchefuna, Head, Department of
Anesthesiology
Dr. Uchefuna is
the only member of the ENMC staff that resides at the hospital except the house
officers. General anesthesia is given
through a Boyle anesthesia machine using a mixture of vaporized halothane and
oxygen following standard pentothal induction.
Some procedures are performed under ketamine anesthesia, and spinal
anesthesia is performed with 5% Xylocaine or 1% Marcaine. Nitrous oxide is expensive and difficult to
obtain, but he would like to use it if available. He inserts the laryngeal tube but does not spray it. When he starts anesthesia he has a blood
pressure cuff in place and monitors with his stethoscope. He does not have a cardiac monitor nor a
pulse oximeter. Face masks and
endotracheal tubes are washed and
sterilized between cases and reused.
The anesthesia machine is in good condition, but the face masks and
bellows bag are reused. After multiple
uses they have to be discarded. Nurse
anesthetists are not used at ENMC but do practice in other parts of Nigeria.
Later we visited
the operating room and saw an operating table with a bucky. The halothane is a liquid poured into a
canister attached to the Boyle anesthesia machine. The bag to the machine was very old and was held together by
either masking tape or duck tape. In
the operating room was a generator for use when the electricity goes out. There were laryngoscopes with various sizes
of endotracheal tubes. They appeared to
be very old, not the disposable kind used in the U.S. One appeared to have an inflatable cuff.
Dr. Enweani, Head, Department of Orthopedics
Dr. Enweani is a
consultant in orthopedic surgery to the ENMC.
The National Orthopedic Hospital is in Enugu and provides physical
therapy services. His activities at
ENMC are devoted largely to acute traumatic injuries e.g. vehicular accidents
resulting in fractures and occasional dislocations, as well as sports and
occupational injuries. Vascular trauma
frequently requires saphenous vein engraftment. In the absence of vascular surgeons in Enugu, cardiovascular
surgeons usually perform vascular surgery.
Orthopedic abnormalities seen often at the hospital include vitamin D
deficiency rickets, clubfoot, equinus varus, genu valgus and varus. Unlike more developed countries, the average
life expectancy is 52.5 years for men and 54 years for women, so there is
little degenerative bone disease, the most common being hip deformities.
Dr. Sam Obi, Head, Department of
Obstetrics and Gynecology
Midwifery is
practiced at the ENMC. Dr. Obi is
called for emergency C-sections for pre-eclampsia and eclampsia as well as
ruptured uterus. Preeclampsia is
treated with aldomet, hydralazine, and diazapam. Magnesium sulfate is not frequently used as the close monitoring
that is required is not readily available at ENMC. Tubal pregnancies are a true emergency and peritoneal taps are
not employed for diagnosis. Most
frequently encountered gynecologic conditions include pelvic inflammatory
disease and sexually transmitted disease (There is an AIDS epidemic in many
parts of Africa). Gynecological
malignancies usually present as an abdominal mass and prolapsed uterus and
include adenocarcinoma of the ovary, choriocarcinoma and carcinoma of the
endometrium.
Interview with the House Staff, ENMC
ENMC was the
first private hospital to be approved by the Nigerian Medical and Dental
Council to train interns. Two are
trained each year. The current interns
are Dr. Modi (male) and Dr. Ndudinanti (female). Also joining us for our discussions with the house staff was Dr.
Anthony Ugwuoke, who had recently completed his internship and had remained on
at the hospital in order to work in the village clinics outside Enugu that the
ENMC operates (See Visit to the Village Clinic at Oduma, Wednesday, Jan. 19,
2000, which follows). When asked what
EMMF might do to enhance the teaching program at ENMC, the interns were quick
to point out that medical instruction is good in Nigeria and closely approaches
the caliber of that seen by Dr. Ndudinanti in England. Nonetheless these young physicians would
favor more exchange of physicians between Nigeria and more developed countries. While medical education is expensive and
most students cannot afford medical texts and journal subscriptions, the major
deficiency identified by the house officers is the lack of equipment in the
teaching hospitals which prevents them from acquiring proficiency with medical
techniques like renal dialysis, radiotherapy, and pulmonary function tests
(blood gas analysis). The interns
remarked that surgical pathology reports may take weeks to months to be
received. Mantoux testing for tuberculosis
is not universally available while equipment and reagents needed for prostate
specific antigen testing is not available in Nigeria.
