Episcopal Medical Missions Foundation
Thomas E. Williams, M.D., Executive Director of Episcopal Medical Missions Foundation (EMMF), and Peggy Williams, RNC (Public Health) visited the city of Enugu, Nigeria, at the invitation of Nlogha E. Okeke, M.D., Medical Director and Surgeon-in-Chief, Eastern Nigeria Medical Centre. during the dates of Jan. 15-21, 2000.
The Purpose of the visit was to inspect the Eastern Nigeria Medical Centre (ENMC), 30, Amaigbo Lane, P.O. Box 38, Uwani, Enugu and to discuss with the medical staff the needs of the Centre.
Preparation: The condition of the Eastern Nigeria Medical Centre (ENMC) and the plight of the people of Nigeria were first brought to the attention of EMMF by The Rev. Daniel F. Crowley, Assistant Rector of St. John’s Episcopal Church in Ellicott City, Maryland, and some Nigerian expatriates and others who have experience with the conditions in Nigeria in general and with the ENMC in particular: The Rev. Canon Dr. Edmund Ilogu, Christian N. Nwankwo, Jr., M.D., M.P.H., Drs. Peter and Lois Wilson, The Rev. Canon Jerome O. Nwagbaraocha, Dr. Manny C. Aniebonam, Ephraim E. Oduche, Mr. and Mrs. Chike Erike, Dr. Okey R. Mbadugha, and Sonni Aribiah. They formed the core of an informal group called “Friends of ENMC” and over a span of 12 months met three times with Dr. Williams and once with Dr. and Mrs. Okeke, to review the current status of ENMC and to plan the visit of a representative of EMMF to conduct a site visit and needs assessment at the Enugu facility. Both site-visitors are active in foreign missions and have current diphtheria, tetanus, polio, influenza, and hepatitis A and B vaccinations. For this visit they received vaccinations for yellow fever and typhoid fever. Cloroquine-resistent falciparum malaria is endemic to Nigeria. Malaria chemoprophylaxis was mefloquine HCl. Visitors should be aware that Dengue Fever is endemic and should wear appropriate clothing and mosquito repellent.
Travel: Visas are required and may be obtained from the Embassy of the Federal Republic of Nigeria, 2201 M Street, NW, Washington, DC. An application is required and can be faxed to the recipient by calling the embassy at (202) 986-8400 and (202) 822-1522. The application requires a passport-sized photo and must be accompanied by the visitor’s passport, a copy of a letter from the host in Nigeria, and a copy of a round-trip ticket. The embassy staff is cooperative and will accept the application by Federal Express. There are daily flights to Murtala Muhammed Airport in Lagos from Europe, and the airport is served by Lufthansa (United Airlines), KLM, and Air Italia among others. There are no US carriers to Nigeria. The site-visitors began their trip at 4:30 PM on Thursday, January 13, 2000, and flew on United Airlines from San Antonio to Chicago and on to Frankfurt where they transferred to Lufthansa for a non-stop flight to Lagos, arriving at 8PM on the following day. They were met at the airport by Dr. Okeke and escorted to the Sheraton Hotel-Lagos where they stayed overnight. (It is recommended that visitors read the latest State Department advisory available on the internet before traveling to Nigeria and register at the American Services Center of the U.S. Embassy, 2 Eleke Crescent, Victoria Island in Lagos before traveling into the interior of the country. The following morning, Saturday, January 15, 2000, they flew to Enugu on "local carrier EAS Airlines. They were met by Mrs. Okeke and escorted to Valley-Inn Guest House, 4 Chime Lane, G.R.A. (off Abakaliki Road), phone (011) 234-42-257-471, fax (011) 234-42-254-286. The rooms are air-conditioned with window units. TV (dish satellite) was provided. Programming included CNN (European edition). Plumbing was adequate. Water pressure and electricity were intermittent. This bed and breakfast also has a full restaurant with excellent food. (The owner is Wilda M. Okeke, RDA, an American who is married to Dr. Okeke’s twin brother.) All ground transportation was provided by Dr. Okeke so that no experience was had with taxis or buses.
Climate: The climate is tropical, i.e. hot and humid.
