Year : 2017 | Volume
: 27 | Issue : 1 | Page : 1--8
Sojourn of a surgeon: The need for cancer registry. 12th eruchalu memorial lecture 2015
Department of Surgery, University of Port Harcourt, Rivers State, Nigeria
Prof. Ndubuisi Eke
Department of Surgery, University of Port Harcourt, Rivers State
|How to cite this article:|
Eke N. Sojourn of a surgeon: The need for cancer registry. 12th eruchalu memorial lecture 2015.Niger J Surg Sci 2017;27:1-8
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Eke N. Sojourn of a surgeon: The need for cancer registry. 12th eruchalu memorial lecture 2015. Niger J Surg Sci [serial online] 2017 [cited 2019 Jan 18 ];27:1-8
Available from: http://www.njssjournal.org/text.asp?2017/27/1/1/230693
This year, we celebrate the 80th Anniversary of the International College of Surgeons (ICS)! In 1935, our founder, Dr. Max Thorek, had a vision to bring global surgeons together to provide better surgical care to all.
All of us in the ICS are involved, among other reasons, to “give back,” to assist our fellow human beings, particularly those in need, as best we can. This entity, which was created 80 years ago, provides us with a framework to give back. It really is a privilege to be a part of this college!
Max Downham 2015
Let me thank the Council for this honor of the onerous task to give this 12th Eruchalu Memorial Lecture. However, I find it petrifying to stand before a distinguished audience of seasoned and seasoning surgeons, as well as a congregation of movers and shakers of society. I am petrified because I feel that by this nomination, the Council has put a giant's robe on a dwarfish oaf, apologies Shakespeare. Being the 12th lecturer, I am consoled by the belief that there will not be a Judas.
I am reminded of a student who was preparing for the GCE O level on religion. Scanning past questions, he convinced himself that that year the question would be on the Life of St Paul. He left no stone unturned in his preparation. Alas, when he opened his question paper, the question was on the life of Jesus Christ. The student prayed for inspiration or a change. He chose change and changed the question. As a preamble, he wrote to the examiner, who am I a sinner to write about my Savior? I would rather write on a fellow sinner, St Paul.
Luckily for me, previous lecturers had the task cut out for me. I have palmed off their lectures. All I need to do is tell you what they said at the risk of being found guilty of plagiarism. God forbid. Let me tell you what they said, thereby acknowledging them and simultaneously acquitting myself of the charge.
Past Eruchalu Memorial Lectures
Medical Education, Time for a Major Change, by Prof. Festus Aghagbo Nwako in Benin, 1987Surgical Horizons, by Prof. Wilson IB Onuigbo, Enugu, 1989Duodenal Ulcer in Nigeria; State of the Art, by Prof. Toriola Solanke, Lagos, 1991Transplantation in Medicine: Matters Arising, by Prof. Emenike Anyiwo, Nnewi, 1995Economic Policy and Health, by Prof. Alhassan Mela Yakubu at Kaduna, 1996Surgical Reconstruction: The Common Factor, by Dr. Odunayo M Oluwatosin, Ibadan, 1997The Heart of the Nation: Surgeon's Viewpoint, by Prof. Humphrey Anyanwu, Owerri, 1998The Challenges of Surgery in a Bleeding Patient in the Era of HIV/AIDS, by Prof. Etim Essien, Port Harcourt, 2000The Communal Knife. Placing the Scalpel in Context, by Prof. Ed 'B Attah, Calabar, 2002Civilizing Nigerian Surgery, Posers, Prescriptions and Pretensions, by Prof. Reginald Ofoegbu, Benin, 2004Man, Mammon, and God in Nigeria's Medical Practice, by Gen Maurice Ezeoke, Kaduna, 2006.
