Report of 2019 AKISAN sponsored Medical and Surgical Mission to of October 21 to October 25, 2019

By Asuquo N. Inyang MD, FRCS (Edin.), FWACS, AFMCS, FASE. Medical Mission Team Leader

Introduction I was called upon by the President of AKISAN (USA) inc. Ms. Margaret Itauma, and I accepted the request to help organize and lead a state-wide medical and surgical mission to Akwa Ibom State of Nigeria that would benefit individuals in locations that will represent all the three senatorial districts of the state. This was a way for AKISAN to give back to our state where attention would be directed to the poor and the infirm in our communities, who have neither the resources nor the ability to pay for their medical and surgical care, wherein, because of ignorance and poverty most of these indigent patients die from very preventable or easily treatable diseases and from the complications of simple surgical conditions. She wanted me to draw from my previous experience of leading a similar AKISAN mission to Akwa Ibom State in 2016. This time, the medical and surgical mission took place in earnest from Monday October 21 to Friday October 25, 2019. The whole AKISAN mission was generously supported by the Family Empowerment and Youth Reorientation Path (FEYReP) Initiative, the First Lady’s pet project, and in , the mission was also supported by Love Without Borders Foundation, a York Pennsylvania based charity organization.

Mission Sites and Site Leadership We decided to locate the missions in areas that had not benefitted from AKISAN missions in the past, the choice of locations was also based on established criteria that are known to be conducive for the effective operation of medical missions. That is how the missions came to be sited at the General Hospital at Ibiaku Ntok Okpo in Ikono Local Government for Senatorial District; Etinan General Hospital, Etinan for Senatorial District, and the Cottage Hospital in Ekpene Obo for Senatorial District. Immanuel Hospital in Eket was the first choice for the mission, but because of renovation work being embarked upon by the State Government, the facility was not available for us to use during the mission.

I invited distinguished, trusted, and reputable individuals to be the team leaders to each of the centers in their respective home local government areas. Bishop Dr. Samuel Ottong MD, President of Bishop Medical pc Family Medicine Practice, Queens, New York, accepted my invitation to lead the team to Ibiaku Ntok Okpo, Dr Nsikan St. Martin MD , Obstetrician and Gynecologist from Louisiana was the team leader in Ekpene Obo, Dr Ally Inyang PhD, Pharmacologist from York, Pennsylvania, President and Founder of Love without borders was the team leader in Etinan. Ally and I, through Love without Borders had been planning for a mission to Etinan, the inclusion of Etinan as one of the centers for the AKISAN mission was a welcomed boost and a happy coincidence that benefitted both AKISAN and Love without borders.

Budget I advised the President of AKISAN that in order to run a credible comprehensive medical and surgical mission, and for AKISAN to have the ability to pay for hotel bills, feeding of volunteers, procurement of medications for the outpatient department that will be dispensed to medical patients, and to pay stipend to the Nigeria based volunteers, that it would cost about twenty thousand dollars ($20,000:00) to run each mission site. Given the three-mission site that was planned, I advised AKISAN to budget about sixty thousand dollars ($60,000:00). The money will be kept and controlled by AKISAN, the money can only be disbursed by AKISAN for direct payment for purchases or to settle mission bills. I refused to accept any kind of deposit or any amount of any sort from AKISAN to organize the mission, and I did not handle any part of AKISAN money.

Volunteers I called on my fellow Akwa Ibomites to volunteer for the mission and to go preferably to their senatorial district of origin. I recruited my family members, friends, and colleagues from the diaspora and from within Nigeria to volunteer for the mission. Members of Mboho Ima Iban Akwa Ibom of Northern California that I affectionately nicknamed the ‘California Angels’ volunteered as a group to serve in Etinan in the pre-operative units and the post anesthesia care units (PACU). Me, and all the volunteers from the diaspora provided our services completely pro bono, that is what true volunteerism is about, something that has yet to be inculcated into our Nigerian based counterparts, because most of the Nigerian based volunteers expected, demanded, and received some amount of stipend for their services. Some of the Ikono volunteers accosted the team leader Bishop Dr. Samuel Ottong in Ibiaku Ntok Okpo and insisted to be paid stipends even before the mission was concluded or before it even went half-way through.

