Healthcare Project Nigeria

Gure Model Health Clinic Upgrade, Baruteen L.G.A, Kwara State Nigeria 

November 2009
By Michael Lear

The Gure clinic, situated near the Nigerian/Benin Republic border, is the only access to healthcare for a population of 154,376 in the Baruteen Local Government area and surrounding towns.  Access to healthcare in the region is so scarce, some from the Benin Republic even cross the border to come for treatment.  Although the clinic activity varies depending on the weather and access to the health center, on average 80 patients are seen per day.  

The goal of phase one of our clinic upgrade is to improve hygiene, function and safety of existing clinic and restore community faith in its operation, so those making the long journey can rely on being treated when they arrive. 

Phase one upgrade activities include: 

1. Provide Medicines and Medical supplies to the clinic
2. Clean and paint interior and exterior
3. Install Screens on all windows and doors to reduce Malaria risk in wards
4. Provide mattresses
5. Investigate Solar electrical supply
6. Quote Bore Hole for drinking water and water to clinic  

Through investment in critical PHC components, medicines, equipment and local staff, we are re-establishing clinic activities at the level of Best Practice, Western Medical Standards and strengthening the delivery of services before we introduce our program modules on a priority basis relevant to the specific needs of the region.  It is through this clinic development process that we’ve gained trust and established a partnership within these communities, so our clinics become a long-term springboard for our modular program outreach.  

Reflecting this was the offer from the village elders of the community who offered land for RMF to build accommodations for visiting staff to support the clinic.  At present there are no accommodations on site and the closest are 5-6hrs away in Ilorin, Kwara State’s capital.  This reflects the trust established during our process. 

Our support of the clinic health fair earlier this year and commitment to the clinic upgrade, has already restored hope for more comprehensive medical services at the long abandoned Gure Model Health clinic.   According to the staff, “the people have taken pride in the clinic and are already enthusiastic about the impact of RMF each time they enter the clinic.” The number of people that now use the clinic daily is steadily increasing and local villagers are coming to have wounds treated and receive medical attention for malaria, respiratory infections and gastrointestinal disturbances. 

Also resulting from our commitment to the Gure clinic, The Nigeria Youth Service Corp (NYSC) in Kwara State, along with the Kwara State Ministry of Health, wish to partner with Real Medicine Foundation to leverage the NYSC network of emerging medical staff and other remote health care clinics to deliver much needed healthcare support to the region. The NYSC is responsible for deploying graduating professionals, including physicians, to Nigeria’s remote regions for their final year of service to their country. 

One area where RMF’s support will have immediate impact is staffing.   Presently exacerbating the clinic’s limitations to serve the community is the lack of year round medical staff due to state budget constraints.   Professional medical staff coverage at the clinic is often limited to nine months out of the year, while a Nigerian Youth Service Corp (NYSC) doctor is in residence.  This means the community must resort to traditional methods of treatment or going without any health care at all for three months.  RMF will ensure the clinic is properly staffed year round to provide the community with reliable access to quality healthcare.  

Looking towards the future: 

With a vision towards expanding our services, additional meetings were held with national healthcare stakeholders to discuss how RMF may support Nigeria’s Millennium Development Goals Strategies through the clinic in Gure.  Child and Maternal Health, MDGs 4 and 5, would be the main focus of RMF activities.  These meetings included Mrs. Amina Hajia Amina Mohammed Az-Zubair, Senior Special Assistant to the President, Millennium Development Goals (MDG) and Gede Foundation Founder Jamila Jennifer Abubakar, to discuss how RMF can support their HIV/AIDS orphans programs in Nigeria.  

While our phase one activities are underway, RMF is already coordinating phase II to ensure continuity of the upgrade.  Planned activities include: 

1. Continued supply medications (fill gaps in supplies from government)
2. Provision of staffing support to ensure year round medical staff coverage
3. Supply of additional medical equipment, to be determined
4. Obtaining quotations on building accommodation room at the clinic
5. Coordinate Bore Hole Drilling/Solar Electricity installation
6. Procurement and installation of a Repeater to improve GSM signal strength within the Hospital
7. Assessment of Maternal and Child Health Care/ Midwifery needs and outreach programs
8. Introduce the Homeopathic Malaria Treatment Support, HIV/AIDS outreach to reduced patient load
9. Staff Training – consideration of continuing education support 

The present state of the delivery room and maternity ward, as well as the medicine stores for a surrounding community of 150,000 provide a glimpse of the necessity of our support.