You can understand my predicament and trepidation, giving this lecture a decade after the previous one. I crave your kind indulgence as I speak from the abundance of my heart. In my plea for your kind judgment, I plead Plato, who said:
Wise men talk because they have something to say; fools, because they have to say something
My encounter with Dr. Eruchalu
Dr. Eruchalu was the guest of honor at the annual Mark Reading ceremony in Government Secondary School, Afikpo, in 1966. This was like an Annual School Conference when the School showcased some of its achievements and gave out prizes to outstanding students. One such outstanding student was Anthony Nwasokwa, now a cardiologist in New York City, who collected the first prize in his class all the years he spent in the school. At the ceremony, I had a booth. I had made Andrew's liver salt from its constituents which we can read from its package. When Dr. Eruchalu got to my booth, and I told him what I was doing, constituting Andrew's liver salt, he asked me if it was genuine. I had to prove it by drinking it. My being here today, some 50 years later, proves my case beyond reasonable doubt.
I would not have known that I would encounter Dr. Eruchalu thereafter except, perhaps, as his patient. I was a science student hoping to be a mechanical engineer. (I had dreamt of producing a car one day.) One thing led to another. Thus, I am here today, delivering this lecture, in memory of a surgical legend.
The life of Dr. Eruchalu
Dr. Raphael Chukwudile Okoye Eruchalu, MB BS (London), FRCS, FMCS, FICS, Officer of the Federal Republic of Nigeria (OFR), was born on March 4, 1926, in Nnobi, in the present Anambra State of Nigeria. He transited in 1978 at the youthful age of 52 years. Old soldiers never die. And so, today, 89 years after he was born, we remember Dr. Raphael Eruchalu with respect and admiration.
Dr. Eruchalu was not just born, and he died. He lived. His quest for education took him through CMS Central Elementary School, Nnobi, Dennis Memorial Grammar School, Onitsha (1942), Higher College, Yaba (1947), University College Ibadan (1948). In 1951, he entered UCH Medical School, London. He got married in 1953 while a medical student and graduated with Distinction in Internal Medicine at UCH, London, in 1954. His wife, Mrs. Caroline Eruchalu, has retired as assistant chief matron from UNTH, Enugu; she is now the matriarch of the family. The marriage has been blessed with 5 children on the trot:
Obinna Eruchalu (eldest/ first son) MD, FACS, FICS, a general and vascular surgeon in North Carolina with an established practiceMrs. Yvonne Isichei (second/ first daughter), Executive Director, Keystone Bank; established banker with varied experience and recognition within professional and industry circlesMr. Nnoduka Eruchalu (third/second son), a long-time practicing lawyer and Realtor in AbujaMs. Ganiru Eruchalu (fourth/second daughter), owner/manager of a Travel and Tours Consultancy in LagosChizor Odibi (fifth/third daughter), MD. Internal Medicine, Hospice and Palliative Care, practicing in Marion, Illinois, USA.
Added blessings to Dr. R.C.O. Eruchalu's nuclear family include the spouses of his children. There are 10 grandchildren (9 grandsons and 1 granddaughter), also establishing their footprints and progressing steadily in their respective fields. The Ada (eldest daughter), Yvonne Isichei, is here. The Opara ( first son), Obinna, is a surgeon, prompting speculators to suggest that surgery is a hereditary “disease.” After the housemanship in UCH, London, he returned to Nigeria in 1956. He went through the Residency program in University College, Ibadan, and became a Fellow of the Royal College of Surgeons of England in 1959. In 1962, he was appointed a specialist surgeon and posted to Enugu by the Eastern Nigeria Government. He was awarded the FMCS in 1970. Four years later in 1974, he was admitted to this great ICS. The hospital in Enugu subsequently transformed into the University of Nigeria Teaching Hospital with Dr. Eruchalu as a senior lecturer in surgery. Dr. Eruchalu was a charismatic and pragmatic general surgeon. Hear him: “A surgeon is an activist in medicine.” As a corollary to his view, we now define a surgeon as a doctor who works. He coined the admonition that surgery is not a correspondence course but an apprenticeship. A famous quote credited to him is, “Nothing recedes like success” in place of “nothing succeeds like success.”
