Thoughts on visit to Nigeria and AFMED
Ray Rogers
People keep asking me about my experience in Nigeria, and, at times, I find it difficult to describe everything I saw, everything I experienced, and everything I sensed while I was there. “Life changing” is certainly a fitting description in that I see our world in a new light. The uncertain imagery that I had in my mind prior to seeing Nigeria was forever replaced with real images of people living in a country where many of the very basic necessities of life are beyond reach.
Clean water, uninterrupted electricity, public sanitation, and quality healthcare – essential provisions that Americans take for granted – seem both possible and impossible at the same time for Nigerians. And yet, the people of Nigeria, at least those we met, are filled with an astounding hope that tomorrow will be a better day, that their standard of living will advance, and that the wealth they possess as a nation could one day find its way to them. In a region with extreme poverty and some of the highest infant and maternal mortality rates in the world, hope may be all that some people have.
With so many unmet needs, it is difficult to imagine where to start: where one’s efforts can impact the lives of a hopeful nation. But the essence of service-to-others lies in knowing that the collective product of many small efforts can be transformational. While disappointment exists in a world fraught with uncertainty, never have I met people with greater hope for what can be done or what might be possible.
I was inspired by the work of team members Dr. George Mulcaire-Jones, a family physician from Butte, Montana, and Dr. Robert Scanlon, an OBGYN from Huntington, New York. Both have dedicated their lives to improving the care of so many people in places that seem so out-of-sight, so out-of-mind. Making sure that a mother is given a better probability of safely delivering a child, of a child surviving those first few critical months, and supporting HIV/AIDS prevention, treatment, and care were all part of the training provided by George and Bob to healthcare providers from throughout Nigeria.
Characteristically, these healthcare workers thirst for better skills, more timely and relevant information, and the dissemination of “best practices” in medical treatment and care. Their desire for knowledge is palpable.
The effort to improve healthcare in Nigeria may at times seem inconsequential in such a vast region with such a large population, but the results can be measured … one healthy mother, one healthy baby at a time. And as these healthcare providers take their new found skills and knowledge to other care providers throughout Nigeria and Africa, the cumulative effect is soon measured in much greater numbers. However, this task must be accomplished correctly; bad training doesn’t help anyone.
Maternal Life and the National Center for Health Care Informatics want to create a multiplier effect – where certified medical training can be propagated to care providers throughout a community, region or nation. From this recent trip, we now know that information technology can play an important role in achieving that desired result. While infrastructure challenges remain an important consideration when attempting to implement any information technology project, we successfully demonstrated that adequate infrastructure indeed is in place.
Using the same video conferencing equipment we use at the National Center for Health Care Informatics, we were able to connect 35 energized healthcare workers in Jos, Nigeria -- many from Our Lady of Apostles (OLA) Hospital where we were conducting medical training -- and 20 IT, healthcare, and faculty representatives at Montana Tech in Butte, Montana. These two groups were in a sustained, high quality, two-way video conference half way around the world with streaming quality nearly equal to that of TV.
When the actual connection between Nigeria and Montana was made, cheers erupted and no one on either side held back their excitement. Spontaneously, several of the health care leaders present in Jos took the occasion to rise and articulate to their new colleagues in Butte the importance of what we had accomplished and the remarkable hope that IT brings to improving healthcare in Nigeria. The opportunity now exists to provide certified, regularly scheduled, on-going video conferencing training sessions to physicians, resident physicians, nurses, and midwifery students at OLA Hospital and elsewhere.
With a better understanding of the myriad healthcare issues and needs of the people in this region of Africa, we collectively believe that we have taken a major step forward in establishing the framework for our African Family Medicine Education and Development Initiative (AFMED). We have envisioned educational training modules that target specific healthcare needs while emphasizing cultural sensitivity and appropriateness to existing healthcare capacity and infrastructure. We also now understand the technological challenges and opportunities of delivering high quality video conferencing/training from locations in the US to locations in Nigeria – connecting healthcare providers.
We recognize that conventional methods of medical training in developing nations are inadequate. Our AFMED initiative fills the gaps and provides a systematic approach to providing continual training that can be easily replicated and highly scalable.
Our next step is to encourage a partnership with funding agencies that align with the goals and expectations of AFMED. Our goal is simple … to improve healthcare by improving the quality of training to healthcare providers. So too are our expectations … to help one mother, one baby, or one malaria, TB, or HIV/AIDS patient at a time. The results will be measurable … in great numbers.
