Dear Team, colleagues, friends and families, Greetings! As the chair of the Medical Mission Committee of the Association of Nigerian Physicians in the Americas (ANPA), I am delighted to share with you the summary of the recently completed ANPA-sponsored medical/surgical/dental mission to Anambra State, Nigeria. It was part of our annual ANPA week that includes the mission, CPD (CME) lectures, and Advocacy activities.  Our partners included Mrs. Doris Nwankwo, Director of Dan C. Nwankwo, MD, Foudation, Anambra State government, General Hospital Enugu Ukwu and Regina Caeli Hospital Awka (mission venues), Nigeria Medical Association Anambra State branch, Federal Ministry of Health Nigeria, Junior Chambers International (JCI) AmeriCares, Lifebox, Kingsway Charities, some members of Nigeria Association of Pharmacy and Pharmaceutical Scientists In America (NAPPSA), Chima Medical Missions Int’l, Ethiopian Airlines (allowed free extra luggage of medical supplies per passenger), and Channels TV. We thank you all for your support and look forward to ongoing partnership.  The magnificent multidisciplinary team of 33 volunteers from the United States and 30 local volunteers in Nigeria included specialists in internal medicine, cardiology, psychiatry, psychology, geriatrics, gastroenterology, family medicine, emergency medicine, dentistry, pharmacy, nursing, anesthesiology, plastic surgery, neurosurgery, general/thoracic surgery, transplant surgery, optometry, ophthalmology, pediatric surgery, OB/GYN, pastoral care, residents, medical and high school students, and various non-medical personnel that helped with logistics, transportation, food, security, accommodation, etc. I would like to mention each of you by name but space would not allow me. You know yourselves and we thank you all for your hard work and dedication to the success of the mission. You rock! This was the largest ANPA sponsored surgical/medical/dental outreach to date! Without our input, some Nigerians had broadcast the mission on social media like Facebook and WhatsApp, thus attracting patients from all over the country!The mission occurred March 21-27, 2018, in Enugu Ukwu and Awka, for the 20th Memorial of the Late Dr. Dan Nwankwo, an ANPA leader.  Despite the strong challenges and obstacles we encountered at different times, our mighty medical and fantastic pharmacy teams saw about 1,000 patients. Conditions treated were numerous and included the common malaria, typhoid, arthritis, hypertension, diabetes, malnutrition, psychiatric conditions, to name a few. Led by Dr. Jide Bamigboye, they referred many surgical cases to the surgical team. Attached are seven files with the breakdowns of each team’s activities and providers names, compliments of our most magnificent Prof. Ajovi Scott-Emuakpor, who compiled and kept detailed records as usual.  Our dynamic dental team (led by Dr. Chris Okunseri; with Dr. Chibuzo Uguru) was very helpful to ANPA in many ways and performed 32 tooth extractions, 64 deep cleanings/polishings, plus oral health education.  Our superb surgical team led by yours truly, performed 80 operations in very tough circumstances, and some days operated till 1 AM (for trauma) and 5 AM because the need was so much!Kudos to some of our non-surgical colleagues who saw the need, realized we were overstretched and stepped into the operating rooms (ORs) to assist us. You know who you are. I tip my hat and salute you all.  Types of surgeries performed included pediatric and adult inguinal hernias, ventral/incisional hernias, breast lumpectomies, lipomas, lumps and bumps, myomectomies, emergency C-section, chest tube, hysterectomies, hemorrhoidectomies, VP Shunts, laminectomies, skin grafts, thyroidectomies, frenulectomies, emergency splenectomy for trauma, to mention a few. Many pictures of the mission to follow in subsequent emails.  Some special surgical mission moments worth highlighting include the first operation performed by Drs. Ngozi Osuagwu and Ejikeme immediately upon our arrival on March 21, 2018 at Regina Caeli Hospital, which was an emergency C-section delivery of a bouncing beautiful baby girl! A joyous occasion. Mom and baby did great.  