In the words of Prof. Ed'B Attah, “Raphael Eruchalu's devotion to surgery was total and his responsibility and communal application of skill exemplary.” He knew a lot and did everything including general surgery of today, pediatric surgery, orthopedics, urology, gynecology, and cardiothoracic surgery. There was no open heart surgery here then. However, thoracotomies (open and closed) were being done. His rise in professional profile was meteoric. In recognition of his diligence and commitment to hard work in surgery, he was awarded the OFR in 1963 at the young age of 37 years. (Today, the youth of his age wear earrings on low waist baggy short trousers and expect their parents to marry them off with tattoos underscribed in their skins, depicting and signposting the Biblical end time!). Dr. Eruchalu, as the prospect of war, loomed in 1967, consoled and reminded his colleagues of the saying of Hippocrates that “he who desires to practice surgery must go to war.” As if in obedience, some of us joined the Biafran resistance forces during the hostilities inflicted upon us. After the war, Dr. Eruchalu continued to hold his fort in our surgical garrison, not as a private, but as a garrison commander with the status of a General. He was indeed a general surgeon par excellence, born in an era of the rule of law. He grew up in it, went to schools at all levels under it. He began his services in Eastern Nigeria in the same atmosphere of the rule of law. Then, all that changed. Military dictatorship descended on Nigeria. Each was to correct certain ills identified and propounded by the usurpers. Draconian rules were spewed out to massage the ego and assuage the whims and caprices of the prevailing rulership. One such was the fiat banning public servants from private practice. This was an attack on academics in general and medical practitioners specifically. The intelligentsia had been causing the usurpers of power sleepless nights. No one cared to know why doctors were engaged in private practice. Private practice was to fill up gaping gaps in the provision of medical services due to shortage of workforce accentuated by strict civil service working-time schedules. The military politicians could not be perturbed. Dr. Eruchalu remained faithful to his belief in the rule of law. Rather than confront authority, even as unconstituted as it was, he resigned from UNTH and UNN to set up a rural medical service in Nnobi to the benefit of the people who had seen him through kindergarten to the lofty heights of education and our noble profession. He joined his ancestors on September 1, 1978, at a young age of 52 years. The dictatorial policies that led to the resignation of the likes of Dr. Eruchalu quickly degenerated to the brain drain.
In the words of another indefatigable great teacher surgeon, late Prof. Festus Nwako, “we remember Chukwudile Okoye Eruchalu, FICS, without question, a brilliant and master surgeon, an inspiring and signal teacher, a truly sound and alert clinician, a witty and sociable man, a uniformly courteous person who was charming in his personal contacts, a talented and surgical ambassador and a most worthy Fellow of the ICS, Nigeria National Section. We continue to miss his wide sense of fun, his flawless surgical wisdom, his impeccable surgical poetry in motion, and his outstanding zeal.
May his great soul and those of our other Fellows departed, continue to rest in perfect peace”.
Tribute to Fellows
The hardworking gentlemen (We are surgeons. No sex please) gathered here have kept faith with our master, Dr. Chukwudile Eruchalu, OFR. Surgeons including all Fellows of this College should be proud of their achievements even in extreme circumstances. We have risen to the height of university vice-chancellors. To name a few, Prof. Festus Nwako, Prof. Kelsey Harrison, Prof. Nimi Briggs, Prof. Chukwuma Ozumba, Prof. Adesola, Prof. Orishejolomi Thomas, Prof. Martin Aghaji, etc.
Damodar Valley Corporations include Profs. RO Ofoegbu and Ben Ugwu, etc.
Provosts of colleges of medicine: Prof. OO Onuba, Prof. AA Otu, Prof. MT Shokunbi, Prof. F Akpuaka, Prof. CA Attah, Prof. B Jiburum, Prof. ND Briggs, Prof. B-D Adinma, Prof. DD Datubo-Brown, Prof. Paul Ekwere, Prof. Chris Akani, Prof. C. Mato, etc.
