Dr Alero Adjene, reports on the recent RCP clinical teaching visits to West Africa
“Doctor, I can no longer perform!” These words, when heard by physicians practicing in Calabar, a city in South Southern Nigeria, are synonymous with the onset of type 2 diabetes in a male patient. While economic forecasts have promised growth, listing Nigeria amongst emerging markets, my experience was that poverty remains the norm. When healthcare is unaffordable, it is unsurprising that diabetes complications are established at diagnosis.
My preparation for the recent clinical teaching visits to Nigeria unearthed many articles declaring non-communicable disease as the next epidemic to hit Africa; but the paucity of data means the true scale of the problem is unknown. This collaboration, between the West African College of Physicians and the Royal College of Physicians, is a sign of the times.
My two-week visit to Calabar was spread across different specialties; the bulk of my time with internal medicine and the rest divided between family medicine, obstetrics, emergency room staff and an impromptu visit to the naval hospital. All sessions were received enthusiastically and culminated in robust discussion. Power outages, infamous in Nigeria, were frequent and the junior doctors manned the generators.
During one clinical session the registrars presented a man with a chronic foot ulcer and underlying osteomyelitis; a self-employed market trader, he had been on the wards for weeks on intravenous antibiotics and subcutaneous insulin. We all agreed that his extended inpatient stay would have led to significant losses in his income, and the doctors marvelled at how such cases can be successfully managed in an ambulatory setting. His church was funding his medication and he lacked a reliable source of refrigeration upon discharge. However, metformin, one of the cheapest drugs available, had not been prescribed; it is underused in Calabar due to a fear of lactic acidosis, a phenomenon rarely seen if used as labelled. This case highlighted the importance of our visit; books and websites are no substitute for seeing medicine in practice and passing on experience between doctors, especially when the burden of diabetes is ever on the rise. Finally, why see a physician when there are other less costly “health providers”? A traditional healer, a nurse-led private clinic … these are some of a myriad of challenges faced by our West African colleagues.
Dr Alero Adjene, Consultant Endocrinologist,
Imperial College London Diabetes Centre,
PO Box 48338, Abu Dhabi, United Arab Emirates.
E-mail: ally_adjy@hotmail.com
Br J Diabetes 2016;16:38
http://dx.doi.org/10.15277/bjd.2016.063