Another special involved an 18 month old girl with congenital hydrocephalus and VP Shut failure, whose parents had paid over N1 million for the initial operation 2-3 months prior, were told to pay another N400,000 (that they could not afford) prior to any re-operation. Our neurosurgeon, Dr. Chine Logan, did the surgery for free and the child did well.  Finally, a 20 year old male fell from a mango tree and presented to the Teaching hospital Emergency Department in abdominal pain, tachycardic, marginal BP, hematocrit was 20, ultrasound showed peritoneal fluid which was bloody on aspiration. He was given a note of referral to another Teaching Hospital. En route to the other hospital in a private vehicle, his parents noticed that he was in more pain and pale, so decided to stop at a closer hospital, Regina Caeli, where we had just finished preoperative evaluation of patients for next day surgeries. It was around 830 PM and we were tired and about to leave when suddenly, the on duty emergency physician ran to inform us of this young man with acute surgical abdomen from trauma. Fortunately, some of the OR nurses were also about to leave but decided to stay and help. I had them set up the OR and called the nurse anesthetist, Mabel, to come back from home, while we were evaluating and rescucitating the patient. Around 1030 PM we took him to the OR and performed exploratory laparotomy with evacuation of about 4 liters of blood and splenectomy for ruptured spleen. Drs. Logan and Nkem Ezeamama assisted me. By the time all was done it was 1 AM! The good news is that he survived and went home 5 days later. The video of his grateful mom thanking God and our team is priceless! Although I would like to name each volunteer am unable to do so for fear of turning this report into a book. The complete list of volunteers and participants from the US and Nigeria was shared in pre-mission emails and communications. Know that on behalf of ANPA President, Dr. Johnson Adeyanju, and ANPA executives and committee chairs, we appreciate you all volunteers at home and abroad.  Please allow me to recognize and thank our brave first time ANPA mission volunteers that were very innovative and functioned like pros. Especially our Anesthesia team (led by Dr. Onyeka Nduaguba; Ruky, Sr. Sabina, Oreh, Mabel), some of the surgeons (Chine, Iyore, Chuma, Ngozi, Chinyere) primary care providers (Prof. Scott-Emuakpor, Osita, Maureen, Uzoma, Ifeoma, Ugonna, Grace, Dele, Austin ), emergentologists (Nkem, Uche) pharmacists (Ify, Florence, Obi) dentists (Chris, Chibuzo) and students (Adaora, Ijeoma). You guys are “da bomb,” and inspire me. If I forgot to list any names please forgive my oversight, since EVERYONE on the team was vital.  Dr. Chine Logan not only performed neurosurgery procedures safely, but spontaneously donated his personal money in the amount of N295,000 ($825) to help ANPA buy medications and supplies in Nigeria for the Eye patients (outnumbered all others) since we didn’t bring enough! The donation is above and beyond what each us volunteers from the US did in paying our own flight and obtaining various medical supplies for the mission. He is still offering his services to operate on a child with brain cysticercosis and seizures whom we did not get to, hopefully in collaboration with the Permanent Secretary of Federal Ministry of Health, Dr. Osarenoma Clement Uwaifo, and Hon. Chike Okafor, Chair Health Committee National House of Representatives. The latter cooperations was made possible due to ANPA Advocacy activities in Abuja, which the chair, Dr. Abraham Osinbowale, already reported on.  Thanks to Profs. Ajovi Scott-Emuakpor and Frank Akpuaka for their steady leadership and influence on and off site. Thanks Prof. Nene Elsie Obianyo (the first female Pediatric Surgeon in Nigeria, as I was told) and her Registrars for helping with pediatric cases. Thanks to Fr. Jerome Madumelu (Administrator Regina Caeli Hospital), Dr.  Onwaocha (CMD Enugu Ukwu General Hospital), Drs. Obiechina, Ekweogwu, Duru, Chukwulebe, Anajiekwu, Nnamani, Pounds, Aiyegbajeje, and all our team champions.  Thanks and congratulations to the Honorable Commisioner of Health Anambra State, Dr. Josephat Akabuike, for his support amidst government transition. And special thanks to Mrs. Doris Nwankwo, who worked tirelessly to assure a successful mission.  