Friday, March 14, 2008
Friday, March 7, 2008
Note From Dr. George
We are on our way home to the USA. We are in the Amsterdam Airport and I have a few minutes to send this quick message. As we left Nigeria, we discovered our video communications equipment weighed too much to be put on the plane. This surprised us because it didn't make sense that we could take the equipment to Nigeria but not bring it back with us. However, after some negotiations we were able to get it through.
The day after we left Our Lady of the Apostles (OLA) Hospital in Jos for Abuja and our training there, Sr. Mary, administrator of the hospital, told us they had a case of a woman who had come to the hospital with an IUFD - there acronym for a intrauterine fetal death. In either the village or at a primitive health center, those providing maternal care had cut two large medio-lateral episiotimies trying to get the baby out. These lacerations bled into her perineum until it was the size of a soccer ball. Doctors at OLA, where we had just conducted speciality family medical training, were able to help the woman and save her life, but it is so tragic what women suffer for want of basic health care.
There will certainly be mountains beyond mountains to climb regarding maternal health care in developing countries, but very good things happened this trip and we continue to make progress.
We are on our way home to the USA. We are in the Amsterdam Airport and I have a few minutes to send this quick message. As we left Nigeria, we discovered our video communications equipment weighed too much to be put on the plane. This surprised us because it didn't make sense that we could take the equipment to Nigeria but not bring it back with us. However, after some negotiations we were able to get it through.
The day after we left Our Lady of the Apostles (OLA) Hospital in Jos for Abuja and our training there, Sr. Mary, administrator of the hospital, told us they had a case of a woman who had come to the hospital with an IUFD - there acronym for a intrauterine fetal death. In either the village or at a primitive health center, those providing maternal care had cut two large medio-lateral episiotimies trying to get the baby out. These lacerations bled into her perineum until it was the size of a soccer ball. Doctors at OLA, where we had just conducted speciality family medical training, were able to help the woman and save her life, but it is so tragic what women suffer for want of basic health care.
There will certainly be mountains beyond mountains to climb regarding maternal health care in developing countries, but very good things happened this trip and we continue to make progress.
Thursday, March 6, 2008
Finishing up in Abuja
From Ray Rogers
We are just finishing up here in Abuja and getting ready to leave. The training has been excellent and George, Gonzaga, and Paskazia and the participants have been very happy with the training. The Faithful House team is looking forward to the training being implemented around Africa.
The heat has been a bit overwhelming. It was 108 degrees F in Abuja yesterday and seems as warm today. We will be returning to much cooler weather in Butte. George is still looking forward to some more cross country skiing.
We are just finishing up here in Abuja and getting ready to leave. The training has been excellent and George, Gonzaga, and Paskazia and the participants have been very happy with the training. The Faithful House team is looking forward to the training being implemented around Africa.
The heat has been a bit overwhelming. It was 108 degrees F in Abuja yesterday and seems as warm today. We will be returning to much cooler weather in Butte. George is still looking forward to some more cross country skiing.
Wednesday, March 5, 2008
Update on Our Trip
Note from Ray
As George mentioned, we have been challenged at the Catholic retreat center where we are staying to get good internet access. But now that we are connected, I thought I'd give a quick update on our activities of the past few days.
We wrapped up the Safe Passages training at Our Lady of Apostles (OLA) Hospital in Jos on Saturday around mid afternoon. The training and interaction with the participants was incredible. George and Bob were able to reconnect with a number of people and we all made many new friends. It was a pleasure working with everyone at OLA. The thirst for medical and IT knowledge is tremendous, and the staff at OLA are looking forward to working with us to connect more often using video conferencing.
We traveled on Sunday to Abuja to a Catholic retreat center on the edge of the city. George has been conducting the Faithful House training with two facilitators from Uganda this week. I assisted the Safe Passages Coordinator with some IT support and have visited some nearby villages. On Tuesday morning, Bob returned home to New York. George and I return on Thursday.
Our trip to Nigeria has been very worthwhile and successful. I look forward to getting back to see how we can advance the education of Nigerian healthcare providers through the application of information technology. During this trip, we successfully demonstrated the potential and quality of training through IT.
As George mentioned, we have been challenged at the Catholic retreat center where we are staying to get good internet access. But now that we are connected, I thought I'd give a quick update on our activities of the past few days.
We wrapped up the Safe Passages training at Our Lady of Apostles (OLA) Hospital in Jos on Saturday around mid afternoon. The training and interaction with the participants was incredible. George and Bob were able to reconnect with a number of people and we all made many new friends. It was a pleasure working with everyone at OLA. The thirst for medical and IT knowledge is tremendous, and the staff at OLA are looking forward to working with us to connect more often using video conferencing.