Daily Itinerary While in Enugu, Nigeria
Sunday, January 16, 2000
Attended Sunday service (Morning Prayer) at The Cathedral Church of the Good Shepherd, Achi Street, Independence Layout, Enugu, The Very Rev. Chike Nwizu, Provost. Attendance estimated at 500-600, music provided by an electronic band, a Hammond organ, and ‘The Glorious Singers’, a 22-person choir (Ikechukwo Igbokwe, President, and Hyacienth Ogbu, Music Director). Service from the English prayer book of ?1628. Homiles were given by the Provost and by the Diocesan Bishop of Enugu, The Rt. Revd. Dr. Emmanuel O. Chukwuma. The service lasted 4 hours. Observed parishioners receiving their pledge boxes, received an official Cathedral Church calendar for a ‘donation’ of $20, and watched a parishioner present a goat for his alms. After the service, were introduced to the Provost and Bishop by the Okeke’s and confirmed that we had an appointment with the Bishop the following morning. Signed the Cathedral guest book and noticed that The Rev. E.A. ‘Tad’ Bordenave, III, Director of Anglican Frontier Missions (AFM), had also signed the guest book in the fall of 1999. (His newsletter of September 8, 1999 indicated that he was receiving immunizations in order to prepare for a trip to Nigeria where he planned to visit with five bishops [Makurdi, Sokoto, Enugu, Maiduguri, and Lokoja] there who, in partnership with AFM, want to begin sending Nigerian missionaries to the Islamic countries of North Africa.)
Monday, January 17, 2000
Interview with Bishop Chukwuma, Diocese of Enugu
Escorted to the Eastern Nigeria Medical Centre by Dr. Okeke. Arrived at the compound to find the hospital staff in Morning Prayer led by Mrs. Okeke in the Commons. Thereafter joined the housestaff on morning ward rounds in a women’s ward and post-partum. Left the hospital for our appointment with Bishop Chukwuma at Bishop’s House, Christ Church Compound. Found the Bishop in consultation with another Bishop and with Dr. Luke Umeh, FFAN, manager of the agriculture division of the African Development Bank. Were ushered into the Bishop’s study where we described the lay ministry of EMMF and explained our purpose for being in Enugu. Discussed the need to receive the Bishop’s endorsement of our activities in Enugu which he indicated he would fax to Houston when he returned from a trip that he was making that morning. Also requested routing and bank identification information of his London account in order that EMMF might send funds there for the Bishop to transfer to ENMC. The Bishop indicated that he would fax that information as well. During the audience with the Bishop we were often interrupted by phone calls from government officials throughout Africa seeking his advice and consultation on issues ranging from foreign debts to the AIDS epidemic. Completed the interview and retired outside for photos with the Bishop. Lunch at Valley-Inn Guest House and then returned to ENMC for interviews with department heads.
Dr. S. Ike, Head, Department of Internal Medicine
Dr. Ike attends at ENMC on Monday, Wednesday, and Friday of each week. He is on call at home for ER consultations. The most prevalent disease that he treats at ENMC is malaria which clinically presents with headache, fever and pallor. Patients often understand the symptoms and treat themselves with over-the-counter (OTC) medications e.g. Maloxine (pyremethamine and sulfamethoxazole) or fancidar. Tylenol and other analgesics are also available OTC. Diagnosis usually requires CBC, ESR, and a thick prep. Most likely form is m. falciparum. WHO has a malaria lab in Enugu for rapid diagnosis of m. vivax and m. malariae. Treatment is usually initiated with chloroquine injection or orally (if the patient can afford it). Second choice is fancidar; we are beginning to see chloroquine-resistant m. falciparum.. If no response within 48 hours he uses third-line treatment such as halofancrine p.o., followed by artesuccinate IV (costly) and lastly quinine IV. When asked about the use of mefloquine for choloroquine-resistant m. falciparum, he professed to know of the medication but had little experience with the drug because of its expense. Hypertension is also prevalent among the patients at ENMC. He follows WHO guidelines for the diagnosis which requires two readings. For readings >140/90 (essential hypertension) he prescribes anti-anxiolitics and no additional table salt. If >180/120 he admits to the hospital for CBC, UA to rule out nephritis, BUN, Cr., CXR, and EKG and 2-D ECHO. Care is individualized and may involve the use of alpha blockers (prazosine), ACE inhibitors (lisinotror), calcium channel blockers with furosemide, or nifedipine.
Dr. Obiakor, Professor of Otorhinolaryngology, Teaching Hospital, Enugu
Most common diseases encountered include sinus and ear infections with mastoiditis. Requires either plain x-rays or CT scan. Tomograms are not available in Enugu.
