One year after the establishment of a Primary Healthcare Centre in Agboyi community, Ketu in Lagos State, pregnant women and nursing mothers continue to patronise traditional birth attendants and have called on the state government to empower the birth attendants to provide better services, writes Rebecca Ejifoma
It was a Tuesday morning. Passengers waited at the creek to be ferried across by the rickety canoe to the other side of Agboyi, a community of about 30,000 dwellers. It has existed for over 500 years, but remains undeveloped.
During the ferry, it quickly became apparent that Agboyi faces a number of serious environmentally unfriendly issues. Although surrounded by water, there is no potable water. Dwellers – especially children – bathe in the murky waters. The stench appears to bother only visitors. Adequate sanitation is also lacking. Their water is the toilet, it is used for public bath and laundry.
There are no good health facilities on the Agboyi side, but just across the creek is a Primary Health Centre (PHC) with 24 hours operation and easy access, but most women in the community patronise Traditional Birth Attendants (TBAs).
One of such women is 33 years old Shakira Yakubu. She has no issues with her choice. Pregnant with her third child, Shakira told THISDAY about her trust for TBA. “I trust her with what she does. She is more experienced to me. I come to her any day and she attends to me.
“I don’t have any problem at all being delivered by the TBA. I am eight months pregnant with my third pregnancy. I collect my drugs and attend ante-natal at the PHC, but I also collect herbs from the TBA.
“I had my first two children here. The first thing the TBA does is to carry out a test on you to see if there is any complication. I like it here. She treats me well. Almost all the women here use her centre,” she expressed.
Barely 20, Kukoyo Islamist is also pregnant. “This place is good. The TBA treats me well. It is my first baby and I have been coming here since day one. I hope to have all my babies here.”
For her, it is the TBA or nothing. “My sister had her baby here and that is also why I come here. Even if I have money, I won’t go to the hospital. I am treated well here. So, I don’t need a hospital. I prefer here. This place is like home to me. I don’t have parents.”
When THISDAY visited the TBA home, there were two pregnant women there. The TBA, known as Nurat, was friendly and expressed passion over her calling – helping to bring life and joy to homes. Nurat considered herself well-trained as she shared her experience.
“I have been practicing for 25 years. I am available round the clock. Pregnant women can come in any time of the day and they will be attended to.”
Speaking in Yoruba, she explained that with just N2,000 for herbs and concoction preparation, the pregnant woman is good to go. The preparation would be taken for three months. “Other payment made is N200 on clinic day – Monday. After their delivery they pay N5000.”
Nurat said she utilises herbs to rectify some issues. “There are certain situations scan show that cannot be corrected with orthodox medicine but we (TBA) can correct. In some instances, the placenta comes before the baby and the hospitals will recommend Caesarean Section (CS) but with herbs, the placenta will return and bring the baby to the right place provided that the foetus is still between six and seven months in the womb.”
“I acquired my skills at a TBA at Bariga, Lagos. I attend programmes related to traditional birth attendants for more empowerment. I have taken delivery of many women whose children are already giving birth. Presently, I have over 200 women who have registered with me since 2016. I got my certificate from Board of Traditional Medicines. I renew my license every year,” she told THISDAY.
Interestingly, Nurat claims to refer patients when cases are beyond her. She spoke about collaboration with health centres and General Hospitals for the safety of the women and their babies. She uses health centre to refer cases that are beyond her ability and if the case is beyond the strength of the health centre, it will in turn refer the patient to Mascara or General Hospital, Gbagada. “These hospitals know me very well,” she noted.
Nurat is well known to the boat owners at Agboyi, such that even at midnight, she could call any of them in cases of referrals. “I have the phone contacts of all the boat riders. I call them at any time to come to my aid even if they have closed for the day and other tricycles whom I beg to help me get boat.”
While the TBA does not provide family planning services for her patients, she says she instructs them to go to Akinyemi PHC Mascara while she goes for the training.
“There is no 24-hour hospital service here that is why people prefer to register with me even at midnight. Perhaps, if there was 24 hours service in this vicinity, it would be better a little.”
Consequently, there have been recorded complications in delivery, especially with women who do not access antenatal care with a skilled birth attendant present – doctor, nurse or midwife.
According to United Nations Children’s Fund (UNICEF) in 2015, it is estimated that about 800 girls and women died every day as a result of pregnancy and child birth-related complications, especially in sub-Saharan Africa, where high fertility rates combine with inadequate access to quality antenatal care and skilled attendance at birth to substantially elevate the risk of death in this region.
