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Nigeria: 'We've had more than a thousand admissions in a month'

11 May 2016

On her first placement with Médecins Sans Frontières Sydney Pharmacist Grace Yoo’s arrival in the emergency obstetric program in Jahun hospital, Nigeria, coincided with the busiest month in the year. “The pharmacy is vital in that we provide all the essential medicines and medical supplies to the project”, she says.

What are the main activities carried out by Médecins Sans Frontières in Jahun Hospital?

Médecins Sans Frontières aims to reduce maternal and neonatal morbidity and mortality in the Jahun area, in northern Jigawa state, by providing comprehensive emergency obstetric care. Another crucial activity is to  improve women’s quality of life through surgical repair and rehabilitation for obstetric fistulas. The majority of patients, about 60 per cent, are adolescents aged 15 to 19. A lot of patients are also coming in from all over the surrounding states, sometimes from across the border. This program opened about eight years ago and receives more patients every year. The first month I was there was the busiest of the year, with just over a thousand admissions. When I was leaving the project the outreach program was about to start, aiming to support women’s health activities in outlying primary healthcare centres.

"The majority of patients, about 60 per cent, are adolescents aged 15 to 19"

How important is pharmacy in the Jahun Hospital?

The pharmacy is vital in that we provide all the essential medicines and medical supplies to the project. This includes not only medications such as antibiotics and anaesthetics, but we also provide medical supplies and bio-medical equipment such as oxygen concentrators and ultrasound machines. Médecins Sans Frontières procures the drugs and medical supplies internationally through our supply centre in Bordeaux, France. Unfortunately we are not always able to guarantee the quality if we source locally due to a high rate of counterfeit drugs in a lot of the countries we work in. That’s also another reason why it’s important for Médecins Sans Frontières to have a pharmacy; that is to make sure that we can provide and promote the quality use of medicines. This means carrying out procedures for appropriate storage conditions, as well as educating the healthcare team.

The pharmacy team works closely with the logistics and medical team to achieve this. This is what I really respect about Médecins Sans Frontières- we work in a team and are all passionate to try and deliver a high standard of healthcare. It’s not always easy and most of the time a challenge. But I really do believe we try our hardest. The Ministry of Health in Nigeria isn’t always able to provide these supplies, and they would have to charge the patients. Our program provides free, quality medicines to the patients.

What were your main challenges during this six month assignment?

Our main issue with the pharmacy is the lack of space, even though the pharmacy has 11 rooms. We had about 960 different items and therefore this led to challenges in the appropriate storage of medications. The environment is very dry and hot for most of the year, and the temperature can go up to 45 degrees. As a solution we decided to hire a bigger and more modern warehouse in Abuja, and send smaller deliveries more often, to help lessen the burden of the storage in Jahun.

Another challenge in pharmacy is effectively managing the stock: that is, ensuring essential items do not go into shortage or rupture. Back home, we receive our orders daily and usually have no issues in receiving our stock in a timely manner. It was not until I was in Jahun did I realise how much I took this for granted, and how accessible things are for us in Australia. In the field because we are doing three orders per year, we often have to forecast at least six months ahead. Hence it can be quite stressful, as patterns of consumption can change quite drastically for various reasons, not to mention shortages due to delays in the order being fulfilled. This was the case for me, as it was for the previous pharmacist. My biggest fear was accidentally forgetting to order something. Shortages and ruptures can essentially translate to the patient not receiving life-saving treatment. However, with the support of the team in the capital (the Coordination team) it is usually possible to find a solution.  

"It was heart-warming and inspiring to work with the Nigerian staff. I felt very welcomed and supported"

How did you work with the Nigerian staff?

It was heart-warming and inspiring to work with the Nigerian staff. I felt very welcomed and supported. The people made my first placement very special. My team was small. I was a pharmacy manager and I worked with a pharmacy supervisor and store-keeper. We worked really well together, and both of them were passionate and believed in Médecins Sans Frontières. They were dedicated to the work. I also tried to get to the hospital as much as possible—the pharmacy was located in a different compound nearby. 

What surprised you most about working in that context?

It was emotional and difficult to hear from the team that mothers and babies were dying— from conditions that may have been preventable if healthcare was more accessible. It was hard sometimes seeing more than one patient sharing a bed, the outcome of having such an overload of patients. Also, people are used to giving birth at home. So, a lot of the women wait right until the end. They might have been in labour for days and when they come it’s often a very complicated case. In addition, so many of them were malnourished, complicated by anaemia, and a lot of blood transfusions were needed. And of course fistula is an almost unknown condition in Australia so that was new for me.