Memories of my Elective Medical Posting in Ibadan, Nigeria
By: Mr. John Buckels, MB ChB, FRCS (Eng), MD, CBE
October 22, 2025
Mr. John Buckels, MB ChB, FRCS(Eng), MD, CBE
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Before the start of the final (fifth) year at my Medical School, Birmingham University Medical School, students were allowed to undertake an elective for 10 weeks in any branch of medicine which interested us. A lot of students went to Australia, and I suspect if I had done this I would have gone there soon after graduation and stayed so that my life would have been very different.
However, a lecture I attended was to have a major influence on my later career. An orthopaedic surgeon, Richard Batten (or Billy Batten as he was affectionately known), gave a talk in which he described his time working at a new hospital and Medical School in Ibadan, Nigeria during the 1950’s.
When they gained independence, at the end of colonialisation, most African sub-Saharan countries did not have universities, let alone medical schools. In order to open new hospitals and medical schools, they needed to import overseas staff, so this surgeon had gone to Ibadan in Southwestern Nigeria to teach and work. As there was a supporting link with University College Hospital (UCH) in London, it was known as University College Hospital, (UCH) Ibadan.
Front view of part of the central wing of the University College Hospital, Ibadan, Nigeria as it looked during my visit in 1971.
In his lecture the orthopaedic surgeon described a young boy who was admitted with severe tetanus and was more than likely to die. The new hospital did not yet have ventilators but did have anaesthetic drugs, face masks and airways.
The surgeon organised the medical students into teams who were shown how to hand ventilate the anaesthetised young boy round the clock. I cannot remember how long the students did this for, but the boy survived and I thought that’s just the sort of place I should do my elective.
After the lecture I went up and asked the surgeon if he still had contacts in Ibadan. The surgeon did and gave contact details for the Professor of surgery there, Professor Victor Anomah Ngu. I wrote to him requesting if I could do my elective there with him and was subsequently accepted. Ibadan was the first university in Nigeria and at that time Ibadan was the most populous city in West Africa.
Working things out
The problem was how to get there. My medical school did have scholarships to help fund elective students. I went and saw the elective tutor (whose name I won’t mention) to ask about how the recipients were selected. The answer was quite simple “When a student goes on their elective, the staff there will look at them and if they seem good, they will say that our Medical School must be good”. I didn’t bother applying. The only other thing the tutor said was that I needed to do a research project whilst I was away, I thought that the tutor believed I was going just to have a holiday.
I had heard from my mother that a Liverpool shipping company, Elder Dempster Lines, sailed regularly to Nigeria. Elder Dempster was the most active shipping company serving the West African area at that time. The Pidgin English Bible was written specifically for Nigerians. In the biblical flood, described in the pidgin version of Genesis, it reads “and Noah built an ark like dem dose Elder Dempster ships”. I phoned the company and was able to arrange an interview with the shipping company’s medical officer. I then hitchhiked up to Liverpool, borrowed my brother’s suit and went for the interview. I was expecting to be grilled a little but all I was asked was when did I want to go?
There was then an issue that needed to be resolved. The elective period was 10 weeks long, but it was going to take about 10 days to get there on the way to Lagos (which was then the Nigerian capital), and 10 days back, quite a big chunk out of a 10-week elective).
My first assignment on my return, which was the start of my final year, was surgery, so I went and asked our Professor of Surgery, Alphonsus Ligouri d’Abreu – or Pon d’Abreu as he was better known, if I could do my final year posting in Ibadan.
He kindly gave me permission to do so as long as I was back for the last Friday of that period to take the exam. He also suggested that on my return that I go back and see him to tell him how I got on.
My contract on the boat was as a “Supernumerary” with a wage of a shilling a month (I never got the shilling). On the trip out on a boat called “Fulani”, after a Nigerian ethnic group of nomadic cattle herders, I was asked by the captain to look at engine room conditions, duly checked temperatures, humidity and general safety issues which I then wrote up for the captain. I even did a bit of minor surgery on the voyage out as one of the crew had a nasty cut on his hand that needed suturing. I was able to spend a lot of time on the bridge of the ship, and vividly remember seeing the lights of Dakar, Senegal to our east.