Among hospital administrators are Fellows who are or have been chief medical directors: Prof. OO Ajayi, Prof. OO Mbonu, Dr. US Etawo, Prof. Ndoma-Egba, Prof. OO Mbonu, Prof. OO Onuba, Dr. EDO Mangete, Dr. US Etawo, Prof. Abba Hassan, Dr. OR Long-John, Dr. Dan Iya, Prof. Ochefu, Prof. R Ofiaeli, Prof. BB Shehu, Prof. Alonge, Dr. Uwa Iweha, etc.
Surgeons as editors-in-chief of medical journals: Prof. da Rocha-Afodu, Prof. O Ajao, Prof. F. Akpuaka, Prof. SNC Anyanwu, Prof. F Uba, Prof. N. Eke, Prof. RO Ofoegbu, Prof. BC Jiburum, Prof. JC Orakwe, Prof. LB Chirdan, Prof. Uche Nwagha, etc.
In politics, our past president, Dr. Dozie Ikedife, has been a lone voice since the 2nd Republic. He served as president general of Ohaneze, a sociocultural apolitical organization. In his tenure as president of this college, one of us, Dr. Chimaraoke Nnamani, served as the governor of Enugu State.
In business administration cum industry, another past president, Dr. AA Obiora, is the chairman, Ecocorp Plc, incorporating Eko Hospital in Lagos. He and a few other surgeons are title holders in the traditional institution.
The Nigerian National Section has produced four African Federation Secretaries: Dr. Dozie Ikedife, Prof. TAJ Ogunbiyi, Dr. AA Obiora, and the current one, Prof. Ndu Eke.
In the 11th Lecture delivered by Brig Gen Maurice Ezeoke (Rtd), the lecturer claimed that he was a medical nonacademic. I plead to disagree. Every certified surgeon has three duties, namely, service, teaching, and research. I posit that each one of us is an academic. Some publish, others may not. Publish or perish is the mantra. However, some publish and still perish justifying Henry Kissinger who said, “University politics are vicious precisely because the stakes are so small.”
The topic of lecture
In this 12th Eruchalu Memorial Lecture, Mr. President, as we itch for the start, let us begin from the scratch to look at the travails and contributions of our surgeons in this our part of the universe.
This lecture will interrogate the current surgical epidemic, cancer; digress in perspective to surgical education and practice as exemplified by Dr. Eruchalu from the past to the present. We shall refer to the need for cancer registry. Finally, we will venture into clairvoyance to prescribe for the future.
The title, “Sojourn of a surgeon: The need for a cancer registry,” may not be apt. It may not be as poignant as Prof. Ed'B Attah's “The Communal knife. Placing the scalpel in context.” But as we are told, passengers for a 911 transport lorry with foreboding inscriptions such as “No telephone to Heaven,” are persuaded: “do not worry about the inscription; board the lorry.”
In our despondency in the present sorry pass, we should allow ourselves some nostalgia to tide us through the present gloom while we hope and strive for a future deserving of a pleasurable life.
Cancer, the surgical epidemic
Cancer is a malignant tumor of potentially unlimited growth that expands locally by invasion and systemically by metastasis (Merriam-Webster Dictionary). It further defines cancer as “Something evil or malignant that spreads destructively.”
The Zodiac sign depicts Cancer as a crab.
The word “cancer” evokes so much omen that doctors are forbidden to use it on patients. This is without prejudice to good clinical practice to inform patients and relatives adequately.