Estimates that there are 300 cases/year of laryngeal cancer in his referral area. Usually presents late with lymphadenopathy. Only treatment is XRT and that is not available in Enugu - only in Ibadan. To adequately diagnose laryngeal cancer, ENMC needs equipment to perform direct laryngosocopy which is not currently available i.e. a laryngoscope, biopsy instruments, and light source. Bronchoscopy is available but the only instrument available is a rigid scope, and he would like a flexible one.
Cleft palates are repaired not by ENT specialists but by maxillofacial surgeons who are only available at the teaching hospital, Enugu.
Atresia of the auditory canal is treated by him. He performs plastic surgery.
For the diagnosis of deafness, audiometry is not available and audiometry technicians are not available. Speech and hearing consultations are available at the School for the Deaf that is 2-3 hours away from Enugu. Hearing aids are not common due to their expense.
Dr. Maduka-Okafor, Head, Department of Ophthalmology
Dr. Maduka-Okafor is called for consultations regarding about 100 cataracts per year of which 70% are senile cataracts and 30% are associated with diabetes. There are approximately 100 cases of glaucoma, per year. Macular degeneration and retinal detachments are best treated with laser therapy, but this is not currently available. Refractory errors are diagnosed with a box of lenses and fitting markers.
Dr. Okoye-Uzu, Head, Department of Dentistry
Dr. Okoye-Uzu performs routine extractions and fillings with old equipment and not enough sets to carry on an efficient practice. Bridge and crown work is available from other dentists in Enugu. Dr. Okoye-Uzu would like to perform this technique but would require a technologist to assist in making the prostheses. Dental assistants in Nigeria do not perform this procedure. Dental hygienists are trained in Enugu. Acute traumatic injuries are referred to a maxillofacial surgeon who also attends at ENMC for tumor cases and mandibular recessions.
Dr. Onyeama, Head, Department of Psychiatry
Dr. Onyeama consultants at ENMC two or three times a week. There is a psychiatric hospital in Enugu. The primary psychiatric illnesses he sees are depression, anxiety disorders, affect disorders, and schizophrenia. Post-partum depression is also seen. For psychotic disorders, the patients are admitted to the psychiatric hospital for electro-convulsive treatments. Major drugs used include tricyclic antidepressants, prozac, haloperidon, trifluperazone, and chlorpromazine. The latter three drugs are usually too expensive for routine use. Psychiatric services at ENMC are hampered by the lack of psychiatric nurses, social workers (only available at the local psychiatric hospital), and psychiatric technologists. The service needs better organization, Journal of Psychiatry, and funds to attend psychiatry meetings in Africa where members of the Menninger Clinic from the US are often invited speakers.
Tuesday, January 18, 2000
Escorted to the ENMC by Dr. Okeke for a full day of interviews with key members of the hospital staff, discussions with department heads and house staff, and inspection of the laboratory, X-Ray Department, and operating theater.
Dr. Uchefuna, Head, Department of Anesthesiology
Dr. Uchefuna is the only member of the ENMC staff that resides at the hospital except the house officers. General anesthesia is given through a Boyle anesthesia machine using a mixture of vaporized halothane and oxygen following standard pentothal induction. Some procedures are performed under ketamine anesthesia, and spinal anesthesia is performed with 5% Xylocaine or 1% Marcaine. Nitrous oxide is expensive and difficult to obtain, but he would like to use it if available. He inserts the laryngeal tube but does not spray it. When he starts anesthesia he has a blood pressure cuff in place and monitors with his stethoscope. He does not have a cardiac monitor nor a pulse oximeter. Face masks and endotracheal tubes are washed and sterilized between cases and reused. The anesthesia machine is in good condition, but the face masks and bellows bag are reused. After multiple uses they have to be discarded. Nurse anesthetists are not used at ENMC but do practice in other parts of Nigeria.
Later we visited the operating room and saw an operating table with a bucky. The halothane is a liquid poured into a canister attached to the Boyle anesthesia machine. The bag to the machine was very old and was held together by either masking tape or duck tape. In the operating room was a generator for use when the electricity goes out. There were laryngoscopes with various sizes of endotracheal tubes. They appeared to be very old, not the disposable kind used in the U.S. One appeared to have an inflatable cuff.
