MRS. Joy Morris was diagnosed with cancer of the colon after undergoing the usual tests. She decided to go abroad for surgery. While there, the doctor decided to repeat the tests to validate the diagnosis and be certain of its accuracy.

To his surprise, the tests were negative for colon cancer, Mrs. Morris had no cancer, she only had an abnormal cecal fold! Meanwhile, some very strong medications had been pumped into her system, pending surgery with the resultant side effects. The doctor wondered how her doctor back home came about the result. Mis-diagnosis, as it is called, happens once in a while with dire consequences.

Some facilities at the centre.

To curb incidences of mis-diagnosis in Nigeria, some Nigerian physicians in the diaspora have found it necessary to come home and contribute their quota towards improving healthcare delivery in Nigeria.

One of such efforts is the establishment of Diagnostic & Therapeutic Endoscopy Centre (D&TEC) in Lagos.

It is described as a “one stop” centre providing accurate high quality diagnosis and treatment for gastrointestinal, urological, gynaecological and respiratory disorders using the latest flexible fibre-optic endoscopes, D&TEC meets international standards these physicians would boast to any who cares to listen.

In a chat with EBELE ORAKPO, the brain behind the project, Dr. Austin Obichere, Consultant General/Laparoscopic Colorectal Surgeon at University College London Hospital and Honorary Senior Lecturer at University College London, strongly believes that once the right diagnosis is made, the problem is as good as solved.

THE truth is that there has always been a challenge in terms of delivering good quality health service in Nigeria and my specific area of interest is diagnostics.

I have always felt that the problem we have in Nigeria is that we are unable to make accurate diagnoses. We don’t have the infrastructure and it is absolutely essential as a doctor that the first thing you want to do is to accurately diagnose the patient’s problem because when you do that, subsequently, it is very straightforward – either you can do it or you refer the patient to the right person.

If you go to an average diagnostic centre today, you will be diagnosed with either malaria or typhoid and nothing else. It is a thing I want to change by designing this concept,” he said.

He noted that diagnostics in medicine has three major areas namely: Pathological laboratory services (histology, microbiology and chemical pathology); Imaging (computed tomography (CT) scan, Magnetic Resonance Imaging (MRI), ultrasound scan, digital mammography etc) and Endoscopy which he defined as introduction of a fibre optic camera to visualise all the internal type organs.

“It is very essential that we have endoscopy service because that is the only way you can accurately make your diagnosis as it enables you to see the pathologic bit, take tissue biopsy and send to the pathologist to look under the microscope and confirm that yes, this is the problem, you have cancer of this or cancer of that,” he stated.

Dr. Obichere noted that endoscopy covers the gastrointestinal tract (GIT), looking into the stomach or through the anal passage to examine the colon and use it to diagnose gastrointestinal cancer. “It can be used in the diagnosis of diverticular disease, inflammatory bowel disease, Crohn’s disease, ulcerative colitis etc.,and to investigate things like rectal bleeding, changes in bowel habit etc.

There is also bronchoscopy to look into the lungs to diagnose lung cancer, cystoscopy to look into the urinary bladder, hysteroscopy to look into the womb etc. We can diagnose all prostate cancers,” saying that “when you put the whole three together – laboratory services, imaging and endoscopy services, then you can begin to say you have a basic diagnostic formula that would allow us to make accurate diagnoses.”

Narrating how the idea came about, Dr. Obichere who runs the outfit with two other specialists – Dr. Abuchi Okaro, a Consultant General/Laparoscopic/Upper GI surgeon at the Kent Oncology Centre, Maidstone and Dr Ayo Oshowo, Consultant

Laparascopic/Colerectal surgeon at the Whittington Hospital, London, said he developed this concept about four -five years ago “and the reason I came up with this idea was that I have been fortunate to have had lots of Nigerian patients referred to me with problems having had so-called endoscopy in Nigeria and the story was that some people had had colonoscopy and that everything was fine but they were still having symptoms, they were sent to me in the UK.

I repeated the endoscopy only to find bowel cancer and of course, you can imagine how devastating it could be for the patient. I have also had other patients who have been told they have bowel cancer and they came to me to advise regarding surgery, only to repeat the colonoscopy and discover that there is no cancer. They just have either a dilated/abnormal cecal fold or a very rigid sigmoid colon.

Then I began to ask myself what sort of endoscopy service we have in Nigeria. The truth is that it is almost rudimentary or non-existent, although that may not be an accurate assessment. Based on that, I felt one needed to develop a concept whereby we would provide endoscopy service that meets international standards. We knew we needed to create a proper self-purpose designed endoscopy suite.

It’s not a case of taking a patient to the theatre and doing endoscopy. Secondly, we needed to provide the expertise to deliver that service and I felt the only way I could do that was to bring people, particularly those in the diaspora like myself, to make a commitment to come here and deliver the service and carry out the procedure. We wanted to quality-assure what we did, provide the patient exactly the same service he would have if he came to see us in the UK or go somewhere else.

And more importantly, we also wanted to actuate a training component and with time, we can invite our Nigerian colleagues who have an interest in endoscopy to come here and see the latest techniques, using the latest equipment and teaching them advanced endoscopic techniques.

It provides an opportunity to diagnose cancer very early and to cure, not treat but actually cure the cancer, particularly colon cancer, which can arise from  benign polyps which if left alone, can grow and become malignant and spread. So the purpose for endoscopy is you can provide screening. Some people have symptoms and some don’t have at all and are worried so you can identify these conditions early and cure them. Even if cancer is found, you can come and we do keyhole surgery or whichever form and that patient will be guaranteed of having a cure.”

He regretted that in Nigeria, patients present quite late “when the disease had spread to different organs in different parts of the body which makes it impossible to cure even if they go abroad all because we do not screen, we don’t consider our health important enough to actually make an attempt to prevent rather than treat the condition.”

Speaking on signs to look out for, he said: “Upper GI cancers (esophageal and gastric) typically present with difficulty with swallowing, patients may get heart burn or dyspepsia which is like reflux of acid. They then begin to lose weight because they are unable to eat properly. These are worrying signs and the moment you have it, you should seek a specialist opinion.

Equally, for those that have rectal bleeding, changes in bowel pattern.For example, one minute you have diarrhoea, the next minute you have constipation, it just keeps changing, people who are losing weight, people who find it very difficult to expel stool, people who feel a lump in their tummy should not ignore it at all,” adding that although the commonest cause of bleeding is piles or anal fissure, which cause 80 – 90 percent of rectal bleeding, “however, the symptom of bleeding from the back passage, be it small, large, or  medium, is exactly the same if you have bowel cancer and because they have similar symptoms.

If you have any other commoner problems like piles or fissures, you should treat them as normal but my advice is if you treat it for two to four weeks and it does not go away, you must go and see an expert because you probably need a colonoscopy.”