We donated the Pulse oximeters and laminated copies of the WHO Surgical Safety Checklists we obtained from Lifebox to both Hospitals we worked at, to help continue a culture of safe anesthesia and surgeries after our departure. Remaining medications and surgical supplies were likewise donated.  Our CPD Educational series on March 26-27, 2018 with Viral Hemorrhagic Fever theme was also successful. Thanks to all presenters, the NMA, Profs. Akabuike, Scott-Emuakpor, Ben Nwomeh, Jude Emejulu; Drs. Adeyanju and Charmaine Emelife.  Running concurrently at another site was a 2 Day Neonatal Perinatal Lectures & Workshops that understandably, could not be fitted into the very crowded and time limited official ANPA/NMA CPD/CME Programs.It was organized by Dr. Udo Asonye (ANPA Chair of Maternal/Child Health Subcommittee) and the Anambra State Ministry of Health. Thanks to Professor Ifeoma Okoye of UNTH,Department of Radiology, her husband, Engr Chris Okoye, and other members of their working Team. It was well attended with over 100 participants! Other noble ventures were undertaken by ANPA members after the above activities. Pictures to come:

1. ANPA Women’s Hat and Tea donated $1000 via Drs. Anyaugo and Emelife, to the Maribel Crisis Center, LASUTH, to take care of battered  women and children.  2. Our Mental Health group (Drs. Maduekwe, Anwunah-Okoye, Aguwa)  visited the Anambra State NeuroPsychiatric hospital Nawka, and laid foundations on how to improve awareness and care in that field.  3. On April 2, 2018, Doris and I represented ANPA at the Traditional Wedding of our team member, Dr. Nkem Ezeamama, at her home in Anambra State. It was a great event and the largest of it’s kind that I have ever witnessed! Congratulations and best wishes to the beautiful bride and groom.  4. On April 3, 2018,  I conducted an ANPA certified medical mission at my village  church in Amafor, Imo State, with the help of Dr. Okey Duru, three other local physicians, six nurses, a pastor, and many non-medical assistants. This was done via my non-profit organization, Chima Medical Missions International and it’s partners. We attended to 400 patients and treated similarly conditions mentioned above plus gave away many reading glasses. The glasses were popular and church members testified that they could read Bible prints easier. To God be the glory! 5. On March 31, 2018, Dr. Udo Asonye also held a medical outreach with a team in his hometown in Abia State. I was also informed that Dr. Julius Kpaduwa and his team were on a mission in Mbano, Imo State. Kudos to them and to others that I may not be aware of.  Many people benefited from our efforts but there’s a lot more work to be done. “The harvest is plenty but the laborers are few.” I hope volunteers benefited from the mission as I did. You touched and changed lives for better and I pray that yours was also enhanced.  There are critics of these medical/surgical/dental outreaches, but I encourage them to go and see the needs for themselves, and perhaps help us find solutions to curtail such practices.  As many of you have heard me say many times, I have volunteered for many medical/Surgical Missions with various organizations worldwide (including the underserved in the United States of America) through the years, even served as CEO, ED, and Chair of such organizations, including ANPA. But my biggest dream is for a day when medical/Surgical/dental Missions will be no more, or occur at a bare minimum, as a result of improved healthcare in developing countries.  Until healthcare becomes readily available, accessible, and affordable, such missions will definitely remain necessary! In fact I leave for another one to Honduras next week.  Hopefully, as technology continues to innovate we can leverage on it by using Telemedicine, teleradiology, EMR, and other online modalities to provide care without physically traveling.  Again, thank you all for your selfless services, thanks for your donations and prayers, thanks to our spouses and families who also sacrifice and allow us to serve (are equally as important), and grateful thanks and glory to the most high God, who empowers us.  Humbly Submitted, Cliff C. Eke, MD, FACSChair, Medical Mission Committe, ANPA