The three deadly delays costing poor Nigerian women their lives
It’s a 20-minute speedboat ride from Lagos’ Liverpool jetty to Onisiwo island, and our small wooden outboard is dwarfed as we slip past giant dredgers and towering cargo ships towards the relative calm of the island.
Onisiwo island, home to 27 villages and an estimated 350 000 people, is considered one of the most under-developed parts of Lagos. There is no electricity or running water and many residents leave the island each day by canoe, headed for jobs, markets and schools on the mainland. There are no cars or motorbikes on the island and all groceries, drinking water, building material and fuel (for the rare generator) must be transported by boat from the mainland.
“In the developed world, it is rich people that live along the sea shore, but here it is the very poor,” says Reverend Andrew Duya, a community activist working on health and education.
As the Nigerian fuel shortage bites, the prices of a boat fare to the mainland inches upwards, putting it out of reach for many island residents who are subsistence fisherfolk and traders.
None feel the distance across the water to the mainland as much as pregnant women, dreading the often-dangerous boat ride to hospital but fearing to give birth on the island.
There is a small health centre built by the local government, which has often benefited from outreach clinics organised by the US Embassy, deploying navy doctors. Now the clinic, which dispenses basic medicines has one trained doctor and a traditional birth attendant at hand. But the women of the community say the doctor lives faraway and does not work every day. The World Health Organisation (WHO) standard is a minimum of 23 doctors, nurses and midwives per 10 000 people.
If women go into labour on a day the sole doctor is not working, or at night, they have two choices: brave the dark water and the boat ride to the mainland, or deliver at home.
“We need a hospital,” says Bola Ibrahim (34) flatly. Ibrahim has given birth to three children, but lost another three to miscarriage. “Mostly women go into labour at night and its risky to get into a boat in the dark. Sometimes there is no boat and the woman has to wait for one to arrive. The boats stop running at 10pm so if it is after that we must find someone in the community with a canoe who can paddle us across – that takes about 45 minutes”.
While she is happy to have a small clinic on the island, she says they do not stock any but the most basic drugs, and patients are forced to go to the mainland to buy the more expensive medicines that the clinic does not have. “My five-year-old son had a high temperature and started having convulsions.
They gave him medicine at the clinic but when we got home, the convulsions started again: it was the scariest thing I have ever seen!” exclaims Ibrahim. “I went back to the clinic again but they didn’t have the drugs he needed so I had to go to buy them on the mainland.”
Ibrahim runs a small shop on the island, and is slightly better off than some women in the community. For those with no income, travelling to the mainland is not an option, and buying extra medicine simply beyond their reach.
Busayo Ganiu (19) is one of those with few options: her husband is away in town looking for work and her grandmother supports her. Heavily pregnant, Ganiu has her three-year-old strapped to her back, where the child cries fretfully, her lips dry with fever. The child is clearly dehydrated but Ganiu doesn’t have the 50 naira (13p/18c) she needs to buy sugar to mix with salt in a home-made rehydration mix.
“My first born has a fever and a cough but they won’t give her medicine at the clinic without money. I don’t have money so I give her herbal potions instead. I don’t know what is inside but it makes the baby vomit, and it helps.”
Like many poor Nigerians, Ganiu relies on traditional herbal potions, cheaply and readily available from local hawkers. Unfortunately, there is no quality control on these mixtures, and it is impossible to tell if they are healing or harming patients.
Travelling to the mainland is not an option for Ganiu and she intends to have her second baby at the local clinic. “The last time the community nurse delivered me at the clinic, but they had no medicine, not even sanitary pads.” She was forced to wad up old clothes and use those instead. “We need the government to give us good hospitals and trained staff, with enough drugs. It upsets me that we have to pay – this service should be free. Here it will cost me about N10 000 to deliver my baby (US$35/GBP26) and even though it is supposed to be free, we pay.”
She would prefer to give birth on the mainland but that is even further out of her reach, as the medical fees alone would cost N15 000, excluding transport costs. “I don’t have an option,” she says bitterly. “As a mother, if I could get free health services, I would be very happy.”
Her grandmother prepares a traditional medicine for her, claiming it will ensure a smooth delivery. Instead it gives her abdominal pain, but she says she cannot stop taking it, as she cannot do her chores without it and her back becomes painful.
She takes us to her one-room home, furnished with little more than a sponge mattress on the floor and some cooking pots. “If I go into labour in the middle of the night I will just have to do it on my own. I can push but my neighbours will have to come pull the baby out. If I scream for help, they will hear me and come.”
“The concerns we are hearing from these women are what we call the Three Delays,” says Dr Francis Ohanyido, senior policy advisor for the ONE campaign. “These are delays in seeking care which is often linked to low status of women, delays in reaching care because of distance, and delays in receiving adequate care because of poor facilities or inadequate medical supplies.”
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