Here are the names of the volunteers to the 2019 AKISAN Medical and Surgical Mission to Akwa Ibom State, the capacity, and the locations where they served.

Eket

Nsikan St Martin GYN Team Leader Michael Ukpe GYN Boniface Effiong Medical Superintendent Richard Akpabio Surgery Okoro Jeremiah Surgery King Udoh Surgery Utibe Umanah Surgery E. Essien GYN David Udoh Surgery Abasiema Ekott Medicine Udo Udo Mfon OPD Akpan Abasifreke OPD Itoro Ukpanah OPD Abasifreke Ekpenyong OPD Umoh Medicine Francis Ejike Medicine Edidiong Sunday Medicine Enobong Udota Medicine Esther Umoh Medicine

Rose Essien Anesthesia Amos Tom Ekwere Anesthesia Helen Udoekong Anesthesia Jimmy Edemekong Anesthesia Nseobong Harry Anesthesia Christian Benson Anesthesia

OR Nurses for Eket Christiana William Blessing Essien Emem Anderson Anthonia Asuquo Patience Akpan Edikan Ibokette Itoro Sampson Imaobong Solomon Agnes Nyong Eno Williams Mrs. Uduak Afiakusin Mr. Idorenyin Akpakpan Mrs. Aniefiok Raymond Mr. Awok Leonard Vasco Joe ------Also served as the Chief of Logistics for Eket Emem Victor

OR Co-ordinator Idara Udoh

PACU Nurses for Eket Mrs. Uduak Umoh Mrs. Franka Etuk Mrs. Bassey Ubeh Mrs. Blessing Ukonsek Mrs. Imo Moses Inieke Mary Tongo Enobong Udo Friday Eyo Jackson Ekemini Utibe Bassey Etimbuk Mbetubong Francisca Bassey

Outpatient Nurses for Eket Mfon Umana Nancy Ntia Agnes Udoh Ukpongmma Oduok Christiana Etukudoh Mrs. Ekanem Dr. Glory Udoh Logistics Ms. Valerie Etukudoh Logistics Obonganwan Dr. Ini Adiahakpan Logistics

Autoclave Technicians for Eket Helen Ekpuk

Pharmacy Nsikak Okon Edidiong Udofa Idongesit Eyo Emmanuel Emerson Uduak Udofia

Laboratory Sunday Udokwo Mrs KufreAbasi Elizabeth Sunday Andy Ewa

Ikono Volunteers OR Doctors: 1) Dr Otobong Asuquo 2) Dr Aniekan Jackson 3) Dr Ugo Ugochukwu 4) Dr Ubong Ubom 5) Dr Oku Okoiseh 6) Dr Ekere

OPD Doctors: 7) Dr Kufre Francis 8) Dr Glory Bassey 9) Dr Ima-abasi Stephen 10) Dr Felix Essien 11) Dr Ekpe-iko Bassey

Anaesthetist: 12) Mr Paul Idu

Pharmacists: 13) John Obo 14) Ugochi Nwabini

OR Nurses: 15) Covenant Ukpo 16) Emefak Okoko 17) Bella Udoekong 18) Raphael Ogar

PACU Nurses 19) Uduakobong Uwah 20) Monica Atsu 21) Promise Moses 22) Umoh Akrasi

OPD Nurses 23) Ememabasi Essienabasi

LOGISTICS/ASSISTANCE 24)Richard Tete STERILIZING UNIT: 25) Richard Jacob 26) Abasiedema Noah

SECURITY (OFFICERS): 27) Bassey 28) Dan

LOCAL VOLUNTEERS: 29) Dr Kyrian Ekpotu MD 30) Charity Wisdom (nurse anaesthetist NA) 31) Mr I Akpan OR Nurse/ in charge theatre 32) Sylvester Akpan (NA)

LOCAL OR ASSISTANTS 33) Aniefiok Umoren 34) Daniel Akpan 35) Ofonmbuk Udo 36) Edet Akpan

US VOLUNTEERS: 1) Dr Samuel Ottong (Team Leader) 2) Mr Uwem Umoren Head of logistic 3) Ene Ben 4) Mr Ime Akpan 5) Theresa Udofia 6) Mr Mfon Akpabio

