Return to West Africa

Excerpts from a sonographer's journal

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Photos clockwise: A village woman with grain of the market; the village kids who taught Polin how to count to 10 in Igbo; the marketplace; a woman in Igbo-Ukwu; a village woman in the market; a hospital patient and her family; woman roasting corn along the road (Photos courtesy of Ann Polin, BS, RDMS)

The new Apex Medical Center in Igbo-ukwu, Nigeria

There are many ways to help:

• Become a medical volunteer
• Donate medical textbooks, working equipment, supplies and money
• Sponsor a child in school or an adult in a small business venture
  

For information about any of these opportunities, please contact:

Ann Polin, BS, RDMS
Program Chair
Diagnostic Ultrasound Program, R130D
3000 Landerholm Circle SE
Bellevue, WA 98007-6484
Telephone: (425) 564-4181
Fax:

(425) 564-4193
Email: apolin@bcc.ctc.edu

 

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In 2000, Ann Polin, BS, RDMS, program chair for the diagnostic ultrasound program at Bellevue Community College, Wash., was invited to Ghana to establish the first comprehensive ultrasound training program in sub-Sahara Africa. In August 2002, Polin was once again asked to visit West Africa, this time traveling to Nigeria to help assemble an ultrasound lab in a new hospital. This article is Polin's account of her experience with the country and its people in a region where technological advances are few and far between.

I arrive at Sea-Tac airport in Seattle at 9 a.m. on Sunday morning, August 11, 2002, and manage to get to the ticket counter with five 70-pound cardboard boxes of donated ultrasound supplies, two suitcases and my carry-on luggage. I give my passport and ticket to the agent and explain that the cartons contain humanitarian medical relief supplies.

Despite the fact I have previously checked with the airline several times to ensure that the cartons would meet airline specifications, the agent informs me that they are not acceptable. I am told that the supplies need to be in duffel bags and that they need to be inspected. I am distraught, and the agent finally agrees to leave them in the cartons, but some of them will still have to be inspected. She assures me that they will carefully reseal the cartons, and I wait while the inspection takes place.

My name is called. They have decided to open only one carton. I am allowed to check it and it appears to be resealed properly. I board my plane for the first leg of my flight — Seattle to Chicago. After a short layover, I am once again in the air, bound for London. After another short layover, I am finally headed to Lagos, in the West African republic of Nigeria.

At 6:30 p.m. Monday night, I arrive at Murtala Muhammed Airport in Lagos. I do not see any familiar faces in the room full of people, but I spot my boxes, haul them off the conveyor belt one by one and wait. Eventually, a man walks up to me and hands me a card. It is from Chief Nwobi, who came to visit me while I was setting up my ultrasound program in Ghana two years ago.

The man informs me that Chief Nwobi is waiting outside. I am relieved to hear the news. I start to load up my cartons when I realize I am about to face my second major hurdle — Nigerian customs. I ask to speak to a customs agent. I show him my letter of invitation stating that I am to give medical lectures in a village hospital and explain that the cartons contain donated medical supplies for the good of the people. However, he insists that I must pay duty for them. I reiterate that I should not have to pay, and the head customs official joins the discussion. He, too, insists that I must pay a substantial duty on the medical supplies that I have brought with me.

Eventually, I ask to go outside so that I may bring the chief in to help me plead my case. I am given permission and find my friend, Chief Nwobi, waiting for me.

After a brief hug and hello, I explain that the customs officials will not release the medical supplies. Chief Nwobi returns to the cargo area with me. He engages in considerable debate with the customs officials. One box is opened for inspection, and the officials finally give permission for me to take the cartons without paying duty.

We leave the cargo area with the cartons in tow, but we don't get very far. At the exit from the airport terminal, we are stopped again. This time, we are told that we must pay an "exit" tax for the cartons. Once again, Chief Nwobi uses his persuasive powers and we are allowed to leave without paying the "exit" tax. It has been a very time-consuming process and I am exhausted from the travel. We quickly load everything into Chief Nwobi's car and a borrowed van and head for his house in the middle of Lagos. It is night and I am tired. I don't really notice much as we are driving, but I am happy. I am back in West Africa.

A Cautious Welcome

I have been invited by Dr. Uchenna Nwosu, a Nigerian/American perinatologist based in Cleveland, to the opening of his new hospital, Apex Medical Center, in Igbo-Ukwu, Eastern Nigeria. Although travel to Nigeria is discouraged by the U.S. State Department, and my tourist book declares Lagos has the highest crime rate in the world, I am still looking forward to this visit.

I will be able to visit Isioma Anumba, a graduate of the ultrasound program I started in Ghana in August 2000. She was sponsored by Dr. Nwosu, in preparation for the establishment of an ultrasound lab at the new hospital in Igbo-Ukwu.

