Nigeria: Seeing a doctor in the slums of Lagos

November 27, 2010

Nigeria: Seeing a doctor in the slums of Lagos © Silvia Fernàndez/MSF

MSF is providing free medical care in the Lagos slums of Makoko, Otto and Badia, where people struggle to make a living in overcrowded conditions and where few people can afford to see a doctor.

It is still early morning – just ten minutes to seven – but dozens of people are already waiting at the gate of Aiyetoro health centre, in the slum area of Makoko, for the day’s consultations to begin. Paul Gidonu is one of those standing patiently in the queue. Two days ago, Paul cut his ankle while cutting wood. Although he bathed the wound at home and applied medicinal plants, he was still in a lot of pain and the injury was not healing, so he decided to see a doctor. The health centre has only been open for three months, but local residents – like Paul – know that this is a good place to receive medical care: it is staffed by trained professionals, the drugs are of good quality and the service is free. These are the reasons that the people in the queue give for its popularity.

Makoko is one of the most deprived areas of Lagos, the largest city in Nigeria – and possibly in Africa – with an estimated population of 18 million. Thousands of people live in slum areas, where conditions are unsanitary and basic infrastructure and services are lacking. If you are poor and live in the slums, getting to see a doctor can be difficult as, even in public hospitals, you have to pay for medical care. That is why MSF has decided to launch primary and reproductive healthcare projects in the slums of Makoko, Otto and Badia.

Medical care for the poorest people

MSF started working in Aiyetoro health centre on 5 July, providing primary and reproductive healthcare, and inpatient and emergency services. In its first three months, there have been more than 12,000 consultations. Malaria and respiratory infections are the most common illnesses in Makoko. Patients who need more specialised care are referred to local hospitals.

When her labour pains started, Blessing Abubarkar, 28, went straight to the Aiyetoro health centre with her husband. She was admitted to the maternity ward at midday, and four hours later gave birth to their son, Muhammad. Three months earlier, Blessing had been the first woman to receive antenatal care from MSF at the centre.

Nigeria has one of the highest maternal mortality rates in the world. Many pregnant women give birth at home because they are unable to afford the cost of going to hospital. Many pay traditional birth attendants to help with the delivery, while others go to churches, which sometimes have their own medical staff. Since MSF opened its centre in Makoko, the number of women coming for antenatal care has grown and grown. Nearly 40 women a day receive antenatal care at Aiyetoro nowadays, and demand is still increasing.

MSF is also planning to extend its work to three other areas of the city using mobile clinics. On 6 October, the first mobile clinic was held in the slum area of Otto. Already, 315 patients have been treated there, and 90 antenatal consultations have been carried out. In Badia, MSF is working to reconstruct a small health post where medical activities will start before the end of the year. MSF is also building a small floating health centre on the lagoon in Makoko, where doctors will see patients twice a week.

Many needs, many challenges

Lagos, one of Africa’s megacities, is constantly growing, with a stream of migrants arriving from rural Nigeria and immigrants arriving from neighbouring countries, particularly from Benin, Ghana and Togo. The city is also a starting point for many would-be migrants to Europe, embarking on their long, perilous overland journies in search of a better life. In the slum areas of the city, where most of the newcomers end up, poverty, overcrowding, violence and poor health are commonplaces of life.

“The problems we are seeing in Lagos are what you would expect for a rural area without an adequate health infrastructure and invisible to the eyes of the state. These include complicated cases of malaria, respiratory infections, diarrhoea, malnutrition and trauma, as well as low coverage of vaccinations, an absence of antenatal services and a lack of safe, hygienic facilities in which to give birth,” says Brett Davis, MSF’s head of mission in Nigeria. “The challenge for MSF is to meet these needs in an urban environment like Lagos.”

For a medical humanitarian organisation such as MSF, the Lagos project is a major challenge because of the sheer size of the city. “The number of people seeking access to our facilities is staggering. Keep in mind that an estimated 2,000 people arrive in Lagos each day,” says Davis. “Meeting people’s needs in a densely populated area is an incredible challenge, but it is also an opportunity to help people who really need it.”

The MSF team in Lagos is mostly made up of Nigerian medical staff, supported by eight international staff. The team plans to support Ministry of Health facilities in the country for a period of two years.

Flora and Caroline’s story

Flora took over the care of Caroline, her brother’s daughter, when she was just one day old. The baby had survived a complicated delivery that had killed her mother, and she herself was not well. When Caroline was just three months old, she weighed less than 3.5 kilos and had problems feeding. The family took her to a series of traditional healers and, in a state of despair, travelled to neighbouring Benin in their search for someone who could help her. But nothing worked.

Soon after the Aiyetoro health centre opened its doors, Flora took the malnourished Caroline to see the doctors there, and everything changed. “She was given therapeutic milk and straightaway she started to improve,” says Flora. After ten days in Aiyetoro, Caroline was referred to a long-term malnutrition treatment programme at the local children’s hospital, where she was admitted for a month. After being discharged from hospital, Flora continued to bring Caroline to the centre on a weekly basis to have her weight checked and her situation monitored. Carolina is now six months old; she is thin, but strong and lively, and she smiles all the time as she sits on Flora’s lap. “We thought nobody could help her,” says Flora, “but MSF did.”

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