Rebecca Ejifoma, who recently visited the Irede riverine community in Lagos, writes that pregnant women practice unorthodox self-antenatal and make use of traditional birth attendants for delivery because of lack of any hospital or health centres
Abike Ahmed is an expectant mother, who is six months gone already. In those six months, Ahmed has not visited a hospital for the much needed ante-natal or a health centre. As one of the inhabitants of Irede community, a riverine community at Abule-Osu, which is off the Lagos-Badagry Expressway, she is today still coping without a health facility. For her, she combines both orthodox and traditional methods simultaneously.
Although she registered at the Ojo General Hospital, she has never visited for antenatal care because of the distance from her place of residence. She said, “There is no hospital here at Irede. Although I registered at Ojo Hospital, but I go to one mama’s place and she gives me ‘agbo’ (a local herbal concoction) to drink for my baby.”
On what she would do if labour pangs begin at night, she said there are traditional birth attendants in the community who are ever ready to help birth the baby. She said, “I don’t pray it starts at night. Since I had my first two children during the day, but if it does, I have help ready.”
According to the recommendation by the United Nations Children’s Fund (UNICEF), 65 per cent of pregnant women between 15 and 49 years old should have access to antenatal care with the present of skilled birth attendant. For expectant mothers at the Irede community, that statistics certainly do not apply to most of them, as they often indulge in self-care and delivery.
It is pertinent to note also that statistics has stated that Nigeria is number one leader of maternal deaths worldwide with 576 deaths from every 100,000 live births. According to the University of Lagos Resident Doctor, Dr. Olufunke Olamigoke, at a recent media roundtable in Lagos, preventive measures must be put in place against maternal deaths, which includes encouraging women to attend and attempt to deliver at hospitals. She said, “Only one third go for delivery after antenatal, which is skilled care during pregnancy and childbirth, emergency obstetric care and immediate post natal care”.
Also in the same forum, BudgIt Project Officer, Agunloye Oyebola, had lamented that globally, it has been estimated that about 350,000 women die yearly of preventable complications during childbirth daily, which approximates to 2,300 under-five years olds and 145 women of childbearing age in Nigeria.
Therefore, it is quite sad that in this time and age, and despite recommendations from UNICEF, antenatal care and the presence of skilled health personnel at delivery, which are essential for eliminating maternal death, is still a mirage for the Irede women.
Lack of Primary Health Centre
Unlike Ibeshe, Ilashe and Makoko riverine communities in Lagos, Irede community is rather clean and almost spotless with white sands. It has buildings too, like in urban areas. It is a journey of 10 minutes’ by wobbling boat on murky waters. The community inhabits about 3,000 dwellers and comprises three communities including: Irede, Ikaree and Iyeghe.
Located at Abule-Osun area of Lagos-Badagry Expressway, Irede community once had a dispensary, which was built between 1979 and 1980 during the administration of Lateef Jakande. Moves were made to turn it into a Primary Health Centre (PHC) but that dream never materialised till date, as it remains uncompleted and deserted save for reptiles and human waste.
As it is, there is no functioning PHC to provide health services to pregnant women and nursing mothers with antenatal care, delivery, postnatal and family planning.
Undoubtedly, Irede is faced with numerous health challenges, chief of which is the lack of primary health centre or health workers. So, pregnant women and nursing mothers patronise Iya-Alagbo, a Yoruba parlance for Traditional Birth Attendants. Others simply practice self-care until their delivery, which is often times done in the comfort of their homes.
Like Ahmed, like Fatima Saliu, is a mother of four, whose last baby is six months old now. According to her, she had her first and second children under the care of an auxiliary nurse at Ojo area, near her mother’s residence, while she had her third and fourth babies at home. She said, “I had my third and fourth babies inside my house by myself. On the day of delivery, my co-wife simply helped me cut the placenta. Not that she is a nurse but she did it because the baby was already out.”
When asked if she ever went for antenatal, she said her husband wouldn’t give her money for it. “Sincerely, I didn’t. I went for antenatal during my first pregnancy only. The reason is that ever since I had a little problem with my husband, he stopped giving me money for antenatal care. That’s why I didn’t look at that side. It is only God that is helping me”, she disclosed.
Now, despite her preference for home delivery, the mother of four said she always takes her kids for immunisation. She said, “I only take them to the hospital for immunisation but that is whenever I go to my mother’s place at Ojo. But sometimes health volunteers come here to immunise our babies”.
But if her last experience with health workers was anything to go by, her tentative touch with orthodox medicine might have come to an abrupt end. Reminiscing, she said some health workers had visited and immunised her baby. She said to their immediate concern, a day after the immunisation, the baby’s arm became swollen.
“People advised I take the child to Ori-Ade. We went there with no tangible result so we moved to the health centre at Ojo road. It took about two weeks before my husband opened the swollen arm with razor blade to drain the bad blood”, she said.
The case of Kate Felomo, a 27-year-old mother of two- a three-year-old and a nine month old – is no different. Although she admitted to going to the hospital for delivery, she however said she skipped out the antenatal part. She said: “I have never attended antenatal before. For my first baby, I just waited until the ninth month then I give birth. But I delivered my second child at a hospital across the water within an hour.”
Confirming what other mothers had said, Felomo said given the lack of health centres, she always relies on medical outreaches by organisations and religious bodies to immunise her kids. “Sometimes, people come here for medical outreaches every month. If there is need, they give us drugs. Since I had my baby, I have not been to the hospital”, she disclosed.
