Less than hundred metres away, a new mother and her baby lie on a single threadbare mattress placed on an old spring frame, covered only by an old wrapper each; the intravenous cannula hooked to the infant’s wrist dangles from a rafter in the ceiling just above the bed.
The entire facility has no electricity, no pipe borne water, no fans, no beds, no doctors or nurses; just a midwife, a couple of extension workers and their purebred optimism. The deserted general ward, home to bed frames with old mats and a roof with no ceiling boards can readily pass for the attic of a haunted house.
The sorry state of facilities like this and healthcare in general in many parts of northern Nigeria come to the fore during periodic outbreaks of neglected tropical diseases. This has been the case in Zamfara where cases of cerebrospinal meningitis (CSM), the inflammation of tissue surrounding the brain and spinal cord due to viral or bacterial infections, has been on the rise again.
The Nigeria Centre for Disease Control (NCDC) stated that the recent outbreak which began in Zamfara in November 2016 had reached ‘epidemic proportions’ in five states including Zamfara. As at last week, the national death toll had surpassed 800 according to Prof. Isaac Adewole, the Nigerian health minister, who also ordered a house-to-house search for vaccination and control.
As at April 1, at least 1.3 million vaccines had been donated to and disbursed by the federal government, 500,000 of which were provided by World Health Organization (WHO), according to the minister.
But while federal might is coming through with intervention for the plagued states with assistance from the NCDC, the WHO, the United Nations Children’s Fund, DFID Maternal Newborn and Child Health Programme and Medecins Sans Frontieres, things are far from good on the local front.
For a state with 3.2 million people according to the 2006 national census, there are reportedly only 30 doctors in the employ of the state, with less than five deployed outside Gusau, the state capital. No recruitment exercise has happened in half a dozen years, say civil servants in the state.
“The governor does not take these things seriously,” said a senior official at a private agency working in development across the state who declined to be named.
F is for Fornication, F is for Fatality
As one of the group of countries within Sub-Saharan Africa that lie along the meningitis belt, Nigeria has had a troubled history with the disease, especially in the dry season.
Meningitis is mainly spread through kisses, sneezes and coughs, especially in rural areas. But Abdulazeez Yari, governor of Zamfara state which has some of the poorest citizens in the country and a high rate of susceptibility during these outbreaks, has a different theory.
“What we used to know as far as meningitis is concerned is the Type A virus,” he said in a recent interview. “The World Health Organization has carried out vaccinations against this Type A virus, not just in Zamfara, but in many other states. However, because people refused to stop their nefarious activities, God now decided to send Type C virus, which has no vaccination. People have turned away from God and he has promised that ‘if you do anyhow, you see anyhow.’ That is just the cause of this outbreak, as far as I am concerned. There is no way fornication will be so rampant and God will not send a disease that cannot be cured.”
The cure, he insisted, was Nigerians repenting from their sinful way of life. After engaging in a war of words with Sanusi Lamido Sanusi, the Emir of Kano who publicly slung a verbal shot in the former’s direction at a public function, the governor was forced to eat his words and eventually setup a committee on the outbreak of the disease, headed by the secretary to the state government, Prof. Abdullahi Shinkafi. This committee reportedly received N50 million from Yari and N3 million from each of the 14 local government councils in the state – a representative for the government declined to comment.
“It was a very serious outbreak in Zamfara as the state recorded the highest number of cases and also the highest number of deaths in the whole of the affected states”, says Dr. Bature Mannir, secretary of the Zamfara state chapter of the Nigerian Medical Association (NMA). “Initially the response from the state government was not appropriate in terms of assembling appropriate teams to tackle the situation. However the constitution of a technical committee comprising of relevant stakeholders yielded and is still yielding a very good result as the number of cases have drastically reduced with very few deaths as a result of effective case management.”
A visit to healthcare facilities across the state however shows that a lot of work still needs to be done. Life expectancy in the state is put at 52 for men and 57 for women and various reports suggest that only about 30-35% of the population have any form of access to medical aid. Worse still, the Maternal Mortality Rate in Zamfara State is 1,049 deaths per 100,000 live births, almost double the national average of 576 deaths per 100, 000 live births.
Little wonder then that cerebrospinal meningitis is a familiar visitor every year.
The Hospitals from Hades
“In six years, not even a bedsheet has been allocated to this hospital, talk more of equipment”, discloses Dr. Talatu Tsafe, Principal Medical Officer at King Fahad Ibn Abdul-Azeez Women & Children Hospital, a secondary healthcare facility in Gusau which has no working ambulance. “The bed capacity is for 70 people but we have about 200 patients here every day.”
His allocation for total monthly expenditure is a meagre N1 million, from which he draws to buy office supplies, pays the salaries of interns and serving corpers deployed from the National Youth Service Corps (NYSC). “All our complaints for more money are in vain so I have to use from my pocket and some small profits from the hospital to fix things.” One of the recently fixed ‘things’ is a repainted wing, standing out from the other dilapidated buildings with missing ceiling boards like a shiny refurbished toy in a refuse dump. In the back, the uncompleted maternity ward, abandoned by the contractor after being paid no monies whatsoever, stands as a reminder that a contract was awarded for it eight years ago. “You can see that it has been constructed up to roofing level”, Tsafe points. “If the contractor was paid even half of what he was being owed, maybe he would have had the heart to just complete it.”
Across town at the state general hospital where there are more rundown vehicles than doctors, things are not so different. Caked blood dribbles down some of the walls; toilets have been converted to stores for the relatives of the patients who cook as well as sleep with most of their belongings in the open courtyard at the mercy of mosquitoes. The air is stale – a mixture of soot and disinfectant.
Still, it is paradise compared to the healthcare centre in Yakofoji, an hour’s drive north of Gusau. The only standing building is a bungalow with two offices, a store with stacks of threadbare mattresses and a tiny kitchen. Outside, half a dozen meningitis patients lie on mats on the floor under a makeshift ward made of bamboo and raffia palm, with drips hanging from the roof. In the ruins of an adjoining building, with large visible cracks running from top to bottom, two more patients lie.
The first case of CSM was reported here in March and since then there have been about 30 deaths from over 350 other cases, with patients made to sit on chairs or lie under the scorching 45-degree sun given the overflow. “Doctors Without Borders come here regularly,” says Bala, a 52-year old extension worker. “They come once or twice a week and treat them,” he points at the six sick under the raffia palm. “But we get no drugs from government.”
Early in April before a new round of vaccines and drugs came through to the centre, he watched helplessly as his neighbour’s ten year old son died of meningitis. “What sin did that boy commit? Is it not the sins of our government we are paying for?”
*Many of the names in this story have been changed.
[Reporting and photographs by Eromo Egbejule; Editing by Stanley Azuakola. Please credit Machaha (machaha.com), a Gatefield Impact, social change project focused on the Sustainable Development Goals]
