25 Mar 19
Mårten LarssonMårten LarssonSwedishDoctorNigeria

Nursing in Nigeria: It's the small things that matter

Swedish paediatrician Mårten shares the story of Bakar, a dedicated Nigerian nurse who survived conflict and returned to treat his community.

We don't do any major surgery that requires anaesthesia at the MSF paediatric hospital in Maiduguri.

The cases we receive with signs of appendicitis, internal bleeding from typhoid fever or any other condition that requires urgent surgical care, we refer to the surgical unit at the teaching hospital in the city.

Nevertheless, we receive a lot of minor wounds, burns, skin infections and abscesses that need minor surgical interventions that we can do at our site.

These patients are mainly treated by our excellent nurse aid Bukar, who specializes in wound dressings.

I was impressed when I first arrived by how accurately he performed cleaning, disinfection, debridement, draining and suturing – also called stitching. This was all with an impeccable “aseptic technique”, a process that helps prevent a wound from becoming contaminated.

Bukar’s story

One day, when we were assessing a child with an infected wound together, I asked him:

“How did you become this skilled with wound dressings, Bukar?”

His eyes shone, and he started to tell his story…

“I have done this for three years now… It started when I worked in the ER and we received a lot of burns and wounds. None of the nurses were very interested in taking care of the wounds so they asked me to do it and I liked it.

“Then I have learnt a lot from all the different international doctors that have worked with MSF during the years I have been here.

“I always learn something new from everyone who comes here, and I always ask if there is something I can do differently to improve. That is how I learnt how important infection control is, and to dress with aseptic technique to not contaminate the wounds.

“I also get a lot of practice. I do almost a thousand dressings per year.”

“Wow, that is very impressive!” I replied, “How did you come to work for MSF in the first place?”

“Ah, it's a long story,” he says and smiles…

Violence in Ngala

“I come from a place 150 km from Maiduguri called Ngala,” began Bukar. “I came here to study to become a nurse in 2013. After that, I returned home.”

His face then became more serious and he stopped a bit to find the words.

“Then, in 2014, the conflict in the state became drastically worse.

“One day an armed group came to my town and started to shoot at everything that moved. Men, women, children, chickens…everything.

“Everyone just ran in any direction to avoid getting shot, but many didn’t make it. It was horrible! I got separated from my family at that moment.

“Me and six other people managed to escape to the west and hiked for several days, always afraid of getting found by the armed men, but finally we reached Maiduguri.

“Here, I was interned in a camp for internally displaced people. It was a tough time.”

“Oh, I didn´t know, Bukar,” I replied, “I'm really sorry. But, what happened with your family?”

“They managed to escape to the east over the border to Chad.

“My father died in Chad, he got sick in the camp where they stayed,” he continued.

"But, my mother and my brothers and sister have managed to move here. Now we have our own place in Maiduguri."

Cholera outbreak

“I'm so sorry, Bukar,” I told him, “But I'm glad you have reunited with the rest of your family.”

“How come you started to work for MSF then?” I asked.

“Oh, yes! One day in 2015, I was called by a doctor I knew from my studies who worked in a cholera hospital that MSF was running.

“They had many severely dehydrated patients who needed intravenous rehydration. However, getting a cannula into their veins was very difficult.

“The doctor knew from before that I am very skilled in this, so he asked me to come and help them. I did so and came every day to the hospital, which was very busy during the outbreak.

“After two months, the manager of the hospital came to talk to me and told me that they thought I was working for the Ministry of Health, but they couldn't find me in their register.

“I said that I didn't and that I was just there to help out and to have something to do.

“The next day I had a meeting with the project coordinator of MSF and signed my first temporary contract… and I’ve continued to work for MSF in different projects since then. Soon, I started to do the dressings, too.”

I just stood there with my mouth gaped and shook my head. Then we laughed together.  

“You are just amazing, Bukar!” I told him.

An infection

Then one of the patients called our attention.

A five-year-old girl, Hafsat, had fallen on a piece of metal and cut her forehead open. She had been sutured, but probably not with a clean technique because she had first arrived at our hospital with an infection.

We had removed the sutures, drained the pus and cleaned the wound, which healed and could be sutured again.

Now she had returned to remove the stitches, and she had even put some make-up on for the occasion!

After they had finished, Bukar came and called my attention. I thought he wanted me to review the scar, but he put a doll in my hand. I looked at him with a slightly confused expression.

“I think you should give this one to Hafsat,” he said and smiled.

I had been the one to inject the local anaesthetic the first time we cleaned her infected wound and she was not keen on me after that. So, I went to inspect the scar and after confirming that it looked well, I picked up the doll from my pocket.

The corners of her mouth almost reached to her ears when she broke into the biggest smile. Her eyes sparkled and her father laughed.

Myself and Bukar looked sideways at each other. These are the small things that really matter.

The backbone of MSF

It is people like Bukar, who come from the community and work in the projects from start to end, who are the backbone of MSF.

International staff like myself usually come for shorter periods and can contribute with some expertise, inventions, quality control and guidance…. hut the real hard work is usually performed by local staff like Bukar.

Without stable and devoted people like him that care for the patients with thoughtfulness, MSF would not be the same.  

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