According to the International Agency for Research on Cancer, cancer rate is expected to increase by 50% in the next decade from now. The disease affects every part of the body in humans and animals. Prostate cancer, for example, affects only man and his friend, the dog. The larger the size of an organ, the more it is attacked by cancer. Hence, the skin which is the largest organ of the body bears the brunt of the burden of cancer. Let us not forget that the blood itself is composed of elements that may undergo malignant change. Hence, the leukemias. These are not of primary attention of surgeons whose role is extirpation of a diseased organ and reconstruction when necessary. It is gratifying that Professor Essien, in the 8th lecture here in Port Harcourt, alluded to the “often cordial relationship” between the disciplines of Hematology and Surgery. An organ can be extirpated in part or in whole if the organism can remain alive. Currently, the common cancers that the surgeon confronts in our clime include the prostate, the breast, the intestines, and the uterine cervix. (I hereby acknowledge that melanin has its uses.) Surgical and/or radiotherapeutic extirpation remains the primary treatment for local and regional involvement with cancer. Often, even at the time of presentation, metastases have left the primary tumor to afflict distant organs. Some organs by their strategic location (e.g., the lungs) and predilection (e.g., the liver) attract and harbor errant malignant cells.
Several factors are involved in the development of cancer. These include environment, age, sex, lifestyle, and race. Evidence implicating environment is obtained from migration of populations. The incidence of prostate cancer in Japanese rises when the Japanese migrate to the United States. The incidence of certain cancers rises with age. Examples include colon cancer and prostate cancer. Often, when such cancers arise in the younger age group, they are more virulent and lethal. Breast cancer occurs more in females than males. Regarding lifestyle, lung cancer from cigarette smoking and cervical cancer from promiscuity serve as examples. There is racial predominance of prostate cancer among black men compared to Asian men. Genetic predisposition has been observed in breast cancer and prostate cancer.
There has been an increase in the prevalence of cancer in Nigeria in the last three decades. Many factors have been speculated. Epidemiological studies are not being done for reasons of facilities, including funds, as well as a motivation among clinicians. Vested interest may reject studies that may implicate an industry. We suspect that prostate cancer now on the rampage in our environment may be linked to the crude oil and its products.
The current treatment of cancer has gone beyond the surgeon to involve medical oncologists, radiation oncologists, reconstructive surgeons, pathologists, radiologists, and primary care physicians. Distant metastases require systemic adjuvant and neoadjuvant therapy with drugs including chemotherapy and hormonal treatment. Advances in molecular biology have introduced more armaments like immunotherapy as well as such concepts as targeted therapy. Knowledge of the cell cycle has allowed cells to be targeted at specific stages with chemotherapeutic agents. With adjuvant and neoadjuvant treatments in many cancers such as radiotherapy and chemotherapeutic agents, surgical oncology is an emerging specialty. While many surgical oncologists are Fellows of the ICS, we may have to find accommodation for medical oncologists and primary care physicians with interest in oncology, perhaps, as associates in our college.
Cervical cancer is preventable by vaccination and lifestyle adjustmentVaccination for prostate cancer is underway through the genetic code.
The case of prostate cancer testifies to the sorry state of inattention by African governments on the health needs of the African. The black man has the highest risk for prostate cancer in the human race and occupies most of Africa. With the exception of the president of Liberia, Ellen Johnson Sirleaf, the heads of regimes in Africa in the last 40 years of so-called independence have been men, who are all at risk of prostate cancer. If a man may neglect himself, what of his wife or wives, sisters, mothers, grannies, etc. who are at risk of breast cancer and cervical cancer? There has been no obvious interest in these ravaging diseases from African governments beyond their frequent junkets on medical tourism at public expense when they and their immediate families are directly afflicted. All the research into these diseases are from outside. Like all other products, except culture, we are experts at consumption and not on production. I am daily reminded of the lamentations of General Odumegwu Ojukwu as we massed up at Umuahia to be messed up when Uzuakoli was threatened during the war. We tend to worship obstacles rather than overcome them.
Nigerian men and women subscribe heavily to medical tourism to India, South Africa, Europe, USA, and lately Dubai for the treatment of cancer and other illnesses. The specialists they seek abroad abound here. Unfortunately, our hospitals, designated as outpatient clinics in 1984, have now become notorious as mortuaries. We look forward to the new president who characterized our hospitals earlier on to reposition Nigerian hospitals as centers of excellence in healthcare delivery, capacity building, and research, the direction we were moving in Dr. Eruchalu's era.