Dr. Enweani, Head, Department of Orthopedics
Dr. Enweani is a consultant in orthopedic surgery to the ENMC. The National Orthopedic Hospital is in Enugu and provides physical therapy services. His activities at ENMC are devoted largely to acute traumatic injuries e.g. vehicular accidents resulting in fractures and occasional dislocations, as well as sports and occupational injuries. Vascular trauma frequently requires saphenous vein engraftment. In the absence of vascular surgeons in Enugu, cardiovascular surgeons usually perform vascular surgery. Orthopedic abnormalities seen often at the hospital include vitamin D deficiency rickets, clubfoot, equinus varus, genu valgus and varus. Unlike more developed countries, the average life expectancy is 52.5 years for men and 54 years for women, so there is little degenerative bone disease, the most common being hip deformities.
Dr. Sam Obi, Head, Department of Obstetrics and Gynecology
Midwifery is practiced at the ENMC. Dr. Obi is called for emergency C-sections for pre-eclampsia and eclampsia as well as ruptured uterus. Preeclampsia is treated with aldomet, hydralazine, and diazapam. Magnesium sulfate is not frequently used as the close monitoring that is required is not readily available at ENMC. Tubal pregnancies are a true emergency and peritoneal taps are not employed for diagnosis. Most frequently encountered gynecologic conditions include pelvic inflammatory disease and sexually transmitted disease (There is an AIDS epidemic in many parts of Africa). Gynecological malignancies usually present as an abdominal mass and prolapsed uterus and include adenocarcinoma of the ovary, choriocarcinoma and carcinoma of the endometrium.
Interview with the House Staff, ENMC
ENMC was the first private hospital to be approved by the Nigerian Medical and Dental Council to train interns. Two are trained each year. The current interns are Dr. Modi (male) and Dr. Ndudinanti (female). Also joining us for our discussions with the house staff was Dr. Anthony Ugwuoke, who had recently completed his internship and had remained on at the hospital in order to work in the village clinics outside Enugu that the ENMC operates (See Visit to the Village Clinic at Oduma, Wednesday, Jan. 19, 2000, which follows). When asked what EMMF might do to enhance the teaching program at ENMC, the interns were quick to point out that medical instruction is good in Nigeria and closely approaches the caliber of that seen by Dr. Ndudinanti in England. Nonetheless these young physicians would favor more exchange of physicians between Nigeria and more developed countries. While medical education is expensive and most students cannot afford medical texts and journal subscriptions, the major deficiency identified by the house officers is the lack of equipment in the teaching hospitals which prevents them from acquiring proficiency with medical techniques like renal dialysis, radiotherapy, and pulmonary function tests (blood gas analysis). The interns remarked that surgical pathology reports may take weeks to months to be received. Mantoux testing for tuberculosis is not universally available while equipment and reagents needed for prostate specific antigen testing is not available in Nigeria.
Inspection of the Laboratory
We were escorted through the laboratory by Mr. Chidi Okwuonu, Supervisor of Laboratories, and the following instruments and other equipment were observed in operation: a single, binocular microscope with multiple lenses up to 100X (oil immersion) with mirror reflection light source, colorimetric spectrophotometer used for determination of hemoglobin, BUN, creatinine, alkaline phosphatase, and bilirubin (approximately 10 renal and liver function studies are performed daily, while other biochemical parameters e.g. calcium and electrolytes are outsourced to another laboratory), hemocytometer for white blood cell and platelet determinations (approximately 10-30 CBCs are performed daily), equipment to prepare blood culture media, incubator for growth of microorganisms.