This had resonance for me as a fellow university student, who enrolled the year after me, had spent a year there doing VSO - Voluntary Service Overseas. Over time he became one of my closest friends. His parents, an English father and a German mother had met late on in the war. They found living in either of these countries problematic at that time so they settled in France. As a result, their son was trilingual. His stories about his time in Senegal certainly reinforced my wish to do my elective in Africa.
The chap was a very charismatic person becoming very popular, especially with the female students. After university he had at one time decided to become a potter and was certainly very skilled at this. I still have an attractive large ceramic platter which we still use on special occasions.
As a family on one occasion, we were able to visit him in the Ardeche when we were on the way back from a camping holiday on the Mediterranean coast near the French/Spanish border. He was in good form and managed to get us to eat an array of offal that he barbequed. Sadly, in his later life he spent too much time smoking weed and drinking, dying at an early age, never having used his talents to the full. His father had died in a car accident which I had been told was also related to drinking.
To return to my first African trip, there were stops on both the voyages out and back in Ghana. In Tema I disembarked and had a short walk on a nearby beach so I could add it to the countries I had visited.
The products dropped off there were mainly vehicles such as tractors and Land Rovers. On the return journey the boat picked up a lot of palm oil in Takoradi. This was an important product for the UK as it was a major constituent of soap made by the Lever Brothers in the 19th century and it is still used today.
Lever Brothers had a factory in Port Sunlight in the Wirral peninsula where Sunlight soap was and is still manufactured. This soap was the world’s first packaged, branded laundry soap. The boat on the return journey was the HMS Falaba. This was somewhat different with a rather grumpy captain having me paint the deck with red-lead paint. Nevertheless, the rest of the crew were a friendly bunch, and I did spend some of my free time again on the bridge picking up more navigation tips as I had done on the voyage out. These would help me much later in my life when I did my Southern Ocean trip.
My time in Nigeria was remarkable. Elder Dempster kindly paid for a flight from Lagos to Ibadan airport, which was little more than an airstrip. As we were landing, there were a group of Fulani tribesmen herding their cattle down the runway just ahead of us. The Nigerian airways emblem at that time was a flying elephant that was visible on the tail wing! Once landed, the tiny airport building had an office and the staff kindly phoned UCH. Professor, Victor Ngu came and picked me up in a Volkswagen Beetle which had “Burkitt Tumour Project” written on the side, so I knew that I had arrived.
Denis Burkitt, the surgeon whose Professor Ngu’s project was named after, was a remarkable man from Northern Ireland who became famous for two separate major contributions to medical science.
He had qualified in medicine at Dublin University in 1935. After serving in the Royal Army Medical Corps in World War 2 in Kenya and Somaliland he went to work in Uganda. There he noted a high number of children with rapidly growing and grossly deforming facial tumours.
Biopsies of these when studied under the microscope showed that the malignant cells somewhat resembled the lymphocyte cells seen in normal blood, suggesting a type of tumour known as a lymphoma. He then contacted other hospitals around Africa to try and work out the distribution of these cases and found they were within a wide belt of land with similar temperature and rainfall.
It later emerged that in this area malaria was endemic suggesting that perhaps this might be affecting their immune systems. He attracted the interest of a virologist, Tony Epstein, who also was suspicious that perhaps a virus might be causing the immune suppression, leading to the tumours.
It took another three years before a previously unknown virus, later known as the Epstein Barr Virus, EBV, was identified This was only possible using electron microscopy, this being unprecedented that such an agent was identified in this way. It was also the first-time demonstration of a malignancy being caused by a virus.
Epstein’s co-worker was an Irish virologist, Yvonne Barr, who was his doctoral student at the Middlesex Hospital when they made the breakthrough discovery. So, it was only appropriate that the virus was called “Epstein-Barr”, and the tumour, “Burkitt Lymphoma”. What was particularly special about these tumours was that the vast majority of cases would respond to and often be cured with a relatively simple chemotherapy regime.
