How did we find Rural Medicine? By Matt and Sue Masel

Free medical outreach to Mountanous Somorika community with no access road

Community members receiving medical care during the free medical outreach

Dr Dako Mamudu

I am Dr Dako Mamudu, a family physician based in Lagos metropolis, Nigeria. I am the chief medical director of Dako Medical Centre and also founder and Chief Executive Officer for Dako Foundation for Rural Healthcare and Education. I lead my team to carry out healthcare delivery in remote, rural and difficult to reach communities. 

I was born and raised in a rural community where ninety percent of the houses were roofed with thatch. My empathy for rural healthcare led to the founding of Dako Foundation for Rural Healthcare and Education (Dako Foundation). Dako Foundation is a registered Non-Governmental Organization in Nigeria and it works to improve the living conditions of underserved and difficult to reach communities in Nigeria through education, empowerment, provision of social amenities, public health programmes and direct medical interventions. 

Somorika is an ancient city in Akoko Edo Local government area in Edo North, Nigeria. It is about five kilometers north-east of Igarra in Edo North. It is a community with a wealth of cultural heritage. However, the rocky geographic terrain of this community (several hills that go as high as 1700 feet interspersed at unequal intervals) and the often inaccessible road to the location result in a great inequality in access and provision of healthcare services to people in this location. 

DFRHCE staff going from the residence of the traditional ruler to the health centre where the medical outreach took place.

I lead my team to this mountainous Somorika community for free healthcare outreaches between 2017 and 2018. Members of my team and I climbed several rocks of varying heights in order to get to this community. Our first point of reach was the resident of the community leader. From where we climbed more rocks of varying heights to access the local primary health centre where we carried out the free medical outreach. Similar to my previous missions to rural communities, health care professionals from my team were brought from urban cities of Lagos, Benin City and Auchi to carry out this medical outreach at this community. This was a four day mission and my team consisted of 20 regular staff of the Foundation comprising of doctors, pharmacists, public health experts, nurses, community health extension workers (CHEWs) together with 15 local volunteers. The attending midwife in this facility together with the assistant; a nursing aid also participated in this mission.

DFRHCE outreach team preparing for Somorika mission

DFRHCE staff on the road to Somorika Community, Edo State, Nigeria.

This comprehensive outreach which includes free surgeries is in tandem with the Sustainable Development Goals aimed to ensure healthy lives and promote wellbeing for all at all ages. The outreach activities consisted of community health education and sensitization, general consultation and treatment of endemic diseases, vitamin A supplementation for children and at risk population, mass drug administration of Albendazole to community members, distribution of lifesaving prenatal and post natal vitamin supplements to women of childbearing age and distribution of easy to use water purifying units to households in the community. Hospital equipments were also distributed free to the dilapidating community Primary Health Centre; the only source of healthcare in the community and its environ. The distributed equipments include artery forceps of different sizes, drip stands, hospital beds and mattresses, bedcovers and delivery couch.

Patients who required surgeries were referred to our partner hospital (Dako Medical Centre, Lagos) for free surgeries and follow up. Surgeries performed include breast lumpectomy, emergency caesarian section, and undescended testis (jointly sponsored by Amazing grace Hospital, Dako hospitals and Dako Foundation).

The community leader conducting the DFRHCE staff round his ancestral palace built in 1900.

The community leaders taking the DFRHCE team round the dilapidating infrastructure of the health centre.

Medical consultation for the Community Head of Somorika

Medical examination for optical refraction for patients with refractive errors.

Community members queuing up for registration for treatment.

Children receiving vitamin A supplementation

Over 5,000 rural patients were reached through repeated visits to the community for free medical mission. This is my passion and I am glad to work with a team that share same passion to bring healthcare to the hard-to-reach and underserved communities. 

My mission to take healthcare delivery to the underserved and difficult to reach communities in Nigeria will continue to take us to the underserved and almost forgotten people across communities in Nigeria. In the next edition, I shall publish our outreach work to Okorogbo and Akatakpo in the ‘urban rural’ communities in the heart of Lagos metropolis. Below are some of the images depicting our outreach activities.

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Dr. Dako Mumudu MBBS,DFM, is the Chief Medical Director of Dako Medical 

Centre, Lagos, Nigeria and founding Chief Executive Officer, Dako 

Foundation for Rural Healthcare and Education.

Life Member, WONCA

Email: info@dakofoundation.org

Post flood disaster intervention to victims of flood ravaged areas of Anegbette, Osomegbe and Ekperi Udaba communities of Etsako central local government area of Edo state of Nigeria

 Outreach team work distance into the communities. 

