Stories From the Field:

NIGERIA

Anesthesiology in Nigeria

Matthieu Newton, MD, a third-year Anesthesia Resident, received an MGH Global Health Travel Award and traveled to Nigeria to provide anesthetic care to over 130 men, women, and children at St. Luke’s Hospital in Uyo as part of Global Image Foundation’s traveling team.

The trip to Nigeria was not an easy one. A delayed flight caused a missed connection, which led to a three hour wait to rebook, an overnight stay in London and a finally a connecting flight the following afternoon. Ultimately this pushed the start of my trip back over 24 hours, but in all honesty; I appreciated the opportunity to rest in a hotel for the night. Prior to leaving, I was in the midst of a busy cardiac anesthesia rotation. I slept for over 16 hours, far more than my typical 5! As it turned out, it was a good thing I got my rest, the ensuing week was going to be quite busy. After spending a night in the city of Lagos, I boarded a flight to Uyo, the capital city of the Akwa Ibom state in the southeastern region of Nigeria. By noon, I had arrived at St. Luke’s Hospital where I would spend the week providing anesthetic care to over 130 men, women, and children.

As a second year anesthesia resident, I was growing more comfortable in my supervised environment in the operating room. However, moments after my arrival and a quick conversation with an attending anesthesiologist traveling with our group, a brief tour of the clinic, and an orientation to some of the drugs and tools at my disposal, I was assigned a case to be done alone. That case, a complex uterine myomectomy, was to be performed under spinal anesthesia, with limited additional pain or sedation medications. There was one blood pressure cuff for the seven operating locations. One oxygen tank was available for use in emergencies. One anesthesia machine was in the corner, broken and unable to be used. Blood oxygen saturation monitoring was available with two portable machines, one of which worked only intermittently. One adult and one pediatric bag valve mask was available if needed. This anesthetic was going to be unlike any I had done previously. While I initially attempted to hoard as many monitoring devices as I could to stay somewhat in my comfort zone, I quickly learned that this was not feasible. I came to rely on my physical exam during my anesthetic. To monitor blood pressure, I kept my fingers on a radial or carotid pulse. To assess for breathing, I used my stethoscope to listen for breath sounds and my eyes and hands to feel the chest rise and fall. To monitor oxygen saturation, I examined the mouth and lips for color change and looked into the surgical field to assess the brightness of the blood. With the lack of monitors, I became more in touch with my patients.

The days were long and hot. The hospital, attempting to accomplish an ambitious task of assessing everyone that came for surgery, made a total of seven operating locations within two rooms; one with four beds, the other with three. There was no air conditioning and little air movement. The electricity would regularly go out at night forcing us to complete surgeries by headlamp and cell phone flashlight. We arrived to the hospital and started operating by 8am and did not complete cases until 10pm. Our equipment frequently would be in use in another operation forcing us to share and prioritize them. Some needed medications were a challenge to find easily and I would find myself pocketing drugs I thought I would need in an emergency.

By the end of the week, our team had treated dozens of women for uterine myomectomies, performed many hernia repairs on men and young children, assisted in several cesarean sections and emergently resuscitated two babies immediately after birth and much to the delight of the local surgeons, we performed the first laparoscopic appendectomy done in the state. Beyond the clinical care however, I was able to grow and form tight bonds not only with my American team members, but with my Nigerian colleagues as well. We are already making plans for a follow up trip in the coming year and have plans to reunite as a team here stateside as well. Ultimately, many of these physicians would enjoy the opportunity to observe and possibly even train in the United States and it would be a thrill to have them join me in the operating room here and show them how we practice medicine.

This was a highly educational and invaluable trip. I’ve learned more than I am able to put into words and know that I will continue to process this experience well into the future. I look forward to continuing to grow as an anesthesiologist and to having these experiences be a regular part of my practice in whatever setting I ultimately choose.