Wednesday, January 19, 2000
Visit to the Eastern Nigeria Medical Centre Annex, Oduma
We were escorted to the ENMC where we met Dr. and Mrs. Okeke and traveled south toward Port Harcourt and the remote rural village of Oduma. The trip required two hours by car. On the way we passed the ENMC Volvo ambulance with blue lights and siren on taking a patient to the hospital. Approximately 20 kilometers from Enugu we passed a piece of property estimated at 20 acres surrounded by a large fence with numerous signs indicating that this would be the site of a university hospital. There was little evidence of construction in progress. About 30 kilometers south of Enugu we encountered a road block of three soldiers with guns. Our driver slowed down, and we were waved through without being searched. On the way we passed through a small town (big enough to have a branch of The Bank of Nigeria) called Nenwe. Oduma is a small village of subsistence farmers who grow yams, other vegetables and palm oil for cash crops. A farmer who has 200 palm trees can make a profit. The money that the farmers make is used primarily to buy food and pay for their children’s education. Books are expensive. The Annex houses a clinic of six rooms in a brick building about three years old. The clinic has no electricity or water and no sanitation. We found an electrician there who was stringing wire and installing receptacles for lighting. He was wiring in series. The wire was 12-2 plastic shield Romex. There is no electricity in the village so the clinic will use a generator. Dr. Anthony Ugwuoke attends in the clinic on Mondays, Wednesdays, and Fridays. He sees about 20 patients each day. On this day he had treated lobar pneumonia, pelvic inflammatory disease, and malaria. When asked if diabetics in Nigeria would use glucometers, he replied that the strips needed to calibrate and make the glucose determinations were too expensive for most Nigerians, but that they would use them if the strips were provided. We met the clinic administrator and another doctor, a Nigerian who is a medical missionary to other villages in that area and identified as Mrs. Okeke’s nephew who had many questions about Burkitt’s lymphoma and suggested that there was an association between malaria and the disease. There were 3-4 patients waiting to be treated when we arrived . Each patient is given an identification card and clinic number. Each patient has an ENMC chart that is about the size of a college test booklet. A small pharmacy was set up in one room and dispensed inter alia NSAIDs, ampicillin, and mebendazole. Mr. Chidi Okwuonu, the laboratory supervisor, was also there and had set up a small laboratory to perform hemoglobin determinations by the Sahli method, urinalysis by Urostix, and blood sugar by Dextrostix. If abnormalities are found, blood is drawn and taken to the laboratory at ENMC for confirmation.
A discussion of family planning programs in Nigeria ensued. At the ENMC Dr. Okeke performs tubal ligations if the family has as many as six children.
Thursday, January 20, 2000
Dr. C.U. Amadi, Head, Department of Diagnostic Radiology
Dr. Amadi has been a consultant to the ENMC for three years. He described the current imaging services of the hospital. A portable x-ray unit is in operation for general use but when, for example, one attempts to use the unit for contrast studies like barium enemas, the quality of the studies is not satisfactory. Doppler studies are not available. Echocardiograms are not available. Dr. Amadi indicated that the plain x-ray developing system at the ENMC is a wet process. In Nigeria studies for coronary artery disease are performed largely by 2-D echocardiography since coronary artery angiography is not readily available. Peripheral artery angiography is performed at the teaching hospital in Enugu. He confirmed that radionuclide scanning is not available in Nigeria.
Dr. Amadi would like to be able to offer CAT scans, and this was confirmed by Dr. Okeke as a high priority for the ENMC. There are no CAT scanners in the region (the nearest is in Lagos), but a Siemens CAT scanner is planned for the new teaching hospital and may be in operation within six months. He emphasized that even if the CAT scanner at the teaching hospital become operational, it will be inadequate to address the needs that are anticipated for the region. He hopes to acquire a fourth generation machine. (If the electric power goes off or amperage fluctuates, a daily happening in Enugu, there is no alternative power source to supply the 125 kilovolt needed to run the CAT scanner. In Nigeria the line power is 220 volt AC.) If a CAT scanner can be obtained for the ENMC it could be installed in a room 40’ X 80’ that currently has two window air-conditioning units. Adjacent is a smaller room with one window AC unit that could serve to house the computer that serves the CAT scanner and another smaller room, also with one window AC, into which could be installed the developing apparatus.
Dr. Amadi also emphasized the need to provide mammography for the region as the nearest mammography unit is in Lagos, but even there it is not consistently available. At ENMC attempts have been made to perform mammography by ultrasound but that does not give good resolution of the lesion in question. If cancer is found, patients must go to the University of Ibada where there is a radiotherapy unit and possibly there is a cancer chemotherapist. In Lagos there is one cancer chemotherapist, none in Enugu.
Inspection of the X-Ray Department
A tour through the X-ray department was conducted by Mr. Sunday Agbam, x-ray technologist. There is only one x-ray machine in operation, a small portable unit. X-ray film is imported into Nigeria. All films are developed by wet process. The department performs 2 or 3 x-rays per day as costs are high, and few patients can pay. X-rays are not ordered with impunity. Carotid angiography is performed at a designated unit in Enugu. Nuclear medicine is not available in Nigeria, and bone scans are not performed.