May 2009
By Sope Ogunyemi

Lagos State:
While Coker/Aguda is still in need of a long-term health care center, RMF has chosen to implement its first Primary Health Care Project in Gure, Baruten, L.G.A. Kwara State, a rural area of extreme poverty where there is a dire need for more comprehensive health care.   Central to RMF’s success is leveraging existing clinics, familiar with the local demands, yet requiring support to fully optimize its function and leverage its presence.

After a thorough review of the situation in Lagos State and surrounding areas, we determined that the Gure, Model Health Care Clinic was better suited for the RMF Model and our assistance would address a larger rural population in dire need of outside assistance. Strategically, we felt that our model could be easily and successfully implemented in this region and then scaled back to Lagos State as originally intended, and Calabar, Cross River State where needs have been identified and interest is high for RMF participation.

Kwara State (Gure Project):

Overview: As outlined in the last report, we were able to create a partnership with the Gure Model Health Care Clinic, which is located in the Baruten local government area (LGA) in Kwara State.  Gure is in the south-west of Nigeria (about 3 hours north of Lagos) and borders the Benin Republic on the West.  The Gure Clinic serves the entire Baruten LGA as well as people from the Benin Republic.  The population to be served is approximately 150,000.  It is a primarily rural area with little access to health care.   The clinic faces several major challenges including: fatalities from easily treatable diseases due to lack of adequate treatment. The most common ailments in the area include: malaria, musculoskeletal pains, gastrointestinal disturbances and ulcers, respiratory tract infections, hernias.

April Health Week: 

Dr. Ejughemre Ufuoma who is the overseeing physician at the Gure clinic organized a health week (4/13 – 4/17) where he invited visiting doctors to assist in providing free basic surgeries and health care to the impoverished residents of the area.  His goal was to spread awareness of the health treatments available at the clinic and avoid preventable deaths.  He heard about RMF’s operations and requested aid.  Real Medicine provided organizational support and financial support for medicines and equipment for the week.

The health week was a huge success (see the schedule below and attached images).  It raised awareness of non-traditional healthcare services at the clinic, 290 people received free treatment and we also brought surgeries for the first time to the area!  In detail: A total of 290 cases were attended to, 5 were surgical cases involving herniorraphy: Malaria-80 Antenatal-30 Respiratory infections-25 Surgeries-5 Herniorrhaphies Musculoskeletal Pains-60 Gastrointestinal/ulcers-40 Others- 50

Kick off ceremony		Crowd gathers at clinic
Patient being treated		Patient with child awaits treatment

Next Steps: The clinic is still in dire need of long-term support. Particular issues include overstretched facilities including lack of surgical and medical amenities, doctors and other medical staff, inadequate staff training and poor communication network. RMF staff is scheduled to visit to carry out an extensive needs assessment of the clinic and its surrounding areas to determine the highest leveraged approach to providing solutions to this community.

The Needs Assessment will include:

1. Clinic health management information system/record keeping.
2. Medical inventory and dispensary procedures, etc. to ensure level of standards and transparency.
3. Preparations of MOU with local and national authorities outlining  RMF’s long term support in the following areas:
4. Communications: Procurement and installation of a repeater to improve GSM signal strength within the hospital, facilitate communication within and outside GURE as well as Internet access through the GSM connection.
5. Clinical upgrade to improve hygiene: (painting, mattresses, mosquito nets, electrical work, etc.)
6. Supply medications (fill gaps in supplies from government)
7. Supply some medical equipment, to be determined
8. Bore Holes for drinking wells - needs assessment to be done
9. Staff Training – consideration of continuing education support/training
10. Maternal Care/ Midwifery - consideration of continuing education support/training
11. Homeopathic Malaria Treatment Support

Another potential partnership is with the Nigerian Youth Service Corps, (NYSC), an organization that supervises Nigerian college graduates’ mandatory yearlong service all across Nigeria.  We are presently setting up a system to recreate our partnership in Gure across Kwara State and the rest of Nigeria. 