Etinan Inyang Udousoro Medicine Ally Inyang Pharm Team Leader Udeme Inyang Anesth Asuquo Inyang Surg/ Anesth Ekamma Inyang Phys/ Therapy OR Coordinator Ini Uboh Admin Edo Etukeren ER Nurse Clyde Strang Urology Francis Essien Surgery Emmanuel Udoeyop GYN Imaikop Mmah Logistics Aniekan Etim RN Schola Idem RN Surgery Glory Udoisa RN Inyang Edem LVN Eme Bassey LVN Medicine Grace Udoh Logistics Matrise Essien RN PACU Agnes Umana Nurse Assist. Blessing Udoffia RN Pat Peters Essien RN Helen Essien NA Gloria Ekpenyong RN PACU Blessing Okon Supplies Mx Grace Udosen RN Grace Joe Eka RN Ebere Mejeha Surgery/ GYN Bassey Etuknwa Surgery Sakhiel Nkanta Surgery Uche Ebi Anesthesia Kate Eyo Anesthesia Afiamma Adiakpantin Anesthesia Comment [NI1]: Isangobong Anyang Anesthesia Michael Ekaete Logistics Iso Usang Iso Scheduler/ Statistics Ignatius Ekwere Logistics Juliet Ekwere Logistics

OR Nurses for Etinan Mr. Pius Brown Mrs. Alice Pius Brown Mr. Bassey Eteng Mr. Ibong Akpan Mrs. Uduak Umoh Mrs. Mary Ekpo Mrs. Inimfon Ekpoudom Mrs. Affiong Ukam Mr. Paul Eboro

PACU Nurses for Etinan Mrs. Mary Ekong Mrs. Grace George Mrs. OtoAbasi Benson Miss Udeme Nkwo Mr. Idaresit Etifit

Autoclave Technician Mr. Samuel Okokon

Pharmacy for Etinan Abasiifreke Sunday Blessing Asuquo Esther Moses

Optometrists for Etinan Godwin Umoh Joseph Ita Christiana Udoinyang

Ground work Since I am domicile in the United States, I needed information on the state of readiness of the different hospitals we were to utilize for the mission. I called on my friend Dr Inyang Udousoro, a retired former Permanent Secretary in the Ministry of Health to evaluate the General Hospital, Etinan and Immanuel Hospital, Eket. I also called on Dr Otobong Asuquo, an OB/GYN senior registrar with UUTH who has served with me in many other missions to assess the Ikono General Hospital, and in addition to evaluate the Konokoniks Hotel where the Ikono team members would be staying. Ms. Margaret Itauma, the AKISAN President also traveled home to confirm the findings in June 2019 at which time she recruited Mr. Vasco Joe to help coordinate activities and offer updates in Eket, and she also recruited Mr. Uwem Umoren to assist with logistics and mission coordination in Ikono.

About three weeks before the commencement of the mission, Dr Ally Inyang traveled to Nigeria to put some finishing touches to the plan. One week before the mission, Ms. Itauma traveled to Akwa Ibom State again to make sure everything was in place for the mission. Accommodation for the volunteers was confirmed. Ikono volunteers were booked into Konokoniks Hotel and McCaire Hotel in Ikot Ekpene, Etinan volunteers were accommodated at Watbridge Hotel in Uyo, while Eket volunteers were housed at Madelyn Hotel and Grace Garden Hotel in Eket.

Mission Materials, Equipment, and supplies About 90% of all the surgical materials, equipment, and supplies utilized during the 2019 AKISAN mission in Akwa Ibom State were personal items supplied by me for the mission, and these were provided completely free of charge to AKISAN, including hardware such as ultrasound machine, anesthesia machine, suction machines, tubings, and suction nozzles, bulb syringes for suctioning, diathermy machines, bovie handles and tips, digital blood pressure machines, pulse oximeters to monitor oxygen saturation of patients, voltage transformers and regulators, hemodynamic monitors-some of which got damaged during transportation, portable autoclaves, surgical basins, trays, dishes, surgical instruments, etc. All the surgical instruments used in Ikono were supplied by me and all the instruments were donated to the hospital at the end of the mission.

