David Irabor
Oyo State, Nigeria

The aim of a surgeon is to ameliorate the conditions of patients with the skills you have learned. Since surgery is a science involving aspects of the patient’s anatomy, physiology, and pathology, morbidity and mortality in most patients can be explained scientifically.

What many of us are not trained for are post-operative developments that are surprising, if not shocking. In Nigeria, these developments are grouped under the umbrella of “visitation from the village” or “Juju.” This explanation is one that many trained surgeons outside Nigeria may never believe, but for those in the country, personal experiences may grudgingly make a surgeon accept this macabre diagnosis.

“Juju” is a spiritual belief system related to traditional West African religions that incorporates objects such as amulets and spells as part of witchcraft.¹ This practice cuts across all social strata, and level of education is not an obstacle to the deep-rooted belief in Juju in Nigeria.²

What is the role of Juju in the practice of surgery?

Settling domestic matters

I had just qualified as a doctor in 1985 and worked as a medical officer in a private hospital that catered to the affluent in society. A middle-aged woman had been admitted for adhesive small bowel obstruction and was treated with nasogastric (NG) tube drainage, intravenous fluids, and antibiotics. She was not doing well at all; there was no drainage from her NG tube and the abdominal distension and pain persisted. The attending surgeon told me to replace the NG tube, thinking it was probably blocked with debris in the stomach. I tried to remove the tube but it was stuck, so I called for help. A senior person tried and had the same result. A lot of force was then applied, giving the poor patient serious pain and a bloody nose before the tube came out, revealing a knot 6 centimeters from the tip! At the time this seemed totally unimaginable, but later in residency I read published reports about such occurrences.³ The next day the patient suffered a massive pulmonary embolism and died. We later found out that there had been serious disagreements between the woman and her millionaire husband, who wanted to take a second wife. He married this other woman a month after our unfortunate patient was buried. Make of this what you will, but those who claimed to know opined that our patient was never expected to leave the hospital alive.

Bizarre, unexplainable or strange event

I started my residency training in surgery in 1989 and in time was promoted to senior registrar, which meant that I was leader in most surgical cases and not first assistant anymore. We had an emergency case one night of an herbalist (native doctor) who had a perforated duodenal ulcer. During surgery, we found a discrete, pale egg-shaped mass about 4 by 6 cm, free of any attachment, which we removed. After we had closed the abdomen, we waited for the anesthetist to reverse the anesthesia and extubate the patient. After nearly an hour of trying, the patient was not coming round and the poor anesthetist was beginning to panic. The scrub nurse, who was middle-aged and wise said (I can never forget those words), “Give him his egg back.” Fortunately, we were still scrubbed up, so I reopened his abdomen and put the “egg” back inside his peritoneal cavity, re-did the abdominal wound closure, and waited. The patient woke up within three minutes. Coincidence? Maybe, maybe not. In 1991 there were no digital cameras or smartphones, so this could not be recorded. Only much later after checking the literature did I come across publications reporting loose intraperitoneal bodies which are said to be very rare.⁴ The patient survived and was discharged after two weeks, but the general consensus was that the egg was the source of his powers as a witch doctor.

Collateral damage, in the sense that because of a need for a blood sacrifice, the unlucky patient happened to pick the wrong day and hospital for a surgical operation

I completed my residency training in 1994 and began work as a surgeon at a big private hospital. I had settled in nicely, doing what I do best. However I noticed a few unexplained deaths where complete recovery and return to health had been expected. I observed that these occurred only when a particular staff nurse was on duty, so in order to test my suspicions I arranged with the theatre sister to do my operations at 6am in the mornings instead of the statutory 9am, and also on weekends when this person was not on duty. We had no more deaths. The amazing thing was she knew that I knew and made these changes because of her. Subsequently she gave me a lot of respect, thinking I also had supernatural powers.

The surgeon could be the target to damage his/her reputation

This happens mostly to popular surgeons who unbeknownst to them have made enemies solely because of their popularity. We have a saying in the University College Hospital Ibadan that is popular among surgeons and anesthetists called “Member of Staff Syndrome (MOSS),” whereby you expect that something will go wrong when you operate on a fellow doctor, doctor’s spouse or child, senior hospital administrator, or a professor from the university. This is when your enemies can strike at you, the surgeon, because such high-profile cases make headlines when things go wrong. And they almost always will go wrong.

Date with destiny

For this group of patients, you get to know the real story much later. They are the ones who join a cult or take an oath in order to make them wealthy and affluent in society. But these come at a price, which is usually a shortened lifespan. When the time is near they develop serious surgical diseases like cancer and start looking for surgeons to help them, knowing full well that their time is up.⁵ Thus whatever you do they end up having complications until they eventually die. Only those in the know will relay this to you.

One may reason that all of this may be coincidence, competency issues by surgeons or anesthetists, or just pure dramatization. But, supernatural forces do not have to invent fantastic events; they just accentuate already known causes of post-operative complications. One should realize the deep involvement of West Africans in supernatural or cosmological traditional concepts, which pervades all spheres of society and still remains a necessary component of society.⁶ Thus its spread into medicine and surgery should be understood and accommodated and not be viewed superciliously⁷. Awareness and discernment may help reduce visitations from the “Village.”

References

1. Juju. Wikipedia. https:///en.wikipedia.org/wiki/Juju Accessed December 2017.
2. Ogunniyi MB. Conceptions of traditional cosmological ideas among literate and non-literate Nigerians. Journal of Research in Science Teaching 1987, 24, 107.
3. Dasani B, Sahder P. Knotting of a naso-gastric tube: a case report. American Journal of Emergency Medicine 1991, 9, 565.
4. Sewkani A, Jain A, Maudar KK, Varshey S. “Boiled egg” in the peritoneal cavity – a giant loose body in a 64 year-old man: a case report. Journal of Medical Case Reports 2011, 5, 297.
5. Olaoba OB. Between Juju and justice. An examination of extra-legal devices in traditional Yoruba society. Africana Marburgensia 1997, 30, 24.
6. Nwolise OBC. Spiritual dimension of human and national security. Eighteenth Faculty Lecture Series, Faculty of the Social Sciences, University of Ibadan, April 26 2012.
7. Irabor DO. Under-reporting of Gossypiboma in a Third-World Country: a sociocultural view. Nigerian Journal of Medicine 2013, 22, 365.