October 3, 2008
By Sope Ogunyemi

As Nigeria Project Director, I traveled to Nigeria on a fact finding trip from September 3rd – 15th. While there, the goal was to evaluate the feasibility of establishing RMF’s pilot health care clinic in the Aguda/Coker area of Lagos, in partnership with Afodise, a local NGO, and the Lagos State Government (see July guidelines for more details).

During the trip, we were able to connect with our contacts at Afodise and Lagos State Government to begin moving the project forward. We finalized the community in which we would establish the clinic, Coker Village in the Surulere Local Government area. We were also able to visit the area in order to survey the need and were very happy to hear from local residents that a clinic is needed and would be much appreciated. Please see the pictures (on this article) of the Coker Village area in which the clinic would be established.

We are currently working on compiling demographic data for the area as well as beginning the registration process for the clinic. In addition we were able to connect with a real estate agent in the area and are in negotiations for a building to house the clinic!

Finally, we were also pleased to connect with Dr. Ben Nkechika in order to discuss the urgent need for basic health care in the other parts of the country, in particular the Niger Delta region. We hope to move forward on the establishing clinics there once we have completed the Lagos State Pilot clinic. We are very pleased with the progress made on what was a very busy trip. Please look out for more detailed updates soon!

A big thank you to the following people for their support of Real Medicine Foundation while we were in Nigeria: Mr. Lawale Edun, Dr. Jide Idris, Dr. and Mrs. Mike Ileka, and Chief (Mrs.) Ogunyemi, Mr. Olubola Sonoiki, and Mrs. Tokunbo Orekoya.

Primary Care Clinic – Nigeria

July 22, 2008
By Sope Ogunyemi

Overview

We are refocusing the Nigeria project and exploring establishing the first clinic at a new site, in the Aguda neighborhood in Lagos, Nigeria. The area is a good potential site because it is a densely populated, low income area with no access to primary health care. Also, the neighborhood is located within the city of Lagos, allowing for ease in logistical planning and execution for the free clinic.

The population to be served is approximately 100,000. Most of the residents are predominately poor and few would classify as low income earners. It is a high density area and most homes are rented one or two room apartments, with dilapidated infrastructure, badly ventilated rooms, poor sanitary conditions and no pipe borne water. The area would greatly benefit from complimentary basic health care, as it does not have any such facility. Current remedies in the area are either non-medical or out of price range for the local residents.

We are extremely excited to have identified an on-ground NGO partner, Afodise, to take over the long term management of the Nigeria clinic, with the hope of establishing multiple centers across Nigeria. Afodise has already established health care clinics in low-income areas in other parts of Nigeria. See below for more information on Afodise.

We are working to establish the facility as soon as possible and estimate that the time to launch the clinic will be 6 months, or January 2009. Real Medicine Nigeria Project Director will be visiting potential sites and meeting with partners in Lagos during August/September 2008.

Project Status

• Name of Clinic: TBD
• Type: Primary Healthcare Center will provide Basic Health Services. The clinic will be established as a "Build, Operate and Transfer" facility (BOT). Real Medicine Foundation will establish the clinic and transfer the running to a local Non-government organization Afodise, in partnership with the Lagos State Government, for long-term management.
• Partnerships
  1. Lagos State Ministry of Health: RMF Board Member, Dr. Ogunyemi, has secured commitment from the Honourable Commissioner of Health, Lagos State, Dr. Jide Idris, to support the clinic, by providing free medication. Additional Support TBD
  2. AFODISE (African Foundation for Development of Infrastructure and Social Services in Rural Communities) is a non-governmental, not-for-profit, non-political, organisation formally registered with the Nigerian Corporate Affairs Commission. The organization began operating as a family charity in 1955 and focuses on sustainable development of basic infrastructure and social service in rural communities. AFODISE currently serves as one of the United Nations Development Program (UNDP)'s Implementing Agents for Akwa Ibom State, and represents NGOs/CBOs on the UNDP/State Trust Fund and the State Project Consultative Committee (SPCC) of the UNDP. AFODISE has also facilitated the establishment of a Health Center by the Akwa Ibom State Government (in Oboetim Nsit), commissioned in 1995, and which currently caters for the needs of the village and its environs.
• Next Steps:
  We are currently working with our partners to reach out to Aguda community leaders for support and to secure a building for the clinic. More updates to come soon.

