Fieldset
Obstetrics in Nigeria: Meeting the “real heroes”

Pippa is an obstetrics and gynaecology consultant from the UK on assignment with Médecins Sans Frontières / Doctors Without Borders (MSF) in Jahun, part of northern Nigeria’s Jigawa state – an area where high numbers of women and children die during childbirth. In this blog, she shares her experience of meeting a local surgeon.

I met the fistula surgeon today. Now, this guy is one of the real heroes.

 He works in a teaching hospital nearby and explains to me the culture of why women have such a difficult time here in Jigawa state.

Wives are easy to come by, he explains, and children work and bring money in. So, you need plenty of children.

He was born nearby, and stayed, choosing to operate on fistula patients.

We have a joke about what would happen if tomorrow all women actually turned up to the maternity unit - overnight we would begin receiving 10,000 pregnant women per month!

Obstetric fistula is a birth trauma, where women who have suffered an obstructed labour are left with severe damage to the birth canal, leading to continued incontinence of urine and/or faeces.

This is never a money-making thing for a surgeon. Fistula patients are the most vulnerable women in society.

He is head of obstetrics in his hospital. Again, in the place where he was born.

So yes, I think the real heroes here are the doctors that stay.

The brain drain

The issue of “brain drain” is a big deal in Nigeria, where skilled professionals move to higher income countries.

The UK is one of the main culprits that lures doctors away from countries that train limited numbers of doctors – to a better salary, an easier lifestyle and in some cases a safer life for them and their families.

But this, of course, means leaving the countries that trained them, where you can often count the number of medical schools on one hand. Some international doctors you talk to describe 90 percent of their former classmates as no longer practicing in the countries that trained them.

Ten thousand women a month

The fistula surgeon tells me about his obstetric unit, and we think about the implications of the message that is often sent out to local people…

In his own hospital’s area, the situation is similar to here, where roughly 10 percent of women give birth in health facilities. However, it is recommended that all women should do so.

We have a joke about what would happen if tomorrow all women actually turned up to the maternity unit - overnight we would begin receiving 10,000 pregnant women per month!

Now that is bonkers! The implication of this is crazy, it would mean between 1000-2000 caesareans per month!

How would an infrastructure be made to cope with that sort of pace of around 33-65 caesareans per day? 

I mean, how many theatres? How many staff? How many units of blood? 

Some sort of megacity maternity unit. My mind boggles.