We traveled on Sunday to Abuja to a Catholic retreat center on the edge of the city. George has been conducting the Faithful House training with two facilitators from Uganda this week. I assisted the Safe Passages Coordinator with some IT support and have visited some nearby villages. On Tuesday morning, Bob returned home to New York. George and I return on Thursday.
Our trip to Nigeria has been very worthwhile and successful. I look forward to getting back to see how we can advance the education of Nigerian healthcare providers through the application of information technology. During this trip, we successfully demonstrated the potential and quality of training through IT.
Tuesday, March 4, 2008
From Dr. George Mulcaire-Jones
March 4, 2008
We finally got Internet connectivity outside of Abuja. Our Internet connections where we have been working in Nigeria have been shaky, and, sadly, we are not able to blog or post pictures as much as we would like. So here's a quick update. Training is going great. We had a good visit with the Deputy Secretary General, Catholic Secretariat of the Nigerian Catholic Conference of Bishops (NCCB). The Catholic Secretariat is the administrative arm of the (NCCB) that oversees more than 320 health facilities in Nigeria and provides some 40 percent of the health care here. Thus, the meeting with the Deputy Secretary was important. He is really impressed with AFMED/Safe Passages and its possibilities. They have elevated AFMED/Safe Passages to a major program within the Secretariat's Health Committee.
There is a paradox here of great poverty, challenges and yet great hope. I am impressed again an again how the people we interact with, especially the Christian community, are reaching out to those in need. I think we can all be pleased with the efforts that have been made and at the same time realize there is so much more to do. Peace and thanks to everyone.
March 4, 2008
We finally got Internet connectivity outside of Abuja. Our Internet connections where we have been working in Nigeria have been shaky, and, sadly, we are not able to blog or post pictures as much as we would like. So here's a quick update. Training is going great. We had a good visit with the Deputy Secretary General, Catholic Secretariat of the Nigerian Catholic Conference of Bishops (NCCB). The Catholic Secretariat is the administrative arm of the (NCCB) that oversees more than 320 health facilities in Nigeria and provides some 40 percent of the health care here. Thus, the meeting with the Deputy Secretary was important. He is really impressed with AFMED/Safe Passages and its possibilities. They have elevated AFMED/Safe Passages to a major program within the Secretariat's Health Committee.
There is a paradox here of great poverty, challenges and yet great hope. I am impressed again an again how the people we interact with, especially the Christian community, are reaching out to those in need. I think we can all be pleased with the efforts that have been made and at the same time realize there is so much more to do. Peace and thanks to everyone.
Saturday, March 1, 2008
Greetings from George
From George:
It is now Saturday morning and we will finish our OLA training today. There is such a collage of faces and events – the cheers and smiles when the satellite transmission worked, the stories of those who work with the poor and face the challenges of providing health care with limited resources and the enthusiasm for the physicians and midwives to learn as much as they can. In the back of your mind is the cases you have seen on the ward – how is the six year old girl with meningitis, does the five month old boy pneumonia and such bad thrush have AIDS, the woman who just came to the hospital with a dead baby after a prolapsed cord.
I am most grateful to everyone who makes our work possible. The challenge of improving maternal, newborn and HIV care in Africa is daunting. Yet I am struck that there are so many African physicians, midwives and nurses who are absolutely committed to the challenge. They give of themselves completely in very difficult circumstances and from them I take much inspiration.
It is now Saturday morning and we will finish our OLA training today. There is such a collage of faces and events – the cheers and smiles when the satellite transmission worked, the stories of those who work with the poor and face the challenges of providing health care with limited resources and the enthusiasm for the physicians and midwives to learn as much as they can. In the back of your mind is the cases you have seen on the ward – how is the six year old girl with meningitis, does the five month old boy pneumonia and such bad thrush have AIDS, the woman who just came to the hospital with a dead baby after a prolapsed cord.
I am most grateful to everyone who makes our work possible. The challenge of improving maternal, newborn and HIV care in Africa is daunting. Yet I am struck that there are so many African physicians, midwives and nurses who are absolutely committed to the challenge. They give of themselves completely in very difficult circumstances and from them I take much inspiration.