Restoration of the Free Clinic for Children in the Makoko Slum, Lagos, Nigeria

Update: January, 2008
by Dr. Deji Shedu

• CHSS received certificate of incorporation from the CAC in August
• Dr. Osin Sunday & Dr. Dotun Ogunyemi - two RMF volunteers visited Lagos in December:
• Dr. Sunday met with our team on ground, held discussions on RMF accounting system and took some pictures of the proposed site for the clinic
• Dr. Ogunyemi discussed the framework of the project with our team members. He also met with the Lagos State Commissioner for Health
• The Commissioner expressed interest in our project and seconded Dr. Jagun from the ministry to help us on the project.
• He also invited us to take part in the various health programs organized by the state
• These include: Malarial program, TB program and the Vaccination program

Update: September, 2007
by Dr. Deji Shedu

• We finally located and had audience with the ruler and authentic head of the community
• We received the letter of invitation into the community
• CHSS has finally been incorporated as an NGO
• The community has donated a plot of land for the clinic
• We already scheduled a meeting with all of Makoko Community for Saturday September 30th, 2007.

Update: May, 2007
by Dr. Deji Shedu

It's "Hurrah" for Team Nigeria in April, as the Federal Ministry of Health supported our application for the registration of Complete Health Support Services (CHSS) - the representative of RMF in Nigeria. To see the approval letter, please click here.

We are also fortunate to have secured the services of a Project Coordinator, who will organize our efforts on this project on site. The Project Coordinator understands the local language, she is familiar with the area our project is sited and is passionate about working with the community. She will be responsible for reaching out to the community through its leaders and to bridge the gap between the host community and RMF. Furthermore, she will be involved in day to day activities associated with setting up the clinic, including arranging for staffing, and account keeping, as well as other duties that may come up.

Update: December, 2006
by Nkem Ndionuka

We met with the community leaders and introduced them to the proposal of RMF.

As expected, it was a great occasion for them which was evidenced in the warm reception accorded us. It was really really great! In the company of Mrs. Balogun we kept an earlier appointment and for about 3 hours had discussions and interactions after which we arrived with the following:

• 1.The makoko community is highly delighted about the news of RMF.
• 2. The community is in dire need of such projects for which RMF is known.
• 3.The community is ready to partner with RMF by providing a place for the clinic's location.
• 4.The community comprises of people from neighbouring countries like Togo, Benin Republic, Ghana and Cameroon whose only source of livlihood is subsistence fishing.
• 5.The only standard healthcare services are provided by a little clinic run by the Catholic Church, although attendance is poor due to costs.

Update: October 4th, 2006

The project Restoration of the Free Clinic for Children in the Makoko Slum, Lagos, Nigeria is starting to gain momentum.We have attracted the interest of Dr. Nkem Ndionuka of Nigeria, Ms. Pei-hsuan Tsai, a nurse in Cambridge, MA, and Mrs. Bukky Balogun, a lawyer working with the Lagos State Ministry of Justice, who are also enthusiastic to see the project come alive. Dr. Nkem and Mrs. Bukky will be visiting the Makoko slum's elders, to introduce the plan and hope to receive their whole-hearted welcome to bring such a life saving service to the community's children. Dr. Nkem is gathering accurate estimates of material costs for the proposal's budget, as a final critical step before the proposal is submitted for funding to various sources.

