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(Tiffy Thompson for The Globe and Mail)
(Tiffy Thompson for The Globe and Mail)

No soap, dodgy power: teaching brain surgery in Nigeria Add to ...

“You are welcome,” the young man at the hotel desk says.

“What did I thank him for?” I wonder.

I hear this phrase repeatedly, and eventually figure out this is Nigerians’ way of saying “Hi, how are you?”

This is my third neurosurgery teaching mission to sub-Saharan Africa. The morning after our arrival amid the wonderful hot chaos of Lagos airport, we’re on the road to Ibadan, a large village. Every 10 kilometres or so, young uniformed policemen with machine guns stop beaten-up, overcrowded cars for bribes. Numerous corpses of abandoned trucks have long ago been picked clean. Countless people in dilapidated vending stalls or carrying heavy baskets of fruit on their head sell their wares. We swerve to avoid cow-sized potholes. A woman in a stunning multicoloured dress and hat walks near a man holding an antelope with its neck slit, blood still dripping.

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It is a time of sporadic turmoil in Nigeria with regular bombings. The Canadian government has issued a travel advisory, and just before our departure date three of my six-person team decide they must back out, after six months of planning.

The hospitals are rundown and the equipment backward. I have seen this many times before in teaching stints throughout the developing world. The power goes off several times a day. There are few sinks for washing hands, and no soap or paper towels.

But the surgeons are eager to learn awake brain surgery, for removing brain tumours, and like most developing world surgeons I have met they are technically solid, even slick. They learn the technique quickly.

It is a good operation for resource-poor countries because it obviates the need for expensive general anesthesia and ICU beds. Hospital budgets are scanty, and sick people pay their own way here. Maybe that is partly why the patients seem so receptive to awake brain surgery.

During one case the patient, an engineer, hears us grinding away on the other side of the drapes and asks why we are not opening his skull with a power drill instead.

We do several cases in Ibadan and several in Abuja – I talk the surgeons through the operations without scrubbing in as they learn more quickly this way and gain confidence. A beautiful chemistry develops between the local nurses and doctors and my team.

We move on to the town of Sokoto in the Muslim north. The broken streets are lined with sellers of everything from brightly coloured peppers to bags of cement. The dusty air is whipped up by the Harmattan, a dry wind that blows in the fall and early winter.

When my team and I arrive at the hospital, we are measured for beautiful Nigerian outfits. They are ready just in time for our lectures, which are attended by the entire hospital staff and punctuated by pomp and ceremony, with one person introducing another after another. I am the fifth person to speak when I get up to give my keynote lecture.

This formality is a residue of British colonial days. The large shiny wall banner the hospital produced for our visit advertises my lecture at “4:00 p.m. prompt” but I speak at about 4:45 p.m. Some people grin when they see us in our flowing outfits, complete with the traditional hat. I, in particular, must look ridiculous, but I feel like the King of Nigeria.

That evening we are invited to a neurosurgeon’s home for dinner. A short distance from his house, a diffuse pile of garbage by the road is being probed by feral cats. The house is made of cement and is dark and unattractive. The front yard is a lumpy, bumpy pad of hard-packed red dirt.

We leave our shoes at the door and enter a single room that’s sparsely furnished and has stained, crumbling acoustic tiles in the ceiling. A single bare light bulb illuminates the room and air quality is left to an old ceiling fan. At one end is a table laden with homemade food – spicy rice, savoury chicken, fried plantain and various bread-like dishes made from pounded yam, cassava and other root vegetables. The liberal use of palm oil in the cooking ruins my low-cholesterol diet but the taste is worth it.

The conversation is high-spirited among the younger surgeons, and the Canadian team are all given nicknames. I am dubbed “Dalong” which means “king” in the part of Nigeria one of the resident surgeons is from (there are about 250 dialects in Nigeria). It is an obvious compliment from people who have already humbled us with their kindness, hospitality and willingness to learn.

At Abuja airport after two productive weeks, the surgeons all show up to send us off on our late-night flight to Frankfurt. We are at the same time animated and subdued, knowing that goodbyes are coming soon. A 36-year-old neurosurgeon who has done some training in Chicago is overcome with emotion and starts to cry.

Once again, my team and I have connected with very special people in faraway places, and once again we have taught and we have learned.

Jew has worked with Muslim, white with black, male with female, old with young, Canadian with Nigerian, resource-rich with resource-poor. The African magic continues.

Dr. Mark Bernstein is a Toronto neurosurgeon

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