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Nigeria: "Good copy"
‘Good copy’. It’s a radio acknowledgement used by Médecins Sans Frontières/Doctors Without Borders (MSF) drivers and watchmen in Jahun, Nigeria. It’s a simple response that mixes together 'Roger', 'Affirmative' and 'Reading you loud and clear'.
I heard the term mostly when returning to base from the hospital.
The driver would notify the base of our approach, and the crackling response of “Good copy” assured us that a guard would be ready to open the gate when we pulled up at the compound moments later.
"The phrase carries a certain ‘esprit de corps’ – a way of saying 'this is a Jahun thing - a Médecins Sans Frontières thing - and I'm part of it.'"
The term was also used by enthusiastic international staff trying to get into the swing of things, and as a light-hearted affirmative response to any question e.g. “Shall we have a coffee?” “Good copy”.
As such, the phrase carried a certain ‘esprit de corps’ – a way of saying “this is a Jahun thing - a Médecins Sans Frontières thing - and I'm part of it."
The significance of that would soon become apparent.
An international team
The national staff were mainly from the south—Lagos, Abia, Rivers. Some had worked with MSF before, but all were fulfilling a long held dream to work for the NGO whose foundation was laid in Nigeria.
The international staff were a mixed bunch: an Indian, a Pakistani, a Liberian, a Congolese, a Brazillian, a Japanese, a Kiwi, a couple of Aussies, a Somali, and a Chilean born Italian obstetrician and gynaecologist who used to live in Australia but now lives in London – Dr Carlos Pilasi.
Carlos and I were in Jahun for two weeks to film as many emergency obstetric surgeries as we could.
Our aim was to produce a series of training videos to help equip and prepare MSF surgeons going to any project where emergency obstetric surgery is likely to happen.
Why we filmed obstetric surgeries
The rationale is simple: a lack of adequate and affordable healthcare means women do not seek or have access to antenatal care during pregnancy. The result is that obstetric cases seen in places like Jahun are rarely seen in the west.
Validating our project was one recently retired obstetrician and gynaecologist who remarked that he had worked his entire career and never seen what he had in his few weeks in Jahun.
"The more prepared our obstetricians and gynaecologists can be - the more they know what they will encounter, the more familiar they are with correct procedures, and the more they understand the resource limitations - the better."
And that underpinned our purpose: the more prepared our obstetricians and gynaecologists can be—the more they know what they will encounter, the more familiar they are with correct procedures, and the more they understand the resource limitations—the better.
Jahun was chosen because the project exists purely for obstetric care. With more than 1,000 admissions every month we knew we would capture a significant number and variety of cases.
What we recorded
By the end of our two weeks, we had filmed 21 emergency and life-saving obstetric surgeries.
Those cases included eclampsia, ruptured uteruses, obstructed labour, retained placentas, placenta abruption, peritonitis, molar pregnancies, prolapse, vesicovaginal fistula (VVF) and the list goes on.
Every case was similar yet surgically different. But unfortunately some outcomes were inevitable – there were women whose lives were saved but who would never fall pregnant again.
And there were those whose lives would be at a significant risk if they did.
And every day there were stillbirths or newborns that never made it past their first few moments.
Jahun can be a tragic and horrifying place.
Yet paradoxically the nickname for Jahun is ‘Paradise’ because it exists as a quiet haven amidst a country caught in continuous conflict.
“Welcome to Jahun Paradise”, I heard time and again.
It was a name I had an increasingly difficult time reconciling to what I was filming.
Yet it is to this ‘paradise’ that so many women choose to travel.
"People trust what we give them, they trust our management, and they know that Médecins Sans Frontières adheres to international standards.”
They do so for two significant reasons: “They know they can get free healthcare,” Samuel Uduma, the Operating Theatre Supervisor told me. “Secondly, they trust what we give them, they trust our management, and they know that Médecins Sans Frontières adheres to international standards.”
Unity Sylvester, the VVF Supervisor agrees. “They come here because most of them are not very well-to-do,” she said, understating the intense poverty of the region. “And they get testimonies from others that we really give them care – maximum care – more than they could get from any other facility in the country.
"So instead of going to nearby hospitals where they will pay money and get less attention, they prefer to come here.”
And come they do, from as far away as the capital Abuja to the south, or crossing over from conflict-ridden Borno state to the east, Kano state to the west or from neighbouring countries like Niger to the north.
So as conflict continues amid the ever-present threat and uncertainty of Boko Haram; and as a desperate malnutrition crisis unfolds; and as Nigeria’s health system struggles under intense need and financial hardship, it is little wonder that our project in Jahun seems like paradise.