No abstract

N igeria, like most other developing countries, is today experiencing an increasing incidence of noncommunicable diseases and the unsolved problem of infectious diseases. The role of surgery in the management of these diseases has continued to increase. Surgical training has traditionally been of a high standard, and this has made it possible for surgeons trained in Nigeria to cope with this change in the spectrum of diseases. A low success rate at the diploma examinations and an increasing loss of local talent to foreign countries has increased calls for a modification of the training programs. There is a need to improve the working conditions and environment of surgeons to stem the attrition. Surgery in a poor resource environment demands more, rather than less, skill from the surgeon, and the training programs must ensure that the specialist is adequately equipped to deal with conditions that may not be considered general surgery. While the unavailability of modern technology has limited the scope of research, it is still possible to conduct appropriate, "low-tech," and relevant research that is subject to excellent study design, proper controls, and scientifically valid interpretations.

Five electrophoretically slow-moving genetic variants of glucose 6-phosphate dehydrogenase are described: four are from Nigeria and one is from Togo. All variants have normal or moderately reduced activity, and they are not associated with adverse clinical or haematological manifestations. Three variants have been fully characterized and are different from all previously described ones. Two variants have been partially characterized and at least one of them is also probably new. The overall population incidence of sporadic variants of G6PD in the Nigerian population is 0-3%. In the course of this study a previously described ion-exchange chromatographic technique for the characterization of G6PD variants has been extensively evaluated. Data are given on ten different variants to demonstrate the high resolving power of this technique.

In 1999, our world's population passed the six billion mark. An estimated one-third to one-half of our world's population-2 to 3 billion people-still lack basic surgical care! In this paper we attempt to address the question, "How best can surgical needs be met in a sustainable manner within resources available for training in less-developed populations?" Our goal is to raise awareness of the enormous unmet needs for surgical care in less-developed regions and to suggest ways in which Fellows of the American College of Surgeons may assist in helping meet the needs. In many developing countries, surgical training programs are patterned after North American or European programs. This tends to encour-age subspecialization and might not produce surgeons adequately trained to manage the broad spectrum of surgical needs for which people attend their local district hospitals. A complete roster of surgical specialists cannot be made available in most district hospitals throughout the world. So surgeons serving in these hospitals require training and experience that encompass a broader range of surgery than is provided by the usual programs for training general surgeons.We will describe the needs, define the spectrum of surgery in most district hospitals, and outline some affordable and innovative options for surgical care. Our emphasis is on training and sustainability.

Breast cancer prevalence continues to increase globally, and a significant proportion of the disease has been linked to genetic susceptibility. As we enter the era of precision medicine, genetics knowledge and skills are increasingly essential for achieving optimal cancer prevention and care. However, in Nigeria, patients with breast cancer and their relatives are less knowledgeable about genetic susceptibility to chronic diseases. This pilot study collected qualitative data during in-depth interviews with 21 participants. Of these, 19 participants were patients with breast cancer and two were relatives of patients with breast cancer. Participants were asked questions regarding their knowledge of breast cancer, views on heredity and breast cancer, and views on genetic counseling. Participants’ family histories were used as a basis with which to assess their hereditary risk of breast cancer. Participant responses were audio recorded and transcribed manually. The study evaluated patients’ and relatives’ knowledge of genetic counseling and the use of family history for the assessment of familial risk of breast cancer. This will serve as a guide to the processes of establishing a cancer risk assessment clinic.