Inspection of the Laboratory
We were escorted
through the laboratory by Mr. Chidi Okwuonu, Supervisor of Laboratories, and
the following instruments and other equipment were observed in operation: a single, binocular microscope with multiple
lenses up to 100X (oil immersion) with mirror reflection light source,
colorimetric spectrophotometer used for determination of hemoglobin, BUN,
creatinine, alkaline phosphatase, and bilirubin (approximately 10 renal and liver function studies are performed
daily, while other biochemical parameters e.g. calcium and electrolytes are
outsourced to another laboratory), hemocytometer for white blood cell and
platelet determinations (approximately 10-30 CBCs are performed daily),
equipment to prepare blood culture media, incubator for growth of
microorganisms.
Wednesday, January 19, 2000
Visit to the Eastern Nigeria Medical
Centre Annex, Oduma
We were escorted
to the ENMC where we met Dr. and Mrs. Okeke and traveled south toward Port
Harcourt and the remote rural village of Oduma. The trip required two hours by car. On the way we passed the ENMC Volvo ambulance with blue lights
and siren on taking a patient to the hospital.
Approximately 20 kilometers from Enugu we passed a piece of property
estimated at 20 acres surrounded by a large fence with numerous signs
indicating that this would be the site of a university hospital. There was little evidence of construction in
progress. About 30 kilometers south of
Enugu we encountered a road block of three soldiers with guns. Our driver slowed down, and we were waved
through without being searched. On the
way we passed through a small town (big enough to have a branch of The Bank of
Nigeria) called Nenwe. Oduma is a small
village of subsistence farmers who grow yams, other vegetables and palm oil for
cash crops. A farmer who has 200 palm
trees can make a profit. The money that
the farmers make is used primarily to buy food and pay for their children’s
education. Books are expensive. The Annex houses a clinic of six rooms in a
brick building about three years old.
The clinic has no electricity or water and no sanitation. We found an electrician there who was
stringing wire and installing receptacles for lighting. He was wiring in series. The wire was 12-2 plastic shield Romex. There is no electricity in the village so
the clinic will use a generator. Dr.
Anthony Ugwuoke attends in the clinic on Mondays, Wednesdays, and Fridays. He sees about 20 patients each day. On this day he had treated lobar
pneumonia, pelvic inflammatory disease, and malaria. When asked if diabetics in Nigeria would use glucometers, he
replied that the strips needed to calibrate and make the glucose determinations
were too expensive for most Nigerians, but that they would use them if the
strips were provided. We met the clinic
administrator and another doctor, a Nigerian who is a medical missionary to
other villages in that area and identified as Mrs. Okeke’s nephew who had many
questions about Burkitt’s lymphoma and suggested that there was an association
between malaria and the disease. There
were 3-4 patients waiting to be treated when we arrived . Each patient is given an identification card
and clinic number. Each patient has
an ENMC chart that is about the size of
a college test booklet. A small
pharmacy was set up in one room and dispensed inter alia NSAIDs, ampicillin, and mebendazole. Mr. Chidi Okwuonu, the laboratory
supervisor, was also there and had set up a small laboratory to perform
hemoglobin determinations by the Sahli method, urinalysis by Urostix, and blood
sugar by Dextrostix. If abnormalities
are found, blood is drawn and taken to the laboratory at ENMC for
confirmation.
A discussion of
family planning programs in Nigeria ensued.
At the ENMC Dr. Okeke performs tubal ligations if the family has as many
as six children.
