In April 2005, I made my sixth trip to Nigeria, West Africa to participate as a medical volunteer with The World Health Mission, a non-profit, Pittsburgh-based charitable organization of health professionals. The World Health Mission is dedicated to people in need of medical care, which may include providing supplies, drugs, and medical equipment; promoting educational programs; and conducting research to improve health care in developing countries. My particular project in Nigeria the past few trips has been to set up and administer diabetes-screening clinics at a number of hospitals around the country. This year my colleague Harlan Lahti, a pharmacist from Vancouver, British Columbia, and I set up clinics at Bauchi Specialist Hospital and Gombe Specialist Hospital, two state hospitals located in the eastern part of the country.

Practicing as both a clinical and natural pharmacist, I am always interested in how professionals can better manage disease states with a more integrative approach. This approach includes a successful balance of drug use with diet, nutrition, exercise, supplements, and other complementary methods that help the patient achieve a better sense of well-being. The concept is just as valid in Nigeria as it is in the United States. Diabetes is a worldwide epidemic disease and a very appropriate disease state to approach in this way.

For this special project in diabetes training, education, and testing, we allocated more than two dozen FreeStyle and Accu-Chek blood glucose monitors. Many of these valuable glucose monitors were donated to me by Global Links, a Pittsburgh-based, charitable organization that recovers surplus medical supplies, equipment, and furnishings in good condition to redistribute to hospitals in third-world countries. We had to purchase the glucose strips and lancets that were not generously donated by the manufacturers. In addition to ancillary diabetes-testing equipment, we also took with us 5,000 doses of Metformin 500-mg tablets and about 4,000 glyburide tablets. These were all donated to the Chief Medical Director (CMD) of each hospital to distribute to needy patients at no charge. Admittedly, the amount of diabetes medications we could carry with us was miniscule compared to the need, but we had hoped that each patient who had severe diabetes and could not afford to buy the needed medication would at least be given a free supply for a month or two to get started on the right track.

The Clinics
The opening day of our screening clinic at Bauchi Specialist Hospital was met with fanfare and excitement. The local Nigerian radio station had previously aired announcements regarding the free diabetes-screening clinic being set up on the first Monday following our arrival. The response was unbelievable. Nearly 200-300 people showed up the first day and crammed into an outside tent structure set up near the office of Chief Medical Director, Dr. Mohammed Bacu. Before we began the screening clinic, we had briefly trained a few doctors and pharmacists who were very willing to assist us in screening the large number of patients. The late morning was hot, nearly 100 degrees. Although the crowd was somewhat orderly, everyone was clamoring to be first in line to have their finger pricked, a blood sample taken, and a reading taken from the glucometer. Small record cards were given to each patient so they could keep an account of their scores.

Many of the patients (ages 20-80) were getting their blood glucose checked for the first time in their lives. I would estimate that about half the crowd knew they were diabetics and were on medication or insulin, but about half had no idea. The screening proved invaluable to a high percentage of the people. We made notes on the back of the record cards of those who registered with high glucose readings, signaling them to see the doctor and go to the hospital diabetes clinic the following day to get their free drugs. The screening went very smoothly. After we completed the screenings, we were whisked off to a new section of the hospital that was, for the first time, designated the home of the Nigerian Diabetes Association (DAN). To my surprise, the hospital administration asked me to cut the ribbon to dedicate the new section reserved for diabetes training, testing, and education. A plaque was erected at the door of the new clinic reading, “Dedicated by Dr. Dan T. Wagner, April 12, 2005.” I was quite moved by the honor. After a photo session and an interview with local and national Nigerian news media, we were taken on a tour of the rest of the hospital.