Remarkably Denis Burkitt was to make another major contribution to medical science. He noted that colon cancer had lower rates in societies that had high fibre diets. He did a number of studies on transit times of food (not a pleasant study to undertake!). This found that the rapid transit time of a young African male on a high fibre diet was much quicker than that of the average schoolboy in the UK. This led him to postulate that high fibre diets were healthier which was soon accepted worldwide.
Interestingly I was privileged to meet him as Burkitt visited Ibadan whilst I was there, and I walked round the hospital campus with Professor Ngu, Denis and a small entourage. Denis was certainly the most famous person I had ever met, apart from the Queen.
Finally, it is worth quoting Denis from later on in his life. He had lost an eye in an accident as a young child and once wrote “God enabled me with my one eye to see things which my predecessors had missed with two”. This reminded me of a Surgical Senior Registrar I had once worked with who also had lost the sight in one eye. Not only was he a very skilled surgeon he was an excellent snooker player, and yes, at that time there was a snooker table in the doctors’ mess. With the longer hours worked then nearly all junior doctors actually lived in the hospital, the “doctors’ mess”, free of charge of course!
My accommodation in Ibadan was in a student’s hostel, the Alexander Brown Hostel, right next to the hospital. For part of the time, I shared a room with a local student, but the student then went off to Johns Hopkins in the USA to do his own elective on a neurological topic. He obviously stuck with this as with the help of the internet, I found that the former student was an expert neurologist in the USA and was able to look him up and even organise a Zoom call many years later.
Prof Ngu was very kind to me and used to let me sit in the Consultants Coffee Room each morning in addition to letting me join all the ward rounds, theatre sessions and out-patients. The tumour clinic he ran saw cases with the most advanced and often most disfiguring conditions such that patients would sometimes attend with towels wrapped around their heads.
He treated many with oral chemotherapy drugs taken as outpatients. I can remember one case who had a form of lymphoma with massive swelling around her neck and the therapy caused terrible ulceration as the tumour necrosed as a result of the chemotherapy.
There was a young Asian surgeon, Saleem Khwaja, working there, who was also very supportive, and I spent many instructive hours with him at the operating table. This surgeon eventually became a professor in the UK and since his death there is a Memorial Fellowship in his name given by the British Association of Paediatric Surgeons, I am only sorry I had not tried to follow the surgeon up after I left Ibadan.
I made two excursions from Ibadan. One was to the famous Wesley Guild Hospital in Ilesha which was about 100 kilometres from Ibadan. This was a Methodist Mission Hospital run by another remarkable man, Dr. Andrew Pearson. He had been born in China and studied medicine in Liverpool. On graduating he went back to China where he developed an interest in leprosy. At that time China was not an easy place to raise a family, so he moved to the missionary hospital in Ilesha.
Dr. Pearson was a deeply religious man and even prayed with his patients. In Ilesha he provided a full medical service to the local community. An early colleague had been a young doctor who went on to become a pioneering paediatrician, Dr David C. Morely. One of his greatest contributions was the development of an “Under 5’s Clinic”.
Mothers were encouraged to bring their younger children to the clinic to be examined, and in particular, had both their weight and height measured. The results were charted in a “Growth and Weight” chart that was protected by a polythene envelope, the charts being provided by one of the largest manufacturers of baby food, ironic really as the clinic was pushing “breast is best”!
The chart was given to the mothers for safekeeping, a clever idea as much less likely to be misplaced. Those failing to thrive were given food supplements, usually beans, and the Under 5 Clinic was very active during my visit. This simple strategy undoubtedly saved countless lives as it was subsequently adopted at many other sites, not just in Africa but in many of the poorer countries around the world.
Much later on in my consultant career I was responsible for organising yearly educational meetings for the consultant staff at the Queen Elizabeth Hospital, Birmingham where I worked. I was pleased that Dr Pearson accepted my invitation to come and give a lecture on his work in Africa at one of these events. Another person who was asked to come and entertain us was a famous comedian who lived locally. His daughter had undergone a successful renal transplant at the hospital, but disappointingly he turned the invitation down.
