After ten years, Medicos has achieved some success with its unique curriculum blending Family Medicine, OB, ER, and surgery. The mission to Nigeria has done 40 surgeries in 2 weeks while also demonstrating skills in procedurally enriched FAMILY MEDICINE (bedside ultrasound, colposcopy, neonatal resuscitation, etc).

Basic general surgery skills combined with ALSO (OB emergencies) has gained almost immediate credibility with the government, medical staff, the nurses, and the patients. Pray that MEDICOS can be part of similar programs in Ecuador and Guatemala.

MEDICOS and the Camellia Foundation are fund raising to support an independent program similar to the Master's in Family Medicine (with Surg/OB) residency program recently established at the University of Moi in Kenya. My compliments to that group.

Speaking of blended skills, yesterday MEDICOS-Memphis, covering for Dr. Berkenstock, 27 yo BF G2P1 LMP 5 weeks ago with pelvic pain and bleeding. Released by Baptist ER after inconclusive US by radiology. Next day in Medicos' office, free peritoneal fluid and adnexal mass were documented and images retained on hard drive. Sent back to Baptist where another US was ambiguous. Digital images from Medicos were reviewed.

Based on Medicos' images patient was taken to laparotomy where perforated ectopic was successfully removed. As published, ultrasound by the clinician at the bedside improves patient care.

Here is God's witness, Dr. Michele Walsh, regarding the final day in Lagos:

Dear Dr. Rodney,

Sorry it took a while to get this too you, but this is the update from the weekend. The week at Ikorodu went pretty well, but Friday was unique.

We got to the ministry of health on Friday and there was an hour long meeting ......we went to Ikorodu (there was some talk of not going) and finish our surgeries. We were supposed to finish by 1-2. The 1st case was a myomectomy done by Yibirin and the ob/gyn. The 2nd case was a vag hyst. The 3rd case was another myomectomy. They wanted Dr. Adebisi and me to do it, but I wasn't comfortable with that as I don't feel skilled with any problems that may arise, so I scrubbed in to finish helping Dr. Yibirin and the ob/gyn left to help Dr. Adebisi.

However, just then an eclamptic patient came in for an emergency c-sec. Unfortunately, before we could do the surgery, the lady died. The ob/gyn did a stat c-sec while Dr. Ali and I did cpr (Yibirn had me unscrub as he was on skin and he knew we'd need to resusc the baby). The baby had a HR of 30, but with O2 and intubation HR came up to 140's. About 15 min later baby started breathing on its own. We extubated after about 30 min and then finally transferred baby to the nursery. Baby ended up transferring to LASUTH, but was doing okay.

Then another c-sec came for FTP. I did that one with Dr. Adebisi. It was about 3:00 and I was told the bus wasn't coming until 6:00 as there had been a change in plans. Dr. Yibirn did a appendectomy and then about 3:30 they said we had another appendectomy and another case. MEDICOS agreed to do the appendectomy .....while the other gen surgeon did the other case.

Well, as we went to put the spinal in ...Dr. Adebisi Jr came in and said the bus was coming and we had to stop (4:50). Well, we (Dr. Yibirin, Dr. Ali and I) didn't feel comfortable with that as we gave our word so we started anyway (the gen surgeons were already busy and the lady had been waiting with an acute abd for awhile) They were in a hurry so we could meet the commissioner of health again, but Dr. Ali said this was our mission to help people and he should understand. Anyway, it was a really difficult case(retrocecal appendix/perforated/friable), so we didn't get it out until 6:00.....

By then the gen surgeon and assistant scrubbed in to help. ...even though government staff were mad at us for staying,.... they still had us pose for extra pictures. We thankfully got back with time to spare before the[Ministry for Health] arrived, and then we had supper together.

[ed-note-MEDICOS and the government are exploring a permanent relationship through funding of a MEDICOS in Nigeria.]

Michele Walsh