Thursday, January 20, 2000
Dr. C.U. Amadi, Head, Department of
Diagnostic Radiology
Dr. Amadi has
been a consultant to the ENMC for three years.
He described the current imaging services of the hospital. A portable x-ray unit is in operation for
general use but when, for example, one attempts to use the unit for contrast
studies like barium enemas, the quality of the studies is not
satisfactory. Doppler studies are not
available. Echocardiograms are not
available. Dr. Amadi indicated that the
plain x-ray developing system at the ENMC is a wet process. In Nigeria studies for coronary artery
disease are performed largely by 2-D echocardiography since coronary artery
angiography is not readily available.
Peripheral artery angiography is performed at the teaching hospital in
Enugu. He confirmed that radionuclide
scanning is not available in Nigeria.
Dr. Amadi would
like to be able to offer CAT scans, and this was confirmed by Dr. Okeke as a
high priority for the ENMC. There are
no CAT scanners in the region (the nearest is in Lagos), but a Siemens CAT
scanner is planned for the new teaching hospital and may be in operation within
six months. He emphasized that even if
the CAT scanner at the teaching hospital become operational, it will be
inadequate to address the needs that are anticipated for the region. He hopes to acquire a fourth generation
machine. (If the electric power goes
off or amperage fluctuates, a daily happening in Enugu, there is no alternative
power source to supply the 125 kilovolt needed to run the CAT scanner. In Nigeria the line power is 220 volt AC.) If a CAT scanner can be obtained for the
ENMC it could be installed in a room 40’ X 80’ that currently has two window
air-conditioning units. Adjacent is a
smaller room with one window AC unit that could serve to house the computer
that serves the CAT scanner and another smaller room, also with one window AC,
into which could be installed the developing apparatus.
Dr. Amadi also
emphasized the need to provide mammography for the region as the nearest
mammography unit is in Lagos, but even there it is not consistently
available. At ENMC attempts have been
made to perform mammography by ultrasound but that does not give good
resolution of the lesion in question.
If cancer is found, patients must go to the University of Ibada where
there is a radiotherapy unit and possibly there is a cancer chemotherapist. In Lagos there is one cancer chemotherapist,
none in Enugu.
Inspection of the X-Ray Department
A tour through
the X-ray department was conducted by Mr. Sunday Agbam, x-ray
technologist. There is only one x-ray
machine in operation, a small portable unit.
X-ray film is imported into Nigeria.
All films are developed by wet process.
The department performs 2 or 3 x-rays per day as costs are high, and few
patients can pay. X-rays are not
ordered with impunity. Carotid
angiography is performed at a designated unit in Enugu. Nuclear medicine is not available in
Nigeria, and bone scans are not performed.
Interview and Tour of the Hospital with
Mrs. Ifeoma Okeke, SRN, SCH. HV. RNT -B.SC, MBA; Director of Nursing and
Administrative Secretary
Mrs. Okeke
received her nursing education and training in Great Britain and the United
States and was awarded membership in Sigma Theta Tau, international nursing
honor society. She has a Masters degree
in Business Administration and has administrative responsibility for all
departments of the ENMC which include:
Male ward for medical and surgical cases
Female ward for medical and surgical cases
Pediatric ward
Maternity department including delivery
room and nursery
Emergency room
Outpatient department
Eye Department
Housekeeping
Laundry
General maintenance including plumbing and
electricity
Cold body mortuary and embalming
departments
Medical Records Department
Accounting Department
Nursing and midwifery services
The current
nursing staff includes ten Nigerian registered nurses. Nursing training in Nigeria is three years
in length. Examinations are given by
the ENMC and the State of Enugu. There are 20 auxiliary nurses, i.e. nursing
assistants with no formal training.
They may have hospital experience.
Not regulated or certified.
Midwives receive a one-year training period in Nigeria. Midwives are employed at the ENMC. They perform deliveries with the
obstetrician called as needed. In all
cases, however, once the baby is delivered the obstetrician is called with a
description of the delivery. The
housestaff examines the baby at birth.