I also provided surgical supplies (Nigerians call them consumables) like surgeons’ gowns, patients’ gowns, operating room hats, masks, shoe covers, operating table covers, surgical drapes and liners, sterile gloves for surgery, non-sterile gloves for handling patients and contaminants, all kinds of sutures absorbable and non-absorbable sutures, (except Nylon 1 and Nylon 2 sutures), mesh for hernia repair, gauze swabs for surgery and other wound dressings, wound drains, surgical sponges, operating room blue and green towels, abdominal wound pads, skin prep solutions, hand wash solutions, instruments sterilizing solutions (Cidex), skin tapes, oxygen masks and tubings, airway materials including oral airway, nasal airway, tongue blades, laryngoscope blades, endotracheal tubes, laryngeal masks, carbon dioxide detectors for safe intubations. I also supplied needles of all sizes and shapes and syringes of all sizes, including hypodermic needles, intravenous cannulas for iv lines, iv giving sets, iv extension sets with 3- way stop-cock, blood infusion sets, spinal anesthesia needles and spinal anesthesia kits, epidural anesthesia needles and epidural anesthesia kits, all these materials were given to the mission completely free of charge to AKISAN. The estimated value of all the equipment and supplies used during the AKISAN mission is worth more than two hundred and fifty thousand dollars ($250,000:00). The leftover supplies and some hardware were donated to area hospitals at the end of the mission.

The materials were sent in a container to Nigeria for the mission. The cost I paid for the loading of the container in my premises and the shipping of the 40 foot container to , Nigeria was eleven thousand dollars ($11,000:00), the clearing of the container in Lagos cost N2,500,000:00 (Two million, five hundred thousand Naira), forwarding of the container to Uyo, Akwa Ibom State cost N900,000:00 (Nine hundred thousand Naira), the cost of warehousing the materials in Uyo for one month was N50,000:000 (Fifty thousand Naira).

AKISAN contributed five thousand dollars ($5,000:00) for the cost of the container, loading of the container on my premises, transportation of the container to the port of New York, and shipping of the container to Tin Can Island Port in Lagos. AKISAN also contributed three thousand dollars ($3,000:00) towards the cost of clearing of the container in Lagos, making a total contribution of $8,000:00 (Eight thousand dollars). The rest of the fees for the transportation of the container, the clearing of the container, the forwarding of the container to Uyo, the warehousing of the mission materials in Uyo were completely borne by me from my personal funds, and from contributions from friends in York Pennsylvania, and individuals like Mr. Hugh Ette of North Carolina who donated One thousand dollars ($1,000:00) towards the mission, Ubium Development Association (UDA) because I had some of their mission supplies in the container, Efik National Association (ENA) because I also had supplies for the mission with ENA in in the container. Some of the mission items for AKISAN could not be shipped on the container and were carried as extra luggage with me on my flight from JFK Airport in New York City to , Nigeria. My wife and I brought in 19 suitcases of medical mission supplies as extra luggage to Nigeria, all paid for from personal funds. We also paid for the extra suitcases to be transported by road from Abuja to Uyo since they could not fly with us on Ibom Air from Abuja to Uyo.

Certain items like antibiotics and anesthesia medications were purchased here in the United States from the York Hospital Pharmacy, and Geisinger Medical Center Pharmacy at cost - for example Cefazolin, Propofol, spinal bupivacaine (heavy Marcaine), because of concerns about authenticity and efficacy of such medicines in Nigeria. Love without Borders gave me a refund of $1,010:56 (One thousand and ten dollars, fifty-six cents) after I submitted the receipt of the purchase of those medications. Some items were preferably purchased in Nigeria because they are controlled and regulated medication that makes their availability restricted here in the USA. The following medications were cheaper or were better purchased in Nigeria because they are heavy or bulky- items like oxygen cylinders, intravenous infusion fluids, local anesthetics like lidocaine, and bupivacaine (bupivacaine for infiltration anesthesia was on back order in the USA at the time and so was not readily available for purchase) for local wound infiltration, and some controlled or regulated medications like Ketamine, Pentazocin, and Diazepam. They were bought and paid for directly by AKISAN from specific AKISAN designated pharmacies at each mission site.