Successful test of Video Conferencing
Note from Ray:
On three occasions this week, we have successfully linked with a video conference between Jos and the Montana Tech campus in Butte. Thanks to the great efforts of the technical team in Butte (Mike, Gary & Eric) and Dr. Sam here in Jos, not only were the tests successful, but they exceeded our expectations. The quality of the video conferencing was outstanding. We accomplished this through a satellite link running at a bandwidth of 512k, but we believe that we can conference at a bandwidth of 384k and still have very acceptable video quality. For our last and final test, everyone from the Safe Passages training was there for the test. When the link with Montana occurred, there was a roar of cheers from everyone in the room. The hope that this technology brings to improving healthcare in Nigeria and other parts of the developing world is beyond words that I can express. Now that we have proven that we can connect and deliver high quality video conferencing on a regular basis, we can begin to deliver real-time training to the physician residents and midwifery students here in Jos. Instead of waiting years for best practices to filter down to these areas, we can now begin to teach these best practices on an on-going, regular basis. This is, after all, not about the technology. This is about saving mothers and babies. The technology just makes it become a reality.
On another note, I was fortunate yesterday to visit some small villages outside of Jos. At one of the villages, named Bomo, we met with the staff of a small clinic and then visited with the teachers and students at the village school. The kids loved the soccer ball we left with them. Seeing this village gave me a real sense of the challenges of providing health care in Nigeria.
On three occasions this week, we have successfully linked with a video conference between Jos and the Montana Tech campus in Butte. Thanks to the great efforts of the technical team in Butte (Mike, Gary & Eric) and Dr. Sam here in Jos, not only were the tests successful, but they exceeded our expectations. The quality of the video conferencing was outstanding. We accomplished this through a satellite link running at a bandwidth of 512k, but we believe that we can conference at a bandwidth of 384k and still have very acceptable video quality. For our last and final test, everyone from the Safe Passages training was there for the test. When the link with Montana occurred, there was a roar of cheers from everyone in the room. The hope that this technology brings to improving healthcare in Nigeria and other parts of the developing world is beyond words that I can express. Now that we have proven that we can connect and deliver high quality video conferencing on a regular basis, we can begin to deliver real-time training to the physician residents and midwifery students here in Jos. Instead of waiting years for best practices to filter down to these areas, we can now begin to teach these best practices on an on-going, regular basis. This is, after all, not about the technology. This is about saving mothers and babies. The technology just makes it become a reality.
On another note, I was fortunate yesterday to visit some small villages outside of Jos. At one of the villages, named Bomo, we met with the staff of a small clinic and then visited with the teachers and students at the village school. The kids loved the soccer ball we left with them. Seeing this village gave me a real sense of the challenges of providing health care in Nigeria.
Greetings from Jos
From Bob Scanlon:
Greetings from Jos, Nigeria.
It has been quite a week. The array of tasks we have accomplished is a cause of joy.
The educational component with the family Medicine Residents and nurse midwives has been successful. The feedback we are receiving when we review indicates that the material is being received and processed. It will be up to them to apply it in the care of their patients.
I was privileged to perform a cesarean section on a mother who was scheduled for one and consented to allow me to operate for the purpose of resident physician education. We delivered a healthy baby boy and both mother and child are doing well. Interesting, the boy’s middle name is Bob, unusual name here in Nigeria!
Finally, our AIM program that is designed to pay for the care of the poor is fantastic. I was able to meet many of the infants and mothers who have benefited from the program. They were all so grateful. The program will certainly continue to grow as the hospital draws the poor; you see they trust that the Catholic sisters will not send them away. AIM will allow Our Lady of the Apostles Hospital to continue this mission without going bankrupt.
As much as I love this work, I miss my family terribly and look forward to coming home. However, with the contacts that have been nurtured and the aid of technology we can continue to aid infants and mothers by supporting our Nigerian colleagues even when we are not physically present with them.
More to come… Bob
Greetings from Jos, Nigeria.
It has been quite a week. The array of tasks we have accomplished is a cause of joy.
The educational component with the family Medicine Residents and nurse midwives has been successful. The feedback we are receiving when we review indicates that the material is being received and processed. It will be up to them to apply it in the care of their patients.
I was privileged to perform a cesarean section on a mother who was scheduled for one and consented to allow me to operate for the purpose of resident physician education. We delivered a healthy baby boy and both mother and child are doing well. Interesting, the boy’s middle name is Bob, unusual name here in Nigeria!
Finally, our AIM program that is designed to pay for the care of the poor is fantastic. I was able to meet many of the infants and mothers who have benefited from the program. They were all so grateful. The program will certainly continue to grow as the hospital draws the poor; you see they trust that the Catholic sisters will not send them away. AIM will allow Our Lady of the Apostles Hospital to continue this mission without going bankrupt.
As much as I love this work, I miss my family terribly and look forward to coming home. However, with the contacts that have been nurtured and the aid of technology we can continue to aid infants and mothers by supporting our Nigerian colleagues even when we are not physically present with them.
More to come… Bob
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