Surgical/medical education from Eruchalu to now
In the 1st Eruchalu Memorial Lecture given by Emeritus Prof. Festus Aghagbo Nwako 3 in Benin titled Medical Education, Time for a Major Change, we were told:
There is now the current fad to align surgical education to other courses offered in universities. There is a latent danger. Surgical education is largely an apprenticeship. It will be misguided to ignore this fundamental difference and teach surgery in credit units like philosophy or pure science. All that glitters is not gold. Our egg head colleagues have tried to underrate our Fellowship below the PhD in a futile effort to rewrite history. Having failed in that bid, this credit unit ploy will also flounder.
Dr. Eruchalu has been acclaimed to be a foremost and dedicated medical educator in the undergraduate and residency programs. There is an overarching need to restore and resume the residency program including the 1-year abroad component. Recently, there have been calls now becoming an agitation to change the method of teaching. Faced with advances in medical practice, it has been observed that medical schools may now be churning out quacks who these schools certificate. This was predicted years ago by Ivan Illich in his book, Deschooling Society, in which the author observed that schools were producing dropouts.
A major handicap with surgical training in Nigeria is the avalanche of innovations in equipment and the necessary skill tied to these equipment abroad. The radiologists, pathologists, ophthalmologists, gynecologists, and urologists have probably faced more innovations than other specialties. Unfortunately, the financial implications of these innovations have now found an answer from government, the proprietor of healthcare delivery. “No money.” How nice it would have been if this was the solution to the problem. It would make more sense to shut the hospitals because they are no longer viable. After all, after the collapse of Nigeria Airways and Ghana Airways, there are now more flights going on within and outside the affected countries.
The only solution to the problem of innovations and acquisition of necessary skills is to provide the equipment to be deployed to transfer knowledge and skill to the users. Individual institutions and individual surgeons are buying into the problems. There should be a coordinated approach to the problems by the Government either directly or by proxy. This approach must address the needs for a conducive practice environment including dependable electricity supply, potable water, and security for life and property.
From the receptions through medical records to the dispensation of services and medicines, it is an agonizing ordeal to patients in public health institutions. When you consider that hospital staff as patients are not immune to ill health, it becomes an absurd endemic whim.
In the days of Dr. Eruchalu, surgeons were doctors who worked. There was dedication to service. There was zeal to solve a patient's surgical and sometimes related problems. Dedication to duty and empathy to patients are golden attributes the surgeon must possess. An integral part of dedication is skills and attitude transfer to one's subordinates. Leadership is part and parcel of dedication. A leader must be fair and just and seen to be so. The uncaring attitude of the hospital, including surgical, staff, and calls for attitudinal change. As students are now younger and graduating even younger, there is an opportunity to impart positive orientation which will be sustainable.
Today, the people remain in dire need of qualitative medical services in the face of ravaging cancer. For our people, innovations in medical practice are more prominent on the pages of the internet, television screens, and medical publications than in the hospitals. This reminds me of the educated housewife who would leave a note for her hardworking surgeon husband whenever he came home late at night. On the dining table would be a scrawl on a piece of paper, “Darling, dinner is on page 64 of the Cookery Compendium.” Let us get back to the circumstances of shortages when Dr. Eruchalu practiced. In spite of several regime changes, in spite of increasing revenue from crude oil, Uhuru continues to elude the common man and woman. Dr. Aduba, an old boy of my School, Government Secondary School, Afikpo, told me that the more things change, the more they remain the same. That certainly is our experience in black Africa. We are victims of lawlessness in high and low places. Many have espoused theories and theorems to rationalize and justify our plight. Corruption, tribalism, and religion have been cited and indicted. Perhaps, Nigeria is a testimony to William Ralph Inge's definition: “A nation is a society united by delusions about its ancestry and by common hatred of its neighbors.”