Adegboyega Opeyemi is another mother of two. Her babies are aged two years and nine-months old. She had her baby in church. “It was on a Sunday. I was in church when labour began. Thank God as with the help of my church members, I had my baby right there.”
But for the impromptu delivery at the church, Opeyemi entrusts her pregnancy with a TBA, where she gets agbo (local medicine). She added: “I registered at Iya Alagbo (TBA) where I had antenatal. The ‘agbo’ woman takes 100 naira only for test. When you go to register, you pay about 3500 naira for registration, card and everything.”
Zero Awareness about Family Planning
Surprisingly, Felomo doesn’t know a thing about family planning in this age and time. All she knows is that she is having her babies. “I don’t know anything about family planning. No one has talked to me about spacing my children.”
She is not alone in this. For 30-year-old Isa Nofisat, who is six months pregnant with her third child, told THISDAY she had her babies across the water. Really, she goes by boat to have her babies given that most of the residents are boat owners. She said, “My husband would knock at their doors to hire a boat. The fare is N1,000 for hire but 500 if you plead with them. There are also motorcyclists here to carry us.”
Interestingly, Nofisat has an excellent way of spacing her babies. Although she knows next to nothing about family planning, her perfect method will startle you. She said, “I don’t know about family planning. But since my home town is Kogi, I go there to stay for a very long time after child birth. That is how I space my babies who are aged five and three years old.”
Although these women had safe deliveries in the end, notwithstanding, they missed out on the many benefits of antenatal care which includes understanding warning signs during pregnancy and childbirth, how to prevent eclampsia, HIV testing, free drugs and insecticides treated nets among others.
Asides the PHC, for the Irede community, their basic needs are not far-fetched. According to the former Chairman, Amuwo Odofin Local Government Area (1999 to 2002) and former chairman Ori Ade LCDA, Mr. Saliu Sekoni, he used to send manpower to man the dispensary then. He said, “There was a dispensary here built in the days of Jakande’s administration in Lagos. It was not very functional until the 1999 when a son of the soil was in the Amuwo Odofin LGA, at 41 Road. We had one LGA sending nurses twice a week to dispense drugs to the community, women and children.”
He added that during the tenure of his successor, Tunde Sanusi, there were plans to upgrade the dispensary centre to a PHC. So, the dispensary was demolished and this structure began but was later abandoned. He said, “Till date, the construction is incomplete and that means health system here has not been working. What does it portend for this community, particularly when it comes to maternal and child health?”
Sekoni, however, commended the TBAs, whom he described as very active in preventing maternal health issues. He said, “We have not recorded any scene of such in this particular village ever since my growing up days.
“Truly, the PHC, which is meant to serve Irede and Ikaare if completed, will come really handy for the residents. Right now there is no PHC that pregnant women can access except Ibeshe, which is 10 minutes boat ride from here.”
Another need of the community is lack of potable drinking water. According to Sekoni, they don’t have pipe borne water, rather they use wells and boreholes. He added that although the water is seemingly clean, they need to visit a laboratory to confirm that.
Another challenge facing the community is High Blood Pressure (HBP) and other chronic illnesses. Lending her voice, daughter of the late Oba, Asisat Adebisi Lawal, said Irede people do not know their health statuses till date. She said, “Most of our people are battling with high blood pressure, high cholesterol and all those kind of internal illnesses. And quack doctors come here, all they care about is what they will make, they don’t refer them to hospitals.”
Regrettably, she said the community lost a woman to HBP. She said, “Those doctors, who come for the medical outreach would claim they have checked the resident’s and they will prescribe drugs, claiming that their blood pressure is high. Despite that, we lost a lady about a year ago. She died out of ignorance because she had HBP.
“The ‘fake’ doctor that always checked on her gave the deceased medications. Her blood pressure was 240/180. By the time she was about to give up she was paralysed and in less than few hours, she died. And there are a lot of people in this environment going about with HBP but don’t know”.
When asked her reason for tagging the medical experts quacks, she expressed that her suspicions led to the arrest of one. “I interviewed them on where their hospital was. If you are a genuine doctor, you will show your ID card. One of them has been arrested.”
Another health challenge facing the community is malaria. However, this issue is prevalent among children in the community. Lawal said although there isn’t much mosquitoes at Irede when the body of is full, she added that when the water dries up, the insects have a field day.
Another challenge facing the community according to Sekoni is lack of electricity. He said, “As I said earlier, the current chairman of the LGA has promised to give priority to this PHC. Besides that, we need the government to intervene on the crazy bill of 250,000 naira PHCN gave us.”
In the same vein, Lawal cited lack of proper sanitary facilities, as most families go to the sea-side and at midnight, they use buckets inside their room.
With these, therefore, residents including pregnant women and nursing mothers plead for express completion of the PHC and equip it with drugs.
Hope in the horizon
Like the rainbow, which foretells the promise of rain, there is hope in the horizon for this community and so many others like it. This is because the federal government has made good its promise to promote PHCs and have assured that funds to power such health centres are released. This promise was the aftermath of the series of the stakeholder’s health dialogue, which has been championed by THISDAY Newspapers.
At the policy dialogue initiated by THISDAY, Vice President Yemi Osinbajo said the disbursement of the Basic Healthcare Provisions Fund will commence in August. This is a welcome development for the health sector because when the senate earmarked N57.15 billion in the national budget for the Basic Healthcare Provisions Fund (BHCPF), in May this year, it looked like a tall dream until the dialogue initiated the fulfillment.
With the release of the funds, many stakeholders in the health sector believe this is the beginning of new things for less privileged and vulnerable Nigerians, and alas might prove to be the solution needed by the Irede Community.