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Tourists never make it this far, Makurdi has nothing to offer them. There are no beaches or monuments to be found in any travel guide. Makurdi is a small dot on the banks of the Benuente River, deep in the heart of Nigeria. A place where the journey is more one of departures, not arrivals, as the young head for a hoped-for better life in Europe.
Yet even in this forgotten corner of the world there are moments when hope blossoms this time thanks to a surgeon from Malaga. César Ramírez, 54, has just returned from another of his humanitarian missions to perform surgery on patients with no health cover, no suitable transport and the nearest hospital some seven or eight hours away.
Ramírez, head of general surgery at Hospital Quirón, travelled to Africa for the first time in 2016, fascinated by the vast land and its people. The state of healthcare frightened him: non-existent except for a very small elite. Most local doctors work in the main cities or overseas.
This latest mission began on 22 November with a multi-leg journey: Malaga, Paris, Abuja and then by winding road to Makurdi. Ramírez and his medical team already know what awaits them: mostly operating on hernias and removing goitres (thyroid troubles are prevalent in Africa leading to disfigurement if untreated).
In one week a total of 177 people will have passed through his healing hands. The youngest patient is barely a year old and the oldest is 79. In some patients the goitre is the size of two fists. Without intervention their fate is a short life as a social outcast.
Ramirez and his team go where public health does not exist due to lack of resources, working ten to 12-hour days, barely stopping for a meal. "We operate at a rate of 25 to 30 per day. We know that if not for us these people wouldn't receive the help they need," says Ramírez. This thought sustains him through operation fatigue.
There are times when Ramírez doesn't even know what day it is, but he stays focused on getting these patients seen to whilst the team is in Makurdi as he knows these patients will not be given a future date for these operations.
The logistics don't just stop being problematic with travelling to Africa, there is no functioning operating theatre in Makurdi, not even the means to administer a general anaesthetic. Ramírez and his team come to the rescue once more, bringing 45,000 euros worth of equipment and materials with them. The makeshift operating theatre could use a lick of paint and the ceiling looks dodgy, but the essentials - the tools for surgery - are guaranteed.
With the help of his own charitable foundation (Fundación César Ramírez Bisturí Solidario) all these resources stay at Bishop Murray Medical Centre in Nigeria. "This is another of our goals. Not only do we want to operate on people, but we also want to help train local doctors and provide them with equipment they don't have," says Ramírez, stressing that: "There are very good doctors here. They give what they can. But they lack everything. Medicines, equipment and machinery."
Talking to Ramírez is also an exercise in acquiring awareness of how big of an issue this is without falling into a pit of overwhelming helplessness for only being able to do so much. The waiting list for such a medical team is endless and the situation will not improve in the near future, if ever.
As Ramírez says: "We push our bodies to the limit, but there comes a time when we have to stop." That time usually comes at around 10pm. As much as he would like to, this surgeon recognises that he needs his head and hands capable of operating. "Every patient is a challenge and I set myself the same demands for results as I would in Spain."
The week is intense, redefining many aspects of life, including a simple thank-you. "Here the thanks are the expressions on the faces of the people," says this Malaga surgeon as he plans his next visit in his head.
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