Celebrating Nigeria at 60: Suffering and smiling

Three years ago, while in theatre, I remember a senior colleague bursting in with good news after reading a World Bank report.

For the first time in history, Nigeria’s maternal mortality rate had dropped by 0.86%, which meant that less than 700 women per one hundred thousand live births were dying due to pregnancy-related issues.

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The percentage might seem minuscule to the layman’s eye but it is a significant stride for a country whose maternal mortality rate has refused to decline over the past years.

Maternal mortality is defined by the WHO as the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by pregnancy excluding accidental causes.

Maternal mortality ratio is, therefore, one of the significant determinants of health care of a country.

However, this article is not about maternal mortality. Maternal mortality, just like infant mortality rate and Under 5 mortality rates, is one of the many, many indices that we use to measure Nigeria’s health care sector.

Today, we celebrate Nigeria at 60, but what exactly are we celebrating?

The WHO defines the Elderly as being aged 60 years and above.

By this definition, Nigeria has now joined the league of other elder statesmen countries. This means we can no more rely on the foolishness of youth as an excuse for our myriad of problems.

It means we have to buckle up and face our problems squarely or forever bury our heads in shame like a poor, destitute old man recounting his failures in life.

I am opportune to work in both urban and rural areas of this country and the difference in the quality of life and healthcare is glaring for all to see.

While tertiary institutions in state capitals are equipped with state of the art medical equipment, some of which are rotting away in stores across the country (a story for another day), and forming public-private partnerships (PPP) with organisations that are bringing wonderful innovations into our healthcare systems, the hospitals in the rural areas remain ill-equipped and are run by staff who are not competent enough to do so.

Some hospitals are not even accessible due to bad roads and insecurity.

And even when they are, the attitude of the masses in dire need of this healthcare needs much to be desired.

The bottlenecks facing the healthcare system in Nigeria are multifactorial and may need some intervention from Madagascar!

Imagine a 15-year-old pregnant girl in labour, in a rural village in the North East.

She has been in labour for four days and has started to convulse.

She is weak and the baby in her uterus has stopped moving.

After several manipulations by the traditional birth attendant- who has received no formal training other than the ancient wisdom being passed to her by her grandmother- the girl is transported in a wheelbarrow (Yes! Wheelbarrow!) to the nearest PHC, which is several kilometres away in the next ward.

The CHEWs knowing that they are not equipped to handle eclampsia and obstructed labour, quickly refer her to the nearest secondary health facility i.e a general hospital.

There, an overzealous midwife will do something called ‘Hawan Machine’ on her.

The first time I heard of this procedure, I was convinced it was some sort of bad joke; only for me to be proven wrong when I witnessed it in the labour room.

A huge midwife (and I use this term loosely because I am not sure of her qualifications) will climb the pregnant woman’s belly and sit astride her in an attempt to push the baby out of the birth canal! In 2020!

Later, the baby is removed forcefully and she goes ahead to develop VVF. She becomes another statistic; one out of the many, many girls with VVF.

Girls with little education, who therefore make poor health choices. Fathers, mothers and children, with poor access to quality healthcare and no form of health insurance to afford it.

The situation is pitiful as it is scary.

Another scenario that commonly happens even in the so-called urban settings, where there is access to health care, is the inability to afford the drugs.

I have lost count of the number of times patients come to the hospital and burst into tears after investigations or drugs are written for them.

As a house-officer in Paediatrics, we had something called ‘empty your pockets’.

During ward rounds, whenever we come across a patient struggling to pay hospital bills, the consultant would ask us to ‘empty our pockets’.

When we stopped bringing our wallets to ward round-for fear that the man wanted to bankrupt us- a fee was fixed on all of us, according to cadre: N500 for house officers, N1000 for registrars, N1500 for the senior registrars and N2000 for consultants.

As I write, this practice still goes in some paediatric departments all over the country. It is not easy to see a child in pain.

However, Nigeria’s story is not all gloom. I know, as Nigerians, we have awarded ourselves the title of ‘Complainer General’ (honestly, I think we deserve a Nobel prize, we can complain for Africa!) the truth is significant strides have been made in the healthcare industry.

With the coming of the National Health Insurance Scheme, a lot of civil servants, who ordinarily might not be able to afford a caesarean section in a tertiary hospital, and even those in the private sector, now have access to quality and affordable health care.

Former President Obasanjo’s VAMED contract of renovating teaching hospitals, even though later abandoned and shrouded in scandal  (but really, which Nigerian contract isn’t?

Are we not currently witnessing the scandal of a school feeding programme?) did wonders for our teaching hospitals in this country.

The recently commissioned Nigeria Sovereign Investment Authority (NSIA) Diagnostic Centre in AKTH and Cancer Centre in LUTH are proofs that we can do great things if we put our minds to it.

So, what am I trying to say? Should we as a country be celebrating when we are still battling with 19th-century health problems? Do we have a right to celebrate?

Have we earned the right to sit at the table with other ‘Elder’ countries? I say we have.

It is a matter of perspective. And in the battle between pessimism and optimism, I would rather see the glass as half full.

Even in these dark times of coronavirus and insecurity, we still have a lot to be thankful for.

We are still standing. The dreaded death toll that we anticipated from COVID-19 did not happen, even as the second wave is fast approaching.

Here, I will wax spiritual, as it is only God that is saving this country, not science.

God, in His infinite mercy, knows that we are not ready and that the Nigerian health care system, that is still battling ‘Malaria Typhoid’, cannot handle Rona and that is why we are still relatively stable.

And also have the guts to say that ‘corona ya tafi’ (Corona has gone). Anyway, I digress.

Are we there yet? Not even close. Have we made progress? By Jove, we have.

Even if that progress is just a 0.86% decline in the rate at which women die due to pregnancy, it will still be counted as progress. We will get there, someday.

Until then, like the late Afrobeat legend, Fela Kuti, sang: we will continue to be suffering and smiling.

Happy Independence Day Nigerians!