Antenatal care and skilled health attendance at delivery are essential for eliminating every preventable maternal death. The world, as a whole, has improved access to these services, with 71 per cent of women delivering with the support of a skilled birth attendant in 2014, compared to 59 per cent in 1990.
Globally, while 85 per cent of pregnant women access antenatal care with a skilled health personnel, only 65 per cent of pregnant women aged 15 to 49 had antenatal care with the present of skilled birth attendant as recommended by UNICEF. This is published in a joint data from Demographic and Health Survey (DHS) released by UNICEF and WHO.
Sadly, THISDAY gathered that Agboyi residents are not really happy about the absence of good facilities in Agboyi. A woman, Mary Abraham, who spoke the mind of the people, berated government for its neglect.
She scolded the government for not living up to its promises during their campaigns. “We gave them our votes after they promised to transform Agboyi. They promised good healthcare. But have you seen any changes here? We have nothing. We are suffering. We need water to drink, schools for our children and hospitals for our sick.”
Lending a voice for the people, Oba of Agboyi and Chief in the kingdom, Prince Timothy .A Bankole, highlighted the many challenges and call for urgent solutions from the state government.
“There is water everywhere at Agboyi but there is no water to drink. The water is good for nothing. We take pipe borne water from the other side of the community – Orugbagbe. The bridge is to connect communities such as Ajegunle, Odogu, Idera, Akpapa Olota after the lagoon among others. The government is working on the bridge. Very soon, we shall all laud their efforts.”
Bankole rates maternal issues as the most lingering in Agboyi that needs dire intervention. “This PHC hasn’t been a clue like the other PHCs I know in the 774 local governments. We are supposed to have 774 centres equipped very well. But some orgsnisations have been helping us bring some infrastructure to the maternity aspect of our PHC. I don’t know if the 24 hours maternity service has begun as promised. It has been an age-long problem for our women, especially when they are in labour.”
The Chief, however, reminisced how his last son was born. “It was at midnight. Before we could transport my wife across the water to the other side, it was serious.
The Head Nurse of the PHC, (name withheld), spoke about her experience with maternity and child health in the area since 2013. “The challenges facing us as nurses here are monumental. Is it plying the water daily without a life jacket? That’s even by the way. The whole environment is dirty and there is nothing you can do. It’s only passion for the job that keeps us going. If you are looking for money you can’t be here. You can’t even get what you want to eat.”
“If you look at this environment, the first illness that comes to mind is diarrhoea. But the people don’t have it. I have to be sincere with you. Gastroenteritis – stooling and vomiting – is not here. If they have diarrhoea, that may be during teething period.”
On the water surrounding them, they assure you they will be fine after taking herbs. What they have is malaria because there are a lot of mosquitoes here. “We give them insecticide-treated nets when they come.”
On a positive note, she remarked: “We have saved many lives; united many broken homes. Girls who ought to be in school come here with unwanted pregnancies. We discourage abortion then urge them to come for family planning.”
Undoubtedly, TBA is their choice. “But we don’t even have anybody that has registered for antenatal cases. They come for immunisation and family planning. They believe in the TBAs.”
Swiftly on the heels of this, the Alliance Chairman for World Health Committee, Mr. Olusegun Makin, assured residents: “The TBAs at Agboyi help the women but give referral when necessary. The TBAs have been trained to that extent. Although I do not have the total number of TBAs in Agboyi, every one of them is known.”
Benefits of ante-natal care
According to the Medical Director and Family Physician, Novavit Hospital, Dr. Odunayo Akinsulire, antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth.
He added: “It can be a source of micronutrient supplementation, treatment of hypertension to prevent eclampsia, immunisation against tetanus, HIV testing, in addition to medications to prevent mother-to-child transmission of HIV in cases of HIV-positive pregnant women.”
In areas where malaria is endemic, the expert continued that health personnel can also provide pregnant women with medications and insecticide-treated mosquito nets to help prevent this debilitating and sometimes deadly disease.
Consequences of missing ANC
He, therefore, said missing out could be all the advantages in the negative way.
Although the community continues with its quota to save its women and babies, the Chiefs alongside pregnant women say they have continued to demand even when previous demands are yet to see the light of day.
Bankole alongside his High Chiefs made a clarion call. “Indeed, we commend government for its efforts. We urge them to increase their efforts so that Agboyi will be a good place it can invest. A reasonable attention should be given us in healthcare for our wives with 24 hours service in the PHC.”
But the pregnant women urged the government to empower their TBAs if they could not give them 24 hours PHC services. “If they can train our TBAs for us, it will help us more,” Shakira said.