Today, the aura of arrogance and inordinate pursuit of materialism prevail. The consequence is the relegation of the patient's need to the back burner. In this, we betray Dr. Eruchalu.
I hasten to re-echo the caution of George Santayana, a Spanish philosopher: “Those who refuse to learn from history are condemned to repeat the past.”
The year 2000 was supposed to usher in panacea for all human shortcomings and deficits. Parodied were “health for all,” “housing for all,” “education for all,” etc. Even our own Emeritus Professor TF Solanke prognosticated, “We must embrace, come 2000 AD, information technology with its twin components of computerization and telecommunications. Laparoscopic surgery will become the order of the day come the next century.” Fifteen years into that century, we should interrogate how far that vision has embraced us or we have embraced it. There has been a lot of motion but very little movement. We have made strides but have not sustained these strides. It is not too late.
Theme from past lectures
The common denominator of past Eruchalu Memorial lectures is lamentation of the plight of medical and surgical practice in Nigeria. Prof. Ofoegbu was quite blunt on this in his lecture, Civilizing Nigerian Surgery: Posers, Prescriptions, and Pretensions'. This ranges from poor training facilities, grossly inadequate healthcare facilities predicated on poor funding, but not necessarily poor economy. Furthermore, work ethics is fast degenerating into an abyss.
Mr. President, Sir, returning to the theme of this conference, Cancer, what is it that we can do?
We need to know the cancers that ravage our people, their prevalence, demographic and geographical distribution, virulence, as well as etiological and associated factors. Ultimately, we hope to device ways to prevent and treat the disease in all its ramifications. The answer that comes to my mind is the cancer registry. To keep a mere register of events that occur in our environment is not rocket science and does not require import license. In addition to the establishment of cancer registry for planning strategies and allotment of resources, research into the epidemiology, etiology, and therapeutics should be encouraged by government and industry through the universities and tertiary hospitals.
The late past president of this college, Prof. Toriola Solanke, championed the establishment of cancer registry in Ibadan. Prof. Clement Adebamowo also participated robustly in this worthy venture in Ibadan. He has since been brain drained to the USA. Here in Port Harcourt, late Dr. Emmanuel Enyinnaya Uche was anxious to establish a cancer registry. There is also a cancer register in Abuja. We have so far failed to coordinate and nationalize the trail. We are still in the habit of citing results imposed on us by foreign authors. Prof. Emmanuel Ezeome, following the trail in which he was baptized in Ibadan has set up a cancer registry in Enugu and reported some data from Abuja. All these erudite scholars are distinguished Fellows of this College.
The ICS can meet the challenges that frustrated the efforts of these founding surgeons of cancer registry. The ICS has the personnel among the Fellows and can muster the financial resources to get the project on the marks, ready to go. The zones that are weary with lack of work can rouse and rise from slumber. Each zone should nominate a young, dedicated Fellow of this noble College to collate data from the zone. Council should develop guidelines and set up centers for the project starting with the current six geopolitical zones. A national coordinator, perhaps a pathologist, should be appointed to liaise with the zonal coordinators. Council has done a similar thing in the past with rural surgery outreach. This was vitiated by security concerns mainly. Council should demand reports on yearly basis to coincide with ICS annual conferences. By the 10th anniversary, and by the special grace of the Almighty, we should have something to celebrate.
The collateral benefits of a cancer registry include public awareness and education.
The register will stimulate research and promote medical education. It will enhance service delivery. Appraisal of one's work or audit is essential in clinical governance. It enables one to discard old habits and imbibe more cost-effective practices. With the attendant need for audit, the dream and desire for good clinical governance will be fulfilled.
Having not been part of the present, the future must be approached with utmost anxiety and apprehension. A situation in which only 40% of places in Nigerian tertiary institutions are filled on merit, certainly short-changes the society. This contrasts sharply from the modus vivendi in the times of Dr. Eruchalu.