Pre-mission Meetings Teleconferences were held in the months and weeks leading to the trip to discuss different aspects of the mission, to disseminate information, offer advice to individuals, and provide updates as new information emerged. I issued guidelines to help individuals with their preparation for the trip which also served as a guide for volunteers during the mission. On Sunday October 20th, 2019, the evening before the mission, we held an all volunteers meeting at Watbridge Hotel in Uyo. Among the attendees at the meeting were the National President of AKISAN (USA) Inc. Ms. Margaret Itauma RN, the Chief Medical Director of Uyo University Teaching Hospital (UUTH) Dr Emem Bassey who gave permission to his staff at UUTH to volunteer and join in the mission, the mission site team leaders Bishop Dr Samuel Ottong, Dr Nsikan St. Martin, Dr Ally Inyang, my Chief of Staff Dr (Mrs.) Ekamma Inyang, the Chairperson of the Medical Mission Committee Dr Idara Udoh, the mission volunteers from the diaspora and from within Nigeria, and Mr. Itoro Columba, the Chairman of Ikono Local Government. Mr. Columba happened to be the only Local Government Chairman present at the meeting. He proved to be an early and enduring partner who was very proactive in ensuring the success of the mission in Ikono. He also donated 500 reading-glasses that were dispensed to patients in Ikono. Mrs. Emeh Bassey from California was appointed the secretary to the group for our meetings for the duration of the mission. I nicknamed her Ban Ki-moon after the current United Nations Secretary General.

Mission Data and Statistics

AKISAN Project Statistics for the 3 Site Akwa Ibom State Mission October 21-25, 2019 Units Ikono Etinan Ekpene Obo Total Medical 1500 850 1960 4310 Outpatients Eyeglasses 500 848 440 1788 Dispensed Surgery 64 85 91 240 Caesarian Delivery 1 0 4 5 Normal Delivery 1 0 0 1 Grand Total 2066 1783 2495 6344

Discussion

Total number of patients seen in medical outpatient at the 3 sites - 4,310 Total number of patients who received eyeglasses at the 3 sites - 1,788 Total number of surgeries performed at the 3 sites - 240 Total number of Caesarian sections performed at 2 sites - 5 Total number of normal spontaneous vaginal delivery at 1 site - 1 The grand total of all patients attended to and procedures performed at 3 sites - 6,344 Total number of patients screened for HIV in Ikono - 908 Total number of patients in Ikono positive for HIV - 4 There were no fatalities and no serious morbidities during the mission.

There were more medical patients seen in Ibiaku Ntok Okpo and Ekpene Obo than in Etinan because most of the medical personnel who were assigned to Etinan were not available for work for most of the mission. In addition, the operating room at the Etinan center performed more high risk, high acuity, low volume procedures that took more time and patience to complete. Additionally, on Wednesday October 23rd, I traveled to Ikono with a team of surgeons to perform some high acuity procedures there, that deprived the Etinan mission of the services of the Surgeons and Anesthesiologists thereby reducing their productivity for that day.

Additional data from Ikono shows that out of the one thousand five hundred (1,500) patients who were seen and treated during the mission, Nine hundred and eight (908) of them were randomly selected to be screened for the Human Immunodeficiency Virus (HIV), and out of this number four (4) individuals tested positive for the virus. Dr Ottong has arranged for the 4 individuals who tested positive to undergo a further set of tests (which is supposed to be a confirmatory test), and if after that the HIV infection is confirmed, the four patients will immediately be commenced on anti-HIV therapy. Although the random screening was not a proper cross-sectional study, on its own, this result would indicate HIV prevalence of about 0.44% in Ikono. This is in sharp contrast to a USAID study done in Akwa Ibom State in 2017 that showed the overall HIV prevalence in the state to be 2.8%, and it is still better when compared to the rest of the country, where the most recent figures from the March 2019 report gave the national prevalence of HIV in Nigeria to be 1.4%.