Ayodeji (Deji) Shedu MD, MPH, June 14, 2006

Background:
Makoko is a teeming shantytown in Lagos State. It has an estimated population of 50,000 people, the majority of who live in wooden huts built on stilts sunk into the dark waters of the Lagos lagoon. Makoko waterside inhabitants are mainly fishermen, who go out to fish in the night and stay indoors during the day, while the women take the fish to sell in the market or to dry. The maximum family income is about $50 dollars a month. The vast majority lives on less than $1 a day. They are mainly of the Ijaw and Egun ethnic stock. The adjoining mainland is inhabited by people from other ethnic groups with similar socioeconomic status.

The social infrastructure in Makoko is very poor. The mainland does not have good roads, the area lacks potable water and the waterside is devoid of a sewage disposal system. This results in high morbidity from malaria, diarrhea and other infectious diseases. To reduce the high morbidity and mortality, medical volunteers in conjunction with the Nigerian Red Cross organized a free clinic for children under the age of five years in 2001. This clinic also provided care for the children in the motherless babies’ home being run by the Nigerian Red Cross in the area. The clinic was shut down the following year because of lack of support from other stakeholders.

Plan:
Provision of adequate health care to the inhabitants of this deprived section of the Lagos metropolis will be three stages.

1st Stage: Restoration of free pediatric services to children under 5years and provision of same to children aged 5 - 11. Duration: 2 years.

2nd Stage: Enlargement of health services to include older children (up to 18 years) and also provision of maternal health services. Duration: 2 years.

3rd Stage: Provision of expanded primary health services to include acute and chronic medical services to adults.

The services of the maternal aspect of the second stage and the third stage will be paid for. The goal is that by reaching the third stage, the health facility will be self sustaining. This proposal is focused on the first stage of the plan.

Goal:
To restore free pediatric care services to the estimated 15,000 children under the age of 12 years (primary school age) in this Lagos slum.

Objectives:

• To improve the access to health care for the pediatric population.
• Provide a standard package of primary health care for the target group, incorporating health education to mothers, disease prevention and health promotion.
• To involve the local community in the health care delivery system, thereby ensuring acceptance of the clinic at the grassroots.
• To train health workers who are interested in working with the underserved urban population, especially in the areas of health education and promotion.
• To collect demographic and health related data of this population and their analysis to improve understanding of their health needs.

Components:
A) Restoring the free clinic for children

• Provision of a health center in the area: This health center will replace the two room facility that was used in the previous attempt to provide services. A building with the best location, adequate number of rooms and standard facilities will be leased for the first phase of the project. Ideally it should accommodate an Out Patient Department, nursing station, doctor’s office, call room, nursing room, treatment room, dispensary, storage and ward of four beds.
• Staffing: The following staff will be hired to accomplish the stated objectives of this project.
  1. A full-time medical doctor who has at least 5 years of independent practice in pediatrics or general medicine with pediatric care experience
  2. Two full-time nurses experienced in pediatric care
  3. Four full-time, experienced nursing assistants
  4. One experienced, part time laboratory technician
  5. One part-time public health practitioner
  6. One part–time cleaner
  7. One full-time watchman
• Drugs
• Equipment

B) Disease Prevention:
The public health practitioner will lead and coordinate the activities of the nurses, nursing assistants and trainees to assess the vaccination status of children especially those in the waterside (according to the National Program on Immunization schedule) through a hut to hut survey. Not yet immunized children will be vaccinated and data will be collected to determine why these children had not been vaccinated. Data will also be collected on the ailments and medical problems that commonly affect this population.

C) Implementation Strategy:
The Real Medicine Foundation, through Comprehensive Health Support Service, will have direct administrative control over the clinic and other public health programs. These programs will be run in accordance with national and state health programs. Community involvement and participation will be a cardinal tenet in the execution of this project to ensure acceptance and sustainability.

1. Up to two part time doctors may be employed as the need arises.
2. The project will start with 2 nurses and this number will be increased to a maximum of four if there is need.
3. Two additional nursing assistants may be employed if the need arises. Up to four nursing assistant trainees will also be hired. Rigorous attempts will be made to hire qualified and motivated personnel from the community, especially those from the waterside.
4. Public health practitioner will coordinate outreach health promotion and health education services to inhabitants of waterside and the adjacent mainland. He / She will also be responsible for data collection and collation.