The solutions to the present impasse are fairly obvious. What is deficient is the political will, guided by vision, regarding the consequences of inaction. There is a need for a comprehensive paradigm shift in our modus vivendi. We should aim for the best. If we attain second best in the process, we can take another leap forward from there. If however we aim lower, we will remain in the realm of mediocrity. Mediocrity will beget mediocrity because you cannot give what you do not have.
Therein, the specter of Ivan Illich's other appraisal of contemporary society, Medical nemesis, with “the medical establishment (becoming) a major threat to health.”
The galloping pace of technological advancement outside the local environment in Nigeria does not absolve us from the obligation to upgrade our practice in line with our contemporaries elsewhere in Europe, Asia, and America. In the 1980s, we were at par with these contemporaries. The industries in these countries termed developed have pioneered innovations in technology that impact on health and healthcare delivery. Unfortunately for us, these technological advances run on electricity. We cannot implore them to invent technologies that run directly on candle or coal power. If we cannot latch on to technology here, our patients will latch on to it abroad on our common wealth. That way, we will have no roads, no electricity, and no drinking water because we fund these for others. This is a case of diminishing returns. Efforts to get into endoscopic surgery, robot-assisted endoscopic surgery, and intervention radiology should be coordinated rather than sporadic as they are now.
International terrorism has accentuated nationalism in Europe and the Americas. This nationalism now approximates to xenophobia. We consequently lack access to these countries for training of our surgeons. African governments, perhaps led by Nigeria, should seek and cultivate cooperation, and collaboration within, with those who are on the path of modern medical services. Continuation of the 1-year abroad program has been pleaded above. Egypt and South Africa can assist in medical workforce development until we are in a position to be independent.
In view of constraints imposed by dwindling facilities in the face of population explosion, good clinical governance predicated on patient safety, we should adopt and adapt simulation and skills laboratories to train doctors at all levels. As part of good clinical governance, we should periodically subject ourselves, hospitals, and practice to audit with the ultimate goal to provide safety for patients.
Lamentations may be Biblical. However, they are defeatist and reactionary. ICS is able and capable of driving the change it desires regarding the cancer registry. The ICS should develop guidelines for setting up centers and approve matching grants to help states and regions to develop. The ICS, being a college of all the surgical specialties, is best placed to champion and maintain the cancer register in the community, local, regional, and national settings.
Let us not be the cynic defined by Sidney Harris, by merely reading bitter lessons from the past while being prematurely disappointed in the future.
To change our present sorry pass, we require courage and hope for the better. To do this, let us boldly pay heed to Sir Ken Robinson, “If you are not prepared to be wrong, you will never come up with anything original.” The Nobel Prize is not for those who just do what they are told.
Mr. President, Sir, Royal Majesties, fellow Fellows, the Press, distinguished ladies and gentlemen, conscious of my position in academic circles; I have painstakingly navigated past plagiarism booby traps by acknowledging others in every significant phrase I have used. I will not get the Nobel Prize. I should, therefore, not be held responsible for the contents of this presentation. It is a memorial treatise as a eulogy on the life of Dr. Raphael Chukwudile Eruchalu, covering many of the areas in which he made giant strides and left huge footprints to provide service to others, to train his subordinates and other contemporaries and in the process participated in the research.
The medical profession has weathered the buffeting and pummeling of society by years of military and civilian misrule. It is now the last frontier; just. In cherished memory of Dr. R. C. O Eruchalu, FRCS, FMCS, FICS, OFR and our forebears, this frontier must not give.
May we learn from him and follow his surgical odyssey to the promised land of modern surgery.
|1||Onuigbo WI. Surgical Horizons. 2nd Eruchalu Memorial Lecture Given at the 7th African Federation Congress of the International College of Surgeons, Nike Lake Resort Hotel Enugu; 8 May, 1989.|
|2||Attah EB. The Communal Knife. Placing the Scalpel in Context. 9th Eruchalu Memorial Lecture Calabar; 2002.|
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