Interview and Tour of the Hospital with Mrs. Ifeoma Okeke, SRN, SCH. HV. RNT -B.SC, MBA; Director of Nursing and Administrative Secretary
Mrs. Okeke received her nursing education and training in Great Britain and the United States and was awarded membership in Sigma Theta Tau, international nursing honor society. She has a Masters degree in Business Administration and has administrative responsibility for all departments of the ENMC which include:
Male ward for medical and surgical cases
Female ward for medical and surgical cases
Maternity department including delivery room and nursery
General maintenance including plumbing and electricity
Cold body mortuary and embalming departments
Medical Records Department
Nursing and midwifery services
The current nursing staff includes ten Nigerian registered nurses. Nursing training in Nigeria is three years in length. Examinations are given by the ENMC and the State of Enugu. There are 20 auxiliary nurses, i.e. nursing assistants with no formal training. They may have hospital experience. Not regulated or certified. Midwives receive a one-year training period in Nigeria. Midwives are employed at the ENMC. They perform deliveries with the obstetrician called as needed. In all cases, however, once the baby is delivered the obstetrician is called with a description of the delivery. The housestaff examines the baby at birth.
Continuing education for the nursing staff is conducted at ENMC and available outside the hospital as well. Among the in-service training opportunities at ENMC was a review of the care of the diabetic given by Mrs. Okeke. These in-service programs afford an opportunity for the nursing staff to identify and discuss ward problems.
Among the equipment in disrepair found in the operation room were:
Stryker dermatome that is not operative because the motor is burned out. The motor identified as model 2010, 230 volt AC or DC, 0.60 cycles, 9 amps. The foot pedal is functional.
A stimulator (?defibrillator) manufactured by CIBERTEC.
Two devises identified as CARDY 8, Mark II, and manufactured by UEDA Electronics Works, Ltd., which monitors temperature, blood pressure, and pulse.
A cautery unit for a Bovie, model SSE 3 manufactured by Valley Lab of Boulder, CO described as a solid-state electrosurgery unit with Iso Bloc and Powerite. An electrosurgical footswitch also manufactured by Valley Labs is attached.
An autoclave Aquametic K. Thermie manufactured by German-Rupp Industries , Inc., in Bellville, OH, USA. It is model RK-200, 115 volts, 60 cycles, 900 watts, 10.2 amps that is used with a step-down transformer.
An autoclave Puls-Matic, GETINGE.
An anesthesia machine manufactured by MEDICAR in Budapest , Hungary. Attachments include a face-mask and bellows bag - both in disrepair.
Operating table that is functional but old by current standards. Does not have a bucky.
The Dental Department is housed in a separate building across the courtyard from the main entrance to the hospital. It contains only one dental chair, circa 1970s, that is connected to water and suction by exposed tubing. Unable to determine if the drill was functional.
Laboratory technologists are university trained and are awarded a bachelor of science degree in laboratory medicine. At the ENMC the laboratory supervisor trains assistants. The instruction period is twelve months and the student assistant pays $5.00 for their training. The supervisor administers a test of proficiency and sends the test results to Mrs. Okeke. The assistants then undergo a six-month trial period, after which their performance is evaluated and a decision made to offer them a permanent position at ENMC. If a position is not offered at ENMC the assistant is allowed to seek employment at another hospital.
There is no full-time pharmacist at the ENMC. The pharmacy does have a pharmacy technologist who is supervised by a part-time pharmacist. The pharmacy was once the source of significant income for the hospital. With materials available locally, the ENMC manufactured and sold plastic IV bags to other medical facilities. A significant problem in Nigeria is that of fraudulent labeling of medications making it difficult to ascertain the strength of drugs.
There is no full-time radiologist at ENMC, but one is available at the teaching hospital in Enugu. Instead the ENMC has a full-time technologist who received his training by a radiologist at the teaching hospital. The current technologist has been employed at ENMC for ten years.
There is a single x-ray unit, a small portable one, in operation at ENMC. It is manufactured by the Hitachi Medical Corporation. It is further identified as Type UG-5ME-OIT, model number A14523-02, 125 KV, O.7 mm A1, K22668E, SIRUS 125 B, 125 KV 1ALF, A14422-04, SX-390402
Two ultrasound devices were found in the ultrasound department:
Siemens Sonoline LX, Probe 3.5 mHz. Attached is a polaroid camera that is not in use (expensive film). Used with SONY Type I (normal) UPP-110 S high-quality printing paper 110 mm X 20 meters. This unit is functioning.
DIASONICS model ADA400 manufactured by Diasonics in Milpitar, CA, 95035. Serial No. 85122957, Model No. 52. This unit is not in operation.
All patients are fed by the hospital; cooking is done over a two burner kerosene stove.
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