International Pharmacy Journal, Volume 11, No.4, 1997

OUT OF AFRICA
by Daniel T. Wagner

"As the first pharmacist ever invited by the World Health Mission to join a group of multi-disciplined physicians, it was a unique opportunity for me to work with physicians as a clinical pharmacy expert. I was overwhelmed by the health and medical needs of the gentle people from Bauchi, a city in north-east Nigeria. The pharmacy situation is quite critical considering there is a lack of variety and quantity of needed pharmaceuticals. Perhaps world-wide recognition - through the readership of IPJ - will help the many multi-national pharmaceutical companies that may be dealing in Nigeria to commence a stronger and more assertive role in helping these people." With these words, Pennsylvania Pharmacist, Daniel Wagner, introduces his diary from his African mission described in this article.

"Mayhem was my first impression as I debarked from the Northwest/KLM 747 airliner in Kano, the largest city in northern Nigeria. A swarm of black men, some in conventional western clothes, but most in traditional Moslem gowns and hats, gathered around our luggage in the sweltering heat generated by the equatorial sun near the edge of the Sahara desert. They were eager to carry the load for a 'tip', hopefully in American dollars.

Getting past the military guards, who initiated the customs search, was a frightening experience because most carried large guns. I had read that Nigeria had a military dictatorship. In fact, the police personnel and military men passed at the frequent checkpoints along the main highway we traveled, looked quite foreboding, but we never felt threatened or endangered during our stay in Nigeria, the most populous of all African countries.

Goats, sheep, chickens and dogs
Kano is a major northern city with well over a million people. Unbelievable traffic noise and congestion rose for huge marketplaces - dingy microcosms of motorcycles, beat-up automobiles, ragged children, old black men, goats, sheep, chickens and dogs. Such sights and sounds somehow define all that is uncertain and intangible in the Third World.

The next day our team was moved on to Jos, a major city in Nigeria's central plateau district and an overnight stop on our way to Bauchi. Jos offered a cooler climate, but little relief from the relentless traffic.

An exceptionally wealthy businessman offered us genuine unexpected hospitality when he invited us to stay in his plush, ornate guest house. He also loaned us two Honda automobiles that greatly facilitated our jaunt east to Bauchi Special Hospital, where we spent the greater part of our trip engaged in medical work.

Bauchi, four hours east of Jos, was more impoverished than any of than other cities we had already passed through. Once again, overcrowding was evident and the heat dust and auto exhaust made for a very negative first impression.

Few drug supplies
The hospital's administrators and chief surgeon greeted our team cordially and enthusiastically. But upon touring the facility, our first dose of reality was sobering: the hospital had little running water, insufficient quantities of medicines, few drug and medical supplies to choose from, a sub-qualified staff, unsatisfactory sanitary conditions, and an abundance of patients in serious or critical need.

Our challenge was formidable. With each day the many task our team would perform seemed to become overwhelming. Although our efforts were contributing to improved patient care, the immensity of the situation led to a disconcerting feeling we were only scratching the surface. One of the most frustrating aspects was that the government did not provide money for patient care. Patients entering the hospital had to pay for their own food, bedding, medicine, bandages, drugs, gauze and other products so essential to proper care and healing. In many cases, patients or their families had no money to pay for these necessities and ended up marooned in worn-out hospital beds waiting for inadequate care during infrequent doctor visits.

Exercise in frustration
The entire area of pharmacy was an exercise in frustration and unbelief. The pharmacy in Bauchi Hospital was poorly stocked because of lack of funding. The total variety of drugs available at the dispensary was probably less than 20. The only antibiotics available were penicillin, ampicillin and dicloxacillin. No broad spectrums were in stock. The only drugs used for psychotropic therapy were imipramine and chlorpromazine. I saw many posters advertising the new SSRI's, like Prozac and Zoloft, but there was no way the hospital could afford to stock them. Most of the drugs available were to treat local ailments; like malaria, dysentery, parasites and infections of all kinds.

I soon realized that my services as a pharmacy consultant would be severely limited, so I took it upon myself to work in the burns unit where dozens of children lay in agony from second and third degree burns, mostly from hot water spills. Patients or their families often had no money to spend on bandages, gauze pads, ointments or pain medication. But our American dollars went quite a long way in the Nigerian economy.

Smiling faces of kids
It was easy for the team members to 'pitch in' to buy much needed drugs and supplies. I purchased most of the drugs from the retail pharmacy outlets in town, where the selection was much better. I compounded a potent burn lotion that helped to soothe some of the extensive wounds. Our team nurse, Donna Whitlock from the University of Alabama Medical Centre, was immensely helpful in cleaning and debridgement of the burns. We were so pleased that most patients in our ward were discharged by the time we left. The smiling faces of kids and mothers was all the payment we needed.

The three obstetrics-gynaecology doctors did individual work in their ward - where they performed surgery, delivered babies and did extensive training for the residents and nurses. The arrival of the fetal monitor we shipped over was welcomed with enthusiasm and vigor. That Bauchi Hospital will now have such an instrument will greatly facilitate the level of prenatal care and delivery.

Fanfare and excitement
I was most fortunate to get a chance to teach at the local university in Bauchi. Professor Abubakar Sambo, chancellor at Abubaker Tafawa Balewa University, invited me to lecture to the biology, biochemistry and botany classes.

My topic was 'pharmacy in the rainforest', which included a slide presentation and lecture on my recent trips to South and Central America. It was well received by the attentive and most cordial student body.

The arrival of our seven crates of supplies on the final day of our volunteer services at Bauchi Hospital generated much fanfare and excitement. The roughly USD 40,000 shipment - long delayed at the customs office - was a lifeline of medical equipment, drugs, vitamins, surgical and medical supplies, medical books and journals, and even toys and candy.

For me, the mission to Nigeria was a life spiritual adventure that will live in my heart and mind for a long, long time. Despite the evident sorrow, poverty and misery of this typical Third World city, in many ways Bauchi was also a city of joy. The warmth, friendliness and appreciation of the Nigerian people was most endearing."

Daniel T. Wagner R.Ph., M.B.A. is the former owner of Medi Pharmacy in Allison Park and currently owns Med-Pharm, Nutri-Farmacy and Wildwood Medical in Wildwood, Pennsylvania, USA.



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