The analysis of our mission patient population showed that fifty three percent (53%) of our patients were females, while forty seven percent (47%) were males, and seventy percent (70%) of them were adults aged 18 to 59 years. Malaria, hypertension, diabetes, arthritis, body aches and pains, respiratory tract illnesses like asthma, chronic bronchitis from cigarette smoking or smoke inhalation from long term cooking with firewood, and helminthiasis (worms) remain the main diagnosis or medical predicament patients complained about; while hernias and scrotal masses of all shapes and complexities were the most common surgical complaint. For the females, symptomatic fibroids remain the most common gynecological issue that made them to seek surgical intervention. It may be anecdotal, but giant goiters are becoming common features that we are witnessing at the missions, and some of the goiters have been associated with some amount of airway compromise threatening to suffocate the patients to death with airway compression and obstruction. 95% of the goiter patients were females. It will be prudent to conduct an epidemiological study in Akwa Ibom State to find out the root cause of the seemingly growing numbers of goiters, and to recommend solutions which could include things like the iodization of table salts for general consumption to provide extra iodine in the diet as it is done in many goiter endemic regions of the world to help reduce the incidence and prevalence of goiters.

On a more delightful and exciting note, we were blessed with six (6) ‘AKISAN’ babies who were delivered by our teams during the mission, two (2) of them were delivered in Ibiaku Ntok Okpo and four (4) were delivered in Ekpene Obo. Five (5) of the babies were delivered by Caesarian Section because their mothers could not deliver them naturally, while one in Ibiaku Ntok Okpo was delivered naturally by spontaneous vaginal delivery. Caesarian section delivery in Nigeria generally carries a hefty price tag that most families can hardly afford.

Here is an example of the surgical cases that were recorded for the Etinan Mission Site:

Inguinal Hernia ------30 Labial agglutination ------1 Refashioning of 3 digital amputation stumps ------1 Hydrocelectomy ------9 Sebaceous cysts ------2 Bartholin cyst ------1 Umblical/ Paraumblical Hernia ------2 Lipoma ------9 Wide excision of Basal Cell cancer of head and neck ------1 Wide excision and reconstruction of left foot mass ------1 Myomectomy ------6 Thyroidectomy ------7 Lumpectomy ------6 Hysterectomy ------2 Ventral Hernia ------2 Keloid excision ------3 Orchiopexy ------1 Giant breast mass excision ------1 Total Number of cases done in Etinan ------85

Follow-up I arranged for patients who needed follow up visits to see me in Ikot Akpamba, Ubium where I was spending another week of missions with Ubium Development Association (USA) inc. following the AKISAN mission. Arrangements were made for patients who needed follow up afterwards to return to the hospitals where their procedure was performed to have a follow up check-up. Materials and supplies were left behind for the different hospitals to utilize in treating the patients, for example, for simple procedures like the removal of sutures and the change of wound dressings.

First Lady’s visit and Event Flag off The First Lady of Akwa Ibom State, Her Excellency Dr. (Deaconess) Mrs. Martha Udom Emmanuel visited the Etinan site of the mission to flag off the event on Tuesday October 22, 2019 in a very grand and colorful ceremony, full of pomp and substance, where she re-iterated her support and appreciation for the love and sacrifice shown by AKISAN and Love without Borders to bring ourselves, our skills, and our resources to alleviate the sufferings of our fellow citizens, which is in line with the philosophy behind Family Empowerment and Youth Reorientation Path (FEYReP) Initiative, her pet project. The First Lady visited the outpatient clinics and the operating rooms to see things for herself. Her Excellency also supported the mission very generously, and she was instrumental in helping us to scale some bureaucratic hurdles that could have scuttled the entire mission were it not for her personal intervention.

Post Mission Meeting We held a post mission meeting in the morning of Saturday October 26, 2019 to discuss the just concluded mission. We talked about what we did right, what we did wrong, and discussed what we could have done to make the mission better. We also discussed how we could be more effective, and more efficient the next time around. It was convenient that the meeting was on the day for the mandatory environmental sanitation in Nigeria, so all the volunteers in Uyo were in house, but the volunteers from the other centers could not make it to the meeting because of the restriction on movement.

