Incidence of medical misdiagnosis that has been occurring in Nigeria in recent times will be significantly minimised if up-todate diagnositic and treatment skills, modern medical equipment and cutting-edge medical diagnostic procedures and technology, were available and appropriately utilisation in the nation's specialist and tertiary health institutions.

Dr. Emmanuel Kalu, Consultant Obstetrician/ Gynaecologist and Sub-specialist in Reproductive Gynaecology and Minimal Access Surgery at the Queen Mary's University Hospital, Roe Hampton Lane, London, observed during the Nordica Lagos Hysteroscopy workshop for doctors recently at the Lagos State University Teaching Hospital (LASUTH) described minimal access surgery as the "future" in Nigeria.

Kalu, who was a facilitator during the activity, said the Nordica Lagos recognised the essence of skills upgrading for medical doctors, hence it was committed to bringing in appropriate skills and equipment from abroad with the aim of improving skills and competences on the local front.

"I can tell you the problem of medical misdiagnosis will be significantly reduced with this type of cutting edge technology. Minimal access surgery is 21st century technology. This type of surgery has made large hole surgeries moribound as many surgeries can now be done successfuilly through a pin hole. Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus to visualise the inside of the uterine cavity on a video monitor.

"For instance, carrying out a D & C as a line procedure would be a challenge, but with the new technology coupled with the updated skills, line procedures aare no more in vogue. With equipment such as the hysteroscope, there is a camera that is inserted and displays an image on the screen for all to see."

He noted that even the patient can see what is going happening on the TV monitor if on local anesthestic, if not, the patient can still go home with a dvd copy of the process that can be presented to any other physician who can play it back as part of the patient's diagnostic history.

"Public tertiary health institutions need to be able to offer minimal access surgery by obtaining the kind of equipment and trained personnel private hospitals such as Nordica Lagos is bringing in. The facility (Nordica Lagos) has the foresight to transfer this technology which we have been familiar with overseas.

In his view, hysteroscopy is desirous in Nigeria because Nigerian patients are deserving of 21st century technology. He said there are many Nigerians abroad with skills comparable to that which is applicable anywhere in the world, and that it is high time they returned home to train local doctors for the sake of the patients.

"I'm here because of my patriotism, but to bring me back permanently will require a degree of motivation and the right environment in which I can work. I'd be making the same amount of money I'm making in London if I came back, but because of the bureaucracy and the gaps in this environment it would be quite a huge challenge. "Things have actually changed for the better, but we need to make the environment better than it is currently, so as to encourage more Nigerian specialists to return home from abroad."

Also speaking, Medical Director, Nordica Lagos Dr. Abayomi Ajayi, lamented the below par status of the nation's medical industry. "It is not impossible for the Nigerian environment to be amongst the best, but it's a tough challenge. Any organisation with good leadership and focus would achieve it. We have the resources in terms of human and financial resource.

"We have seen that the problem is not with the equipment being available but rather with the unavailability of capacity management hence the need to train doctors in this regard. It's actually about good governance. I believe that if the leadership is focused and wants to transform the system, it can be done. But there must be a focus. I think it's about time our public healthcare system woke up to the fact that we need to invest in health care infrastructure and equipment."

There is a big need for hysteroscopy in the Nigerian environment in that there arre so many procedures we carry out right now such as open surgery that can be achieved by minimal access. Many hysterectomies are avoidable and also the treatment of infertility can be better managed. We can see that the indications are present in the environment but the equipment is very rarely used.

"When a woman's uterus begins to develop problems,. It can be removed, but with the aid of this approach, the doctor can look inside to see if there is cancer and can also treat without necessarily requiring removing the uterus. It is also less invasive and less incapitating."

The training which is first in series is expected to be held quarterly so that there can be in-training doctors to utilise the equipment.