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‘Cancer menace: What the Minister of Health should do’

Could we know what you are doing in the UK? I started my post graduate training in Nigeria and sat the West African College of…

Could we know what you are doing in the UK?

I started my post graduate training in Nigeria and sat the West African College of Surgeons Exams. I became a Senior Registrar in General Surgery and went to do Post Graduate Training programme in the United Kingdom.

In the United Kingdom, I have been working through the ranks. I actually started training all over again in Urological Surgery. I first went to the Middlesex Hospital in London in 1991 where they had St Peters Group of Hospitals; here urologists specialise. I developed a very keen interest, and trained as a fellow for two years. In 1993, I came back to Nigeria to sit my exams in the West African College of Surgeons and became a Fellow, and then a Urological Surgeon. I was appointed a consultant to Teaching Hospital, Ilorin in 1993.

But I was not satisfied with knowledge and experience at the time and I went back to the UK. I went through the North-east Training programme for surgeon in London and became Urological Surgeon with special interests in endoscopic surgery and Kidney stones mainly. I also do open operations.

You benefited from all this trainings because you were able to move out of Nigeria.

Unfortunately, Nigeria does not have such training opportunities. These opportunities are also limited in the UK, hence, I see myself as being lucky and blessed on the one hand, and a pioneer of some sort on the other hand, since one is self-motivated in various ways.

Would you know if Nigeria has got any specialists in the field of Laparoscopic Surgery?

There may be some laparoscopic surgeons who do certain work but certainly not on the prostate and not in the kidney. I do not know of any one at all in Nigeria. For endoscopic, there may be a handful indeed with limited repertoire, as I was at the meeting of the National Association of Urological Surgeons as a special guest in November last year and only very few people do endoscopic work and even what they do is absolutely limited either by experience or equipment! So Nigeria is well behind where it should be despite its potentials, due to lack of modern training facilities and also equipment, perhaps motivation…

Could you tell us more about this laparoscopic surgery thing?

Laparoscopic surgery, involves putting small but long specialised instruments through the skin into the abdomen and you have a camera in one of those instruments. It is like working with a ‘’fork and knife’’ inside someone. But you have a camera and a light source that show you everything inside the patient. So you can use that to make dissections and remove organs inside the patient: remove cancers inside the patient without cutting them open! You are watching everything as you progress on a TV monitor.

And when you remove these things, you bring them out through very small holes instead of having a nine-inch or a one-foot long cut on the abdomen which tends to keep the patient in hospital for nearly two weeks. With key-hole operation through laparoscopy, the patient can go home in three days. Not only they have shorter time in the hospital, much less pain after the operation, they also go back to work quicker. It becomes an economic benefit for all concerned, the patient, the employer, and their businesses, including hospital bed costs ie the government. Never mind all the pain and the scarring from open operations, ‘’key-hole’’ surgery as it is commonly called, (laparoscopy) gets you there quicker.

This newly resurgent innovation has been going on for the last 10 years in the developed world. It is not just a novelty in hospitals now, it is mandatory that surgeons can provide the service in the developed world. And most jobs are advertised based on this.

People like you are always reluctant to return to Nigeria and share your wealth of knowledge on the excuse that here, there are no infrastructure.

I think where there is a will, there is a way. We who are Nigerians owe our country a lot. An average university graduate in the UK owes the government or the bank about £30,000 in educational loans. But we got our education free. We even got bursary awards from the country. We owe this country Nigeria a lot and should each give something back—that is my impression.

Yes, we can’t come from the UK and offer the skills only. We need some support locally. But some of us will have to dig into our own pockets and bring something out to support what we are talking about. We can talk from now till tomorrow, if there is nothing on the ground, there is going to be nothing to show for all that talk.

So what specifically do you have in mind?

To be back home to teach, train doctors, and also to share my experience in health care management and give something back to the people. I will like to work in partnership with already established hospitals. Also, to be able to create a bilaterality of training for the Nigerian surgical trainees so they also can enjoy what I have enjoyed. My hospital in the UK is happy to allow people spend three to six months period without any charges so long as the trainees can support themselves to some extent. Those who are registrable may even have paid jobs for that period, on the proviso that they will return here to help. We might be able to provide a room for people to stay in the hospital, to watch and learn what we are doing and bring back something. People say, if you give a man fish, then you feed him for the day. If you teach him how to fish, you feed his whole family and you empower him for ever. I can only do so much but if someone comes to us, then he can come back home and provide more services. That is only one side.

On the second side, I would like to be involved in the local prostrate cancer campaign because it is a silent killer where people don’t even know they are already harbouring disease until such time that it has metastasised [spread] to their bones and then it is too late. I would like to be involved with cancer campaign especially the prostate cancer where people can have simple blood test PSA and a doctor who is well trained can examine the prostrate from the back and that is enough to be able to pick up majority of cancer cases in the prostate.

Also kidney and bladder cancers are fairly easy to pick by doing simple urine tests by sticking a dip stick into the urine and if it comes out with blood, then you require an endoscopy even if the urine appears clear with no obvious blood to the naked eye. By western standards, and as a matter of urgency, it is a compulsory requirement for doctors, if the dispstix picks up the blood in the urine, then you are required to have a endoscopy to inspect inside of the bladder, to make sure there is no bladder cancer and also an ultrasound scan of the kidney to ensure your kidney does not have any cancers in it. These are very simple tests and campaigns that can be run at local hospitals, primary, secondary and tertiary care centres in Nigeria at very little cost. Yes, I would like to be involved in that.

Considering all this you have in mind, if you were to meet the minister of health today, what exactly would be your message to him?

Firstly, I will simply show him the statistics from the developed world: 65 out of 100,000 men will develop prostrate cancer in the white community. But two times more risk in the black community; i.e., 135 to 100,000 black men who live in the USA would develop prostrate cancer. And so ‘’dear’’ minister, please provide facilities so that we can do simple PSA test first to pick those who are suspected to have the potential to develop this cancer. Men over age of 50 years must have this test, and those who have family history of this cancer should have it done earlier. And the tests should be done yearly. And when we do the test, please provide facilities so we can arrange modern prostate biopsy facilities and treatment which doesn’t exist in the country at the moment… A concerted campaign will definitely save people’s lives. Nigerians will pay the odds to look after their health, as we see so many in the UK. They won’t need to travel out of their own country.