On Healthcare in Nigeria

I am saddened by the death of Mrs. Amuda Ajoke Bello (RIP). I pray her sweet soul rests with Him.

It is the fate of humanity to be born, to live and to die. People die in hospitals all over the world, every day, and no country has a perfect health system.

Still, World Health Organization statistics (pages 30 to 34) put Nigeria’s Maternal Mortality Rate at 1,100 per 100,000 live births in 2005. This rate translated to 59,000 maternal deaths in 2005, the second highest behind India’s 117,000 (from a lower MMR of 450).

It is valid to argue about the accuracy of ANY statistics from Nigeria, and apparently our first lady has disputed the MMR statistics for Nigeria that were reported by UNICEF. Then again, the fact that we still do not generate trustworthy statistics is itself indicative of the issues I am raising in this post.

So forget statistics for a moment. Let me talk about an issue I discovered a few years ago, the problem of obstetric fistula, an ailment you would not with on your worst enemy. The things you need to do to maximize the prevention of fistula are fairly easy and straightforward, and if it happens nonetheless, the surgery to correct it has a better than 90% success rate. The so-called “developed” countries essentially eliminated fistula by the end of the 19th century, over a hundred years ago, equipped with nothing more than 19th century medical knowledge and technology.

Apparently fistula (like meningitis and polio) has been a problem for a long time in some of our northern states – apparently thousands of women have been affected. I discovered the issue years ago when I stumbled on an article about a foreign doctor volunteering his services to treat our women for free. I monitored the news for signs of some effort, any effort at all on our part to deal with this – and was rewarded with news of polio spreading. In 2005, more foreign doctors came to Nigeria as part of a programme (the “Fistula Fortnight”) to offer free fistula surgery as well as free training to Nigerian doctors so they could do the surgeries too.

I am ashamed. Why does it have to take foreigners to tell us we are supposed to take care of our women? We could have trained doctors to do fistula surgery decades ago, or better yet, pushed for preventive measures so they don’t have to deal with the problem in the first place. But the fact is we don’t even talk about practical and important stuff like this, much less take action. Good God, we waste our time arguing about states’ creation, “marginalization” of “geo-political zones”, “resource control”, “power shift” and all sorts of meaningless rubbish, while, a simple health issue other countries wiped out in the 19th century is still a Nigerian scourge in the 21st century.

Our doctors and nurses are as good as any in the world; when they work abroad in the same enabling environment as their foreign peers, they excel too. Our secondary and tertiary science students, all of them potential doctors, are of equal intelligence as any students anywhere in the world; as I said, we could very easily have educated doctors to deal with fistulas or anything else, and given them a work environment where their training could change our mediocre W.H.O. statistics.

Unfortunately healthcare in Nigeria, though it attracts a lot of lip service, is good only for the opportunity to award contracts of dubious substantive benefit. Year after year our governors commission new hospitals and clinics they’ve built, but these same governors nevertheless fly abroad when they have any medical issue to address. Somewhere in this fact there is an unspoken truth about Nigeria, a truth about power stations that produce no electricity, refineries that produce no fuel, and police that enforce no laws. Government in Nigeria consists of little more than being hailed for awarding contracts for major projects, with nobody bothering to look beneath the surface to ask whether anything substantive has been accomplished even if the project is completed.

Ultimately, Nigerians, not just doctors, but industrialists, teachers, everyone has to work that much harder than their peers elsewhere in the world to achieve results of any kind, because the basic things we need to ease the path to success are still absent.

Only God knows how many wealthy and powerful Nigerians fly abroad for medical care – we only hear about it when something terrible happens. I do not begrudge any Nigerian doing the best they can for their family. If my father were to have any medical complaint, I would think about flying him abroad for medical care too. But I can’t. I don’t have the money for that. It scares me.

The wealthy and powerful, those who can actually influence government decisions and actions, have no pressing need to fix our healthcare system because they can access quality healthcare abroad. What are the rest of us supposed to do? What are our doctors and nurses supposed to do?

The family of the late Mrs Bello did not have the option of flying her abroad for medical treatment once they discovered she was carrying sextuplets (and that is assuming, or rather hoping, that ultra-sounds were done well before time, allowing her doctors to know she was carrying six beautiful babies). And it isn’t just a financial issue; one of my all-time favourite Nigerian football managers, Musa Abdullahi, was denied a visa to go to the United States for treatment . Coach Abdullahi did manage to go to Egypt and is back in Nigeria as I type this, but would life not be simpler for him, for me, for my father, for all of us if he and we could get the same quality of care in our own country? Even Nwankwo Kanu’s Heart Foundation has to go to extraordinary lengths to connect beneficiaries with care. This is not right.

We citizens are not given the proper opportunity to use our votes to set government spending priorities through elections. The late Mrs Bello was a mother and was one of millions of Nigerians who are neither rich nor middle-class. Maybe her vote, along with the votes of other women and mothers, some 50% of our population, would have punished “leaders” who under-fund healthcare and rewarded those who provided the care our families need.

Worse, even if we had substantive democracy, we are so distracted and divided by geographic, ethnic and religious fear and distrust, it would be a miracle if Moslem women, Christian women, Traditionalist women, Kanuri women, Kalabari women, Borgu women, all Nigerian women rallied as one to force and compel better healthcare.

And this is the key issue. I did not write this post to criticize our leaders. It is not about them, it is about we the people. It is up to us to create effective healthcare in Nigeria, not our leaders. If the 140 million people of Nigeria demanded healthcare reform, and refused to tolerate anything less, we could move mountains. Sadly it is easier to rally us for ethno-religious strife than it is to rally us to fight for healthcare. We have the power to create the change we want, but choose not to use it. We pull ourselves down rather than help each other up.

At the end of the day, our leaders have access to the healthcare they need.

We the people do not.

It will be this way until we decide to do something about it.