During the drive to Chief Nwobi's house, we discuss the pros and cons of driving vs. flying to Eastern Nigeria. I am reluctant to fly because I am unsure of the dependability of the small, private airplanes that make these flights. Chief Nwobi, however, is concerned about the bad road conditions and the fact that there is a real problem with bandits along those roads. I decide to take my chances with the airplane and fly out the next morning on Sosoliso Airlines.

It is an uneventful flight on a fairly large plane (about 100 people) to Enugu Airport, about a two-hour drive from Igbo-Ukwu. As I walk across the tarmac, I hear someone calling my name. There, on the other side of the metal fence, are Dr. Nwosu and Isioma, both dressed in traditional Nigerian clothing. I run to the fence, and Isioma and I both shed tears of joy.

Neither one of us thought we would ever see each other again when we left Ghana one year ago.

As I head towards the tiny terminal, I glance back at the plane and realize that I am once again in a place where technological advances are few and far between. The luggage from the airplane has just been loaded onto two large wooden carts, which are now being hand-pulled across the tarmac by a number of young men.

Local Flavor

Two days after leaving Seattle, I arrived in Igbo-Ukwu. Amazingly, the five cartons I brought along with me have all arrived intact. I have volunteered to help Isioma get started in her ultrasound scanning lab in the new hospital and to give several ultrasound workshops to physicians and other interested medical personnel.

I am to stay one month. After settling in, I am given a tour of the village. At first glance it looks pretty small, with one main road running down the middle, several substantial buildings and a typical African outdoor market where foods and goods are sold. It is deceptive — I am told that there are approximately 45,000 to 65,000 people living in this "village."

Amazingly, even with that many people, there are no telephones here: no house phones, no "communication centers" for public use (which were a common sight in even the smallest villages in Ghana) and no mobile phones (which were a fast-rising commodity among the young people in Ghana).

Although the concrete buildings and rutted red dirt roads look much the same as Ghana, I soon discover that there are other significant differences between the two countries. Here, water is even more precious because the ground water is so deep that it is impossible to drill wells. In order to have a continuous supply of water, each house uses a system of gutters and downspouts that collects rain water during the rainy season in concrete cisterns.

This water is stored and used sparingly throughout the year. The supply of electricity isn't much better. Although most buildings appear to be wired for electricity, it rarely works. The electrical company is officially known as NEPA — National Electric Power Authority — but I am told that it is more aptly nicknamed "Never Expect Power Always." Those who can afford it have generators, but because fuel is so expensive, the generators are used sparingly as well — a few hours in the morning, a few hours in the evening and otherwise, only when absolutely essential.

Setting up Shop

The new Apex Medical Center is a multi-level, multi-winged building made of red brick on the outskirts of the village.  It is really the most beautiful of all the African hospitals I have visited so far. Dr. Nwosu's dream of a hospital here has finally come true.

Work crews are busy in the courtyard repainting bed frames and assembling donated equipment. Other workers are busy in the hospital rooms cleaning and getting ready for patients. I am excited. I will get to watch one of the first surgeries performed at the hospital. Ultrasound examination will be one of the first services offered to patients at the hospital. I am told that the patients have been lining up daily in hopes of getting an ultrasound as soon as it is up and running.

The ultrasound room is a small, empty, gray concrete room with two barred windows. There is a bathroom adjacent to the ultrasound room containing a toilet and sink. There is also a large waiting room with plenty of windows and a nice view of the courtyard.

A large wooden crate which contains the donated ATL ultrasound machine sits in the waiting room. I discuss what we will need with Isioma and Dr. Nwosu — a table/bed for patients to lie on, a scanning stool, a desk and some cabinets and shelves for the supplies I have brought with me. Workers are sent to find the items and prepare them for the ultrasound room. This time, I have not brought any old sheets or towels with me, but Isioma says that we can find some at the outdoor village market.

Finally, it is time to check out our ultrasound machine. Some workers help us break open the crate. It looks great, except that the monitor is not attached to the rest of the system and the VCR and paper printer are not connected either. I examine the parts carefully and realize that I will need a Phillips screwdriver and an Allen wrench to mount the monitor onto the ultrasound system. I have forgotten to bring a tool kit with me on this trip and I know it will be very difficult to find one here. We will be unable to use the system until I can somehow find these tools.

I take the monitor with me and start questioning every roadside vender I can find in Igbo-Ukwu. After many stops, I locate and purchase the right-sized Phillips screwdriver. After many more stops, I am able to locate the Allen wrench. But, the vendor uses it in his engine repair business, and since they are very scarce, he is unwilling to part with it. He says he will charge me 10,000 Naira (about $76) if I want to buy it. I explain that we don't want to buy it and ask if I can rent it. He finally agrees to let me borrow it for a day, and I head back to the hospital where, with the help of the Allen wrench and Phillips screwdriver, I am finally able to install the monitor.

Showtime

We are ready for the big test. I have rounded up a regulator, to protect against the frequent surges in voltage, a transformer, for conversion of 220 volts to 110 volts, and a multiple plug adapter, so that the American plug can fit into the African socket. I carefully check to make sure that they are correctly aligned. I switch the ultrasound machine on. We all break into cheers as the monitor lights up and I am elated. We can now start scanning patients.