The other significant trip I made when I was in Nigeria was when I hitchhiked up to Kano in the north. I had heard there was a remarkable market there, and being just at the edge of the Sahara had a wide range of products from both north and south that were remarkably cheap and very popular with the expat community.
To start my journey north I was recommended to go to the distribution site in Ibadan for the New Nigerian newspaper very early in the morning where there would be a van that would take copies of the newspaper further north. It would also take a few passengers, no money was involved, and my first thought was that the driver wanted company for what would inevitably be a long drive.
It all started well as I was put in the front passenger seat. This was only for a short time until the driver pulled into a nearby garage when I was displaced into the back of the van by someone else who was either a friend or someone willing to pay. I was taken as far as Ilorin and after that it was hitching more rides. The people on route were remarkably generous, and I was put up in houses where on one occasion I thought the family had given me the marital bed. Bathroom ventures were a challenge, merely going outside.
On the way I stopped in Kaduna and visited the hospital there, introducing myself as a medical student. One of the paediatric wards was almost full of cases of Cancrum Oris, a flesh-eating type of disease that affects the face and causes severe deformity as well as difficulty with eating.
Reconstructive surgery for such cases would require a very skilled surgical team which was not available at that time locally. These days we see adverts asking for donations by a team who primarily deal with cleft lips and palates, but the same charities also helped these children. Cancrum Oris is also known as Noma, not to be confused with the famous restaurant with the same name.
I then hitchhiked on to Zaria and eventually to Kano with its famous market. I had been told by a group of American Peace Corp workers that it would be worth getting a Fulani blanket which is made of sheep’s wool. This required a bit of bargaining, and I also bought a Fulani shirt that I would have to admit that I’ve never worn.
The Fulani blanket I purchased in Kano market, Niorthern Nigeria in1971. Ckick on image to enlarge.
On the way I had met some Fulani women who clearly wanted to chat, albeit in a language I couldn’t understand. Several of them wore agate necklaces which must have been a challenge to afford and are probably worn as status symbols.
My other significant purchases in Nigeria were wooden statues, made from Iroko wood. These were carved by a very skilled Yoruba craftsman, Gani Fakeye. Fakeye lived in Ibadan, and I was able to go to his workshop and make my selection. I chose two, a “flute player” and a woman holding a casket whose breasts were exposed and jutted out somewhat in front of her. This latter statue was bought as a gift for my maternal grandmother who definitely wasn’t at all impressed with the nudity of the statue and it was eventually returned to me after her death. I had never understood why the term “passed” is used when people die. I suppose it just means “passed on” but just used by itself makes me wonder “what did they pass” – maybe wind?
Nigerian wood carvings bought in Ibadan, 1971. Sculptor: Gani Fakeye. Click on image to enlarge.
It is worth noting that my journey up in Northern Nigeria was barely one year after the end of the Biafran war but nobody I spoke to suggested it was unsafe.
The Biafran war was a real tragedy for Nigeria which like many African countries was a casualty of the actions by the European powers when they cut up Africa like a cake at the Conference of Berlin which took place between 1884 and 1885. The resulting map that was drawn created new countries which mixed together differing ethnic groups, people who spoke different languages, had different religions and ate different food yet were expected to just “get on with it”. Within the area designated as Nigeria there were three different major ethnic groups, the Yoruba in the west, the Hausa Fulani in the north and the Igbo in the south east.
The war started when the Igbo people living in the south east wanted independence from the rest of the country. It is estimated that up to two million people died, not so many from fighting but mostly from famine and disease.
Newspapers all round the world carried photos of the starving children. They were suffering from protein-calorie malnutrition, a condition now known as Kwashiorkor. This was a Ghanaian word meaning “deposed one” – roughly translated as “the sickness the baby gets when the new baby comes”. The disease occurs as a result of a diet that is carbohydrate based but lacking in protein. The Nigerian government’s response had been to prevent food reaching the people of Biafra. The UK supported the Nigerian governments’ actions for which it should still be ashamed.