I had personally volunteered in this hospital eight years prior to this trip. At that time the hospital was in dire straits: no running water, poor sanitation, inadequate lighting, lack of medical equipment, and a hospital pharmacy with many more empty shelves than ones filled with drugs and medications. The positive changes the hospital had experienced since that time were truly remarkable. The roadways around the hospital were newly paved; the pharmacy storeroom was better stocked with drugs; new wards had been built and adequately equipped; and sanitation had greatly improved. The staff was well trained and moral was high. This miraculous transformation of the hospital is due solely to the caring efforts of the governor, His Excellency Ahmadu Adamu Mu’azu. Governor Mu’azu is a man I have personally known since I began traveling to Nigeria eight years earlier (before he was elected governor). Since his election victory five years ago, he has transformed Bauchi into a “flower in the desert” by vastly improving the schools, the roads, the libraries, the hospitals, and the general infrastructure of the state. Considering Nigeria is a country with many, many poor people, it is comforting to know that in a few of the 36 states government leaders are committed to improving the health care of the people. Bauchi Specialist Hospital is now a model for all of Nigeria.

After a very successful diabetes-screening clinic at Bauchi, we were off to Gombe Specialist Hospital, located about three hours east of Bauchi. The topography along the way was dry savannah. For the first time we saw huge, ancient acacia trees dotting the landscape. The few rivers that the well-paved highway bridged over were dry as a bone. The rainy season comes to Nigeria during late April and early May, and lasts up to three months. It will not rain the remaining nine months of the year. We were probably one to two weeks away from the rains.

Gombe Specialist Hospital is located in the middle of the crowded and dusty city of Gombe. Much like Bauchi, the governor and deputy governor of this eastern state are very progressive. They are spending millions of Nigerian naira (one U.S. dollar equals about 135 nira) to improve the infrastructure. There is also a genuine commitment to the betterment of the hospital. I had been to this hospital on my initial trip to Nigeria over eight years ago, and the changes have been miraculous.

We had planned a two-day diabetes-screening clinic at the hospital, but because of the kind (but forceful) persuasion of the deputy governor (His Excellency Atiku Abubaker), we agreed to perform a three-day clinic. It went extremely well. The assistance afforded us by resident physicians, pharmacists, and nurses was gratifying. Each morning we arrived to find hundreds of people waiting outside in the hot sun, eager to get into the clinic to get their blood glucose taken, along with their weight and blood pressure.

We decided to meticulously record data on each patient we serviced. We recorded their age, weight, blood glucose number, and whether or not they knew they were diabetics. It was interesting to review the results of hundreds of patients. Generally, we discovered a higher-than-normal rate of adult-onset diabetes (NIDDM), especially in men in their 30’s and 40’s. It would be premature to establish what the main cause could be. I suspect that they have a predisposition to diabetes from heredity; however, their diets are high in starch (mainly from potatoes and cassava), with a lack of vegetables, higher-than-normal sugar use, and most disconcerting, a heavy consumption of sugar-laced soft drinks, including Coca-Cola and Fanta. Keep in mind that in any third-world country (I imagine even in our own country), you would rarely drink tap water. So if they can afford it, many people will buy purified bottled water. But it is disturbing to discover that bottled water in Nigeria is actually more expensive than Coca-Cola. Many Nigerians consume 2-8 bottles of soft drinks a day. There is little doubt in my mind that this practice is a contributing factor to the high incidence of diabetes.

It was very helpful to the team of doctors, nurses, and pharmacists at Gombe Specialty Hospital that we were able to leave behind a dozen meters and hundreds of glucose strips and lancets. Nigerian hospitals do not have access to such technology, so screening patients before surgery, screening women in labor, or just identifying those patients with diabetes is extremely difficult.

In the end, we had the professional and personal satisfaction of knowing our team saved lives. Since the inception of our diabetes program four years ago, no patient has died of ketoacidosis or diabetic coma in the hospitals where we have instituted a screening clinic. This is solely because the hospitals now have the means to identify patients at risk for diabetes. This is truly what our medical mission is all about.

The friendships and relationships we made with many peaceful and gentle Nigerians will always be a memorable part of the trip. I also hope that as ambassadors of our bountiful country, we can play a small part in helping to improve the quality and quantity of life for many third-world people.

Dr. Dan Wagner is a clinical and natural pharmacist from the North Hills. He owns and operates Nutri-farmacy at 2506 Wildwood Road, Wildwood, PA 1509. Visit on the web at www.nutrifarmacy.com.