The village midwives have been notified that we will scan their patients for free for one week. The patients have been lined up for days. Most look like they are about to deliver. I guide Isioma's hand as we start to scan the first patient. She has been busy re-reading her notes from my program in Ghana in preparation for this day, but she has not performed a scan in a year. She catches on quickly and by the third or fourth patient, I let her scan while I watch. We scan patients all day long for the rest of the week. Most of the cases appear normal. We find a lot of twins, but I am not surprised. I know that Nigeria has the highest rate of twinning in the world.

I am invited to watch the first surgery in the new operating room (OR). The procedure is an appendectomy on an adolescent boy. The room is a far cry from the dark and dingy operating rooms I have seen in some other African hospitals I have visited. It is large with white-tiled walls. Although there's not much equipment in the room, it is light and airy.

The surgeon and scrub nurse have already gowned, gloved and put on shoes that are only worn in the OR. Because I have no "clean" shoes to wear in the OR, and because there are no disposable "booties" (or disposable anything) here, it is decided that it would be better for me to be in the OR with my clean, bare feet than to wear my "dirty" street shoes. I take off my shoes, put on a cloth mask, grab my camera and stand bare foot in a corner of the OR as the operation gets under way.

The operation goes smoothly. There is even an anesthesiologist present who sedates the boy, intubates him and then hand ventilates him during the procedure using a small anesthesiology kit, which he carries around with him in a bag. All this without the benefits of an EKG, pulse oximeter or blood pressure cuff.

Making the Report

The weekend arrives. It is time to do the first "Ultrasound Update" workshop for Nigerian physicians that I have been scheduled to give with Dr. Nwosu. It is a two-day series that we will give twice during my visit. We have rented an LCD projector from Port Harcourt to use along with the laptop computers that Dr. Nwosu and I have brought with us. I load up the projector, my laptop computer, some ultrasound CDs and the "goody bags" I have brought from Seattle to give to the physicians. My friends at Seattle Nuclear Medicine and Ultrasound, the American Institute of Ultrasound in Medicine, the Society of Diagnostic Medical Sonogra-phers, Philips Medical Systems and Siemens Medical Solutions have all donated items to fill the bags, such as pens, gestational age calculator wheels and t-shirts.

The lectures go well in the morning, the "goody bags" are a big hit and I am especially delighted when a bus pulls up at lunchtime filled with medical students from Nnamdi Azikiwe University Teaching Hospital in Nnewi. The dean of the medical school has heard that we are lecturers from America and has given special permission for the students to come and hear our lectures. The physicians and medical students ask thoughtful questions, and we have some lively discussions about current "state-of-the-art" practice and the practicality of initiating "state-of-the-art" practice in Nigeria, where there are many limiting factors to consider.

Around Town

The month goes by quickly. I am only sick for two days. I recognize the symptoms as probable Ghiardia, which resolve soon after I start to take the antibiotics

I have brought with me. Once again, I manage to stay malaria-free. In my free time, I visit several Igbo cities, villages and hospitals and a large outdoor market with narrow dirt alleys containing "hospital row," where used medical equipment and supplies are sold. I am thrilled to find that they actually sell ultrasound gel here in one of the little stalls. Isioma will not have to get it from Lagos, some 300 miles away.

I am allowed to take pictures of most of the people I meet and most are friendly and talkative. The elders share their stories of the Biafran civil war, and I am shown the bombed out remnants of buildings in Ogidi. I remember watching TV as a child, seeing the images of starving Biafran children on the news. The younger people I come across have no recollection of the Biafran war because they have not lived through the horrors of war. Younger people speak of wanting to create a new Biafra (as Igbo-Ukwu was known during civil unrest in the 1960s), free from the constant tribal conflicts between the Igbos, Hausas and Yarubas, and free from a corrupt and negligent government.

I ask all of the children I see why they are not in school. I am told that the teachers have been on strike for over a year because the government has not paid them wages for the previous year. It is hard to grasp the true scope of the circumstances by which these people must live: poor infrastructure, few resources and little hope in sight.

Going Home

It is time to leave. I tearfully say goodbye to all those who have taken such good care of me and whom I have come to know and love — Isioma, her husband, Azuka, and their children; Donatuse, my trusty "driver," his wife and child; Teresa, who made my favorite akara for me, and whom I have taught to make French toast and omelets; and Comfort, my young Ghanaian friend who now lives with Isioma and conversed with me in Twi.

It is so hard for me to leave them all. I know the hardships they will continue to face when I leave. There will be little I can do to help from 10,000 miles away. As I get into the car to begin the journey home, someone softly says, "Please tell everyone in America that we are not all bad here. Please tell them that we are good people and that we need their help."

— Ann Polin, BS, RDMS, is program chair for the diagnostic ultrasound program at Bellevue Community College, Wash. Questions and comments are encouraged and can be directed to editorial@rt-image.com.