Calabar, Nigeria
Calabar, Nigeria
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尼日利亚卡拉巴尔
DOI：
10.1136/jnnp.2009.182436
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发表时间：
2009
影响因子：
2.8
通讯作者：
U. Williams
中科院分区：
文献类型：
--
作者：
U. Williams
于是，当我坐下来写这封神经学的信时，我的思绪又回到了卡拉巴尔。我目前在尼日利亚西南部伊巴丹大学学院医院的神经科进行临床实习，但正是在卡拉巴尔大学教学医院，我在医学院学习，大约13年前我开始了我的神经科之旅。作为一名医学生，我日复一日地站在会诊病房，努力理解内科不同专业的所有概念。但神经学总是不同的;与我的基础医学知识，我可以很容易地理解的概念。就像房子里的布线一样，神经元要么串联（长束），要么并联（伦肖细胞）。脑海中浮现出这样的画面，我对神经学非常着迷。卡拉巴尔是尼日利亚尼日尔三角洲地区克罗斯河州的首府。它是尼日利亚最宁静的城镇之一，以其铺设良好的街道和甜美繁荣的花径而闻名。在克罗斯河位于山区奥布杜养牛场的旅游景点，全年气候温和，卡拉巴尔码头和蒂纳帕商业度假村，像迪拜自由贸易区一样建造。难怪卡拉巴尔是尼日利亚的旅游中心！作为独立前尼日尔海岸保护国的政府所在地，它被描述为尼日利亚的第一个首都。来自苏格兰邓迪的传教士玛丽斯莱瑟的雕像位于城市中心，她的坟墓位于杜克镇墓地，证明了卡拉巴尔与欧洲人的长期关系;事实上，它是西非主要的奴隶港之一。每年12月举行的克罗斯河州年度圣诞节吸引了来自尼日利亚国内外的数千名游客。在尼日利亚从事神经病学工作是一种独特的体验。这些挑战是社会文化、宗教和政治方面的。突然发生的神经系统疾病，使曾经独立运作的人濒临死亡，只能被一些人解释为“精神”。癫痫患者被认为是“恶魔附体”，在某些文化中，中风被认为是鬼魂的攻击。显然，这些人会去一个精神家园（教堂，本地治疗师，传统治疗从业者）。如果他们向神经科医生报告，那是在紧急护理的重要时间已经失去，或者并发症已经出现之后。更糟糕的是，功能性的救护车服务几乎不存在，“门到针”等概念在这里几乎不适用。另一个挑战是经济方面。大多数神经系统检查和治疗都非常昂贵，即使有，也不在国家健康保险计划的覆盖范围内。在最便宜的政府医院进行脑部CT检查的费用相当于近200英镑。在政府部门工作的工人的最低工资不到每月最低工资的三分之一。这意味着即使是少数早期出现可能的缺血性卒中的患者也不能溶栓。而富人，尤其是有政治地位的人，更愿意飞到海外接受治疗，即使他们得到的是U E威廉姆斯U E威廉姆斯，尼日利亚克罗斯河州卡拉巴尔卡拉巴尔大学教学医院内科神经科高级注册员; williamsuduak@yahoo.co.uk 237威廉姆斯
A nd so my thoughts drift back to Calabar as I sit down to write this neurology letter. I am currently on clinical attachment to the neurology unit of the University College Hospital, Ibadan, South West Nigeria, but it was at the University of Calabar Teaching Hospital, where I was at medical school, that my journey into neurology began about 13 years ago. There I stood day after day on the consultant ward rounds as a medical student, struggling to understand all the concepts in the different specialities of internal medicine. But neurology was always different; with my knowledge of basic medical sciences I could understand the concepts easily. Like the wiring in a house, neurons are either connected in series (long tracts) or parallel (Renshaw cells). With pictures like these in my mind I was fascinated by neurology. Calabar is the capital of Cross River State in the Niger Delta region of Nigeria. It is one of the most serene towns in Nigeria, renowned for its well paved streets and luscious flourishing flowery paths. In Cross River are located the tourist attractions of the mountainous Obudu cattle ranch with its all year temperate weather, Calabar Marina and Tinapa business resorts, built like the Dubai free trade zone. No wonder Calabar is the tourist hub of Nigeria! As the seat of government of the pre-independence Niger Coast Protectorate, it has been described as the first capital of Nigeria. The statue of Mary Slessor, a missionary from Dundee, Scotland, is in the heart of the city and her tomb in the Duke town cemetery attests to Calabar’s long relationship with the Europeans; indeed, it was one of the major slave ports in West Africa. The Cross River State annual Christmas festival held every December attracts thousands of visitors from within and beyond Nigeria. Practising neurology in Nigeria is a unique experience. The challenges are socio-cultural, religious and political. Neurological conditions occurring suddenly, leaving people who were once functioning independently moribund, can only be explained by some people as being ‘‘spiritual’’. The patient with a seizure disorder is thought of as being ‘‘demon possessed’’, and stroke in some cultures is considered as an attack by a ghost. Obviously, these people will go to a spiritual home (churches, native healers, traditional healing practitioners). If they report to the neurologist, it is after the vital time for acute care has been lost, or complications have already set in. This is made worse by the fact that a functional ambulance service hardly exists and concepts such as ‘‘door-to-needle’’ are scarcely applicable here. Another challenging aspect is economic. Most neurological investigations and treatments are very expensive and where available are not covered by the national health insurance scheme. Brain CT at the cheapest government hospitals costs the equivalent of almost 200 British pounds. The minimum wage of a worker in government service is less than one third of that per month. This means even the few patients that present early with possible ischaemic stroke cannot be thrombolysed. And the rich, especially holders of political positions, prefer to fly overseas for treatments, even when they are being given U E Williams U E Williams, Senior Registrar, Neurology Unit, Internal Medicine Department, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria; williamsuduak@yahoo.co.uk 237 Williams