Dr Dako Mamudu 

I am Dr Dako Mamudu, a family physician based in Lagos, a mega city, Nigeria. I am also the founder and chief executive officer of Dako Foundation for Rural Healthcare and Education. I was born and raised in a rural community where ninety percent of the houses were roofed with thatch. The inhabitants of my village and its neighbouring communities were peasant farmers, hunters and petty traders. The only sources of water supply were about half a dozen of deep wells and a stream which was about five kilometers away. The six room block of classrooms in the community primary school which I attended was one of the buildings roofed with corrugated iron sheets. These were the prevailing situation of the communities in the region where I lived. 

Over the years, quality of health care delivery in rural communities has gone from bad to worse in most underdeveloped and developing countries of the world especially Sub Sahara Africa. In Nigeria in particular, the situation is worse in rural, riverine and difficult to reach communities. My empathy for these communities and its people led to the founding of Dako Foundation for Rural Healthcare and Education (Dako Foundation). Dako Foundation is a registered Non-Governmental Organization in Nigeria and it works to improve the living conditions of underserved and difficult to reach communities in Nigeria through education, empowerment, provision of social amenities, public health programmes and direct medical interventions. 

Anegbette, Osomegbe and Ekperi Udaba are parts of the riverine communities in Etsako Central Local Government Area of Edo State, Nigeria where we regularly carry out our activities. The main occupations of the people of these communities are peasant farming and fishing. Together, the population size of all the riverine communities in this local government area is about 250,000. The closest accessible point of good healthcare to these communities is about 50km away and for about six months of the year, there is no access to these communities by road. 

Recently, just like it happened in previous years, tributaries of the River Niger, especially River Alika overflowed their banks (climate change) and swept over the communities; covered their farmlands and swept away their crops. Their homes were covered with water for over two months and they had to take refuge in refugee camps. 

Houses submerged by flood in the affected communities. 

As the flood started to recede, I led a post flood disaster intervention to these communities through Dako Foundation aimed to alleviate the pains inflicted on these communities and its people by the devastating impact of the disaster . Also, this outreach is in tandem with the Sustainable Development Goals (SDGs) SDG 3: to ensure healthy lives and promote wellbeing for all at all ages. 

DFRHCE team at our base station preparing for takeoff for the mission.

Still at the base station; donated clothes awaiting transfer to our work location. 

Health care professionals from my team were brought from urban cities of Lagos, Benin City and Auchi to carry out this medical/social outreach. This was a four day mission and my team consisted of 22 regular staff of the Foundation comprising of doctors, pharmacists, public health experts, nurses, community health extension workers (CHEWs) together with 20 local volunteers. Some health workers from the local health facilities were co-opted to participate in the outreach. 

I have previously carried out some health care missions with Dako Foundation to some of these communities in 2016. The only accessible road to the index communities was through a wooden bridge across a deep flowing river. 

 A Dako Foundation staff guiding the outreach vehicle through a wooden bridge (the only accessible road to most of the communities). 

During the post flood disaster intervention to the communities, myself and my team travelled over 500km from Lagos by road to our local base in Edo North. We then travelled another 35km on a daily basis through a lonely, rough, winding and dangerous road to the only accessible village in the community by road. From here we either walked to the near community or drive across a dangerous wooden bridge across a deep river to the communities. On arrival, we carried out health education and sensitization for community members followed by free medical consultations, prescription and treatment of local prevailing diseases (Figure 6, 7and 8). Also, items distributed include antifungal drugs; clothes; prenatal and postnatal multivitamin supplements for pregnant and lactating women; bread, medicated soaps, toothbrushes and toothpastes. Vitamin A supplementation was given to children and other at risk population (Figure 9). There was also mass drug administration of Albendazole to community members. 

Lactating woman received free drugs distributed by DFRHCE. 

Nursing staff carrying out blood pressure and vital signs measurements after registration.

Community members queue up to get registered for medical consultation 

Distribution of Vitamin A and albendazole to children during the outreach. 

In addition to the above, we distributed easy-to-use potable water sanitizing units with storage tanks to households in the communities (Figure above). This equipment does not require electricity and it is user friendly. It functions in such a way that when it is filled with water, and pressure is applied through the external hand pump, the buildup pressure within the unit drives water flow through the filtration component into its external tap where water is collected and stored in a clean storage. Water that flows through this filtration unit is suitable for drinking. 

Water purifying units distributed to heads of community households.

Overall 5,132 rural members were reached through three targeted visits to the communities for the free medical mission and distribution of relief materials. This is my passion and I am glad to work with a team that share same passion to bring healthcare to the hard-to-reach and underserved communities. I hope to arrange additional interventions to other communities in this locality that were not accessible at the time of this intervention. 

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Dr. Dako Mumudu MBBS,DFM, is the Chief Medical Director of Dako Medical
Centre, Lagos, Nigeria and founding Chief Executive Officer, Dako
Foundation for Rural Healthcare and Education.
Life Member, WONCA

Email: info@dakofoundation.org