One of the issues that no doubt influenced the UK government’s decision was that there were considerable oil reserves in the river Niger delta which was located exactly where the Igbo people wanted to set up their independent state. The oil was being extracted by two British companies, Shell and BP, so support for the Nigerian government was clearly in the interest of two major UK firms.
An exceptional French doctor, Dr Bernard Kouchner, highlighted what was going on in Biafra - remarkable that it was a Frenchman rather than an Englishman who acted. Dr Kouchner was critical of the complicit behaviour also of both the French government and the Red Cross and started a new medical humanitarian organisation, Medecins San Frontieres (MSF), for which I would later work. This doctor had been born in Avignon; his paternal grandparents were Russian born Jews who escaped the pogroms by immigrating to France but perished decades later in Auschwitz. After the Biafran war an effective peace followed which seems surprising given the scale of the atrocities which had occurred.
Returning to the elective tutor’s instruction to do a research project I found out that the Professor of Pathology in Ibadan at the time, Professor Olufemi Williams was active in research. When I went to see him to ask if I could be involved in a project, Professor Williams only had to turn his head to look at the wall behind his desk as there was a long list of planned research studies.
I was allocated one, which was taking blood samples and doing a test to detect “Australia Antigen”. This was studying different local populations which included the Nigerian Armed Forces, school children and pregnant women. I was allocated to take blood samples from Nigerian soldiers. Armed, not necessarily the best word to use, with needles, syringes and test tubes I entered a barracks room in which the men were already assembled.
Obviously, Professor Williams had cleared all this with the army medics in advance. As soon as the soldiers worked out what I was planning to do, several left the room, some even through the windows – I even remember the Sergeant shouting “Come back Tumba Terry”. Nevertheless, I had plenty of samples to test and between the different groups we had enough data to submit a paper to an American Journal that was subsequently accepted.
Australia Antigen was of interest as it was an antigen first found in the blood of an Australian aborigine that reacted with an antibody of a patient with haemophilia.
Haemophiliacs inevitably have a lot of transfusions of the clotting factor they are missing, now known as Factor VIII, as the cells in their own bone marrow are unable to make it, which is why they are haemophiliacs! Whenever they have an injury, even a minor one, they will bleed but this will be limited if they can be given Factor VIII. As a result of these transfusions many haemophiliacs later developed liver disease. With Australian antigen later being identified as a virus that can infect the liver, the virus is now universally known as Hepatitis B.
This was a particular issue in the UK at the time as it was importing Factor VIII from donors in the USA. The problem was that they were being paid to donate, and many were drug addicts who already had the virus due to sharing needles and were happy to earn money relatively easily. Compensation to the victims in the UK was significantly delayed and overall, this was handled very badly by successive governments, and there are still unresolved issues today.
The problem of contaminated blood was only resolved when donated blood and blood products were tested for Hepatitis B and other potentially infectious agents. It was perhaps remarkable that my first publication in a prestigious journal would predict my future surgical specialty, as well as satisfying the elective tutor. I also felt that I had made a useful contribution to knowledge on an important topic.
Sooner than I expected, my time in Nigeria was coming to an end, but my visa was due to run out just days before I was due to catch the boat back. This required a visit to a Nigerian government representative who proved to be rather pompous and wore traditional Nigerian clothes rather than western style which most of the government employees wore, but fortunately he extended the visa.
With all the things that I had bought it was just as well that I was travelling back by boat as it would have cost dearly to bring them back by plane. All this shopping sounds rather extravagant but everything there was remarkably cheap and affordable even on a student’s budget.
On the return voyage I got quite excited to glimpse Lands’ End and was told that I had “the channels” which is what the sailors called such a state of mind.
My visit to Nigeria left a marked impression on me and undoubtedly was a major factor in my retiring early and my many later trips to more countries in Africa.
Related source: Williams AO, Williams AIO, Buckels J, Smith JA, Francis TI. Carrier state prevalence of hepatitis associated antigen (AU/SH) in Nigeria. American Journal of Epidemiology, 1972;96(3)227 0230. https://doi.org/10.1093/oxfordjournals.aje.a121452
Published: October 22, 2025
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