Lessons Learned This is the second time I have led a state-wide AKISAN mission to Akwa Ibom State, as with the mission in 2016, holding the mission at 3 different sites involved splitting resources in 3 different places, it was taxing on our ability to coordinate activities and it also put a heavy strain on our logistics capabilities between the three different centers, but it satisfied the need to have a mission in close proximity to the patients’ hometown. There was a lot of good will for the mission and the personnel from the general public. However, and disappointingly so, some of the volunteers did not turn up for mission work after expressing, and confirming their interest in the mission, especially the medical personnel who were assigned to Etinan, this led to a slow-down of service in the Etinan outpatient clinic.

There is a consistently present and a continuing widespread need for short-term, stop-gap health intervention in Akwa Ibom State like this project that has just been accomplished by AKISAN. It should also be noted and emphasized that because of the current deteriorating economic conditions in the country that have also affected the people in Akwa Ibom State, when added to the absence of a system that can help pay for medical bills especially for the indigent patients, (like a health insurance scheme), then this healthcare dilemma we are witnessing now has the potential to continue into the future and may even get worse if these combinations of bad circumstances are not mitigated.

Nevertheless, although things look rough, tough, and desperate, the future does not look completely bleak, and it may not be all gloom and doom afterall; there is hope in the horizon. It is encouraging that the government is actively seeking for ways to solve some of the healthcare maladies in the state. It should be noted with pride the strides that the current government in Akwa Ibom State is making in the healthcare sector by renovating, re-equipping, and revamping many of the long standing otherwise decrepit and decaying hospitals in the state like the Etinan General Hospital, Ikono General Hospital, Immanuel Hospital Eket, just to mention the three that I have been directly involved with, and allowing missions like ours to use these facilities to treat and help our fellow citizens. I understand that there are plans to also renovate and upgrade community health centers and rural health centers in order to bring healthcare closer to the people. Therefore, the current government in our state deserves our appreciation and commendation and should be lauded and applauded in that regard.

Conclusion In conclusion, this was an overwhelmingly successful AKISAN mission, the enthusiasm and dedication exhibited by the AKISAN volunteers was simply nothing short of spectacular, the logistics to provide the required equipment and the necessary supplies on a daily basis, from our temporary warehouse in Uyo to the mission sites in Etinan, Ibiaku Ntok Okpo and Ekpene Obo was daunting and tested our resolve, but this was overcome by sheer determination and a purposeful will to succeed by our very excellent team of coordinators and talented logistics personnel. We were able to accomplish a lot in treating patients and alleviating a lot of suffering. We saw and treated a grand total of six thousand three hundred and forty-four (6,344) patients and performed two hundred and forty (240) surgical procedures, we dispensed a total of one thousand seven hundred and eighty eight (1,788) reading glasses in all the three centers over a period of only five days. We were even blessed with the delivery of five (5) babies by Caesarian section and one (1) by normal spontaneous vaginal delivery. In Ikono nine hundred and eight (908) patients were randomly screened for HIV from which four (4) turned in positive test results. All the surgical procedures and all the medical treatments were provided completely free of charge to the patients.

The National President of AKISAN Ms. Margaret Itauma deserves our appreciation for her hard work and tenacity, working tirelessly, day and night, traveling to Akwa Ibom State on numerous occasions to ensure the mission succeeds. I must mention my Chief of Missions, my Chief of Staff, my Chief of Logistics, my wife Dr (Mrs.) Ekamma Inyang, whose support and wise counsel has been invaluable to the planning and the execution of the mission, the Team Leaders and the Mission Team Members deserve our gratitude and a lot of commendation for their hard- work and dedication to duty. Her Excellency Dr (Deaconess) Mrs. Martha Udom Emmanuel, the First Lady of Akwa Ibom State deserves our special thanks and appreciation for her kindness and generosity in making this mission the great success that it is. We thank the Executive Governor of Akwa Ibom State, His Excellency Dr (Deacon) Udom Emmanuel for his unwavering support for AKISAN and his support for the just concluded AKISAN mission to Akwa Ibom State. May God continue to bless Akwa Ibom State of Nigeria.

Submitted by Asuquo N. Inyang MD, FRCS(Edin), FWACS, AFMCS, FASE 2019 AKISAN Medical Mission Team Leader