Continuing
education for the nursing staff is conducted at ENMC and available outside the
hospital as well. Among the in-service
training opportunities at ENMC was a review of the care of the diabetic given
by Mrs. Okeke. These in-service
programs afford an opportunity for the nursing staff to identify and discuss
ward problems.
Operating theater
Among the equipment in disrepair found in
the operation room were:
Stryker dermatome
that is not operative because the motor is burned out. The motor identified as model 2010, 230 volt
AC or DC, 0.60 cycles, 9 amps. The foot
pedal is functional.
A stimulator (?defibrillator) manufactured
by CIBERTEC.
Two devises
identified as CARDY 8, Mark II, and manufactured by UEDA Electronics Works,
Ltd., which monitors temperature, blood pressure, and pulse.
A cautery unit
for a Bovie, model SSE 3 manufactured by Valley Lab of Boulder, CO described as
a solid-state electrosurgery unit with Iso Bloc and Powerite. An electrosurgical footswitch also
manufactured by Valley Labs is attached.
An autoclave
Aquametic K. Thermie manufactured by German-Rupp Industries , Inc., in Bellville,
OH, USA. It is model RK-200, 115 volts,
60 cycles, 900 watts, 10.2 amps that is used with a step-down transformer.
An autoclave Puls-Matic, GETINGE.
An anesthesia
machine manufactured by MEDICAR in Budapest , Hungary. Attachments include a face-mask and bellows
bag - both in disrepair.
Operating table
that is functional but old by current standards. Does not have a bucky.
Dental Department
The Dental
Department is housed in a separate building across the courtyard from the main
entrance to the hospital. It contains
only one dental chair, circa 1970s, that is connected to water and suction by exposed tubing. Unable to determine if the drill was functional.
Laboratory
Laboratory
technologists are university trained and are awarded a bachelor of science
degree in laboratory medicine. At the
ENMC the laboratory supervisor trains assistants. The instruction period is twelve months and the student assistant
pays $5.00 for their training. The
supervisor administers a test of proficiency and sends the test results to Mrs.
Okeke. The assistants then undergo a
six-month trial period, after which their performance is evaluated and a
decision made to offer them a permanent position at ENMC. If a position is not offered at ENMC the
assistant is allowed to seek employment at another hospital.
Pharmacy
There is no
full-time pharmacist at the ENMC. The
pharmacy does have a pharmacy technologist who is supervised by a part-time
pharmacist. The pharmacy was once the source of significant income for the
hospital. With materials available
locally, the ENMC manufactured and sold plastic IV bags to other medical
facilities. A significant problem in
Nigeria is that of fraudulent labeling of medications making it difficult to
ascertain the strength of drugs.
X-Ray Department
There is no
full-time radiologist at ENMC, but one is available at the teaching hospital in
Enugu. Instead the ENMC has a full-time
technologist who received his training by a radiologist at the teaching
hospital. The current technologist has
been employed at ENMC for ten years.
There is a single
x-ray unit, a small portable one, in operation at ENMC. It is manufactured by the Hitachi Medical
Corporation. It is further identified
as Type UG-5ME-OIT, model number A14523-02, 125 KV, O.7 mm A1, K22668E, SIRUS
125 B, 125 KV 1ALF, A14422-04, SX-390402
Ultrasonography Department
Two ultrasound devices were found in the
ultrasound department:
Siemens Sonoline
LX, Probe 3.5 mHz. Attached is a
polaroid camera that is not in use (expensive film). Used with SONY Type I (normal) UPP-110 S high-quality printing
paper 110 mm X 20 meters. This unit is
functioning.
DIASONICS model
ADA400 manufactured by Diasonics in Milpitar, CA, 95035. Serial No. 85122957, Model No. 52. This unit is not in operation.
Kitchen
All patients are
fed by the hospital; cooking is done over a two burner kerosene stove.
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