…As TBAs overrule doctors
By Chioma Obinna
Governor Akinwunmi Ambode of Lagos State must hear this! There is only one Primary Health Centre, PHC, in Ibeshe Ward in Oriade Local Council Development Area, Amuwo Odofin Local Government Area, serving nine densely populated settlements in the state. Residents of the communities of Ibeshe, Ibeshe-Beach, Ibasa, Imore, Ilashe, Okun -Ilashe, Igbo-osun, Igbo-Eseyere and Okun-Ilashe and other riverine communities within that axis are wishing that the Governor would pay them a visit.
Such visit would be a revelation as it would not only enable the Governor to experience, first hand, the socioeconomic challenges faced by thousands of residents of the communities, but bring to the fore, the unpalatable state of healthcare delivery around that axis.
A visit would be the only way that the Governor, and the state government, would appreciate the hazards of the lack of social amenities including basic healthcare as a result of absence of a befitting primary health care centre.
The Healthcare Facilities Monitoring and Accreditation Agency, HEFAMAA, an Agency of Lagos State Ministry of Health, says there are 26 registered General Hospitals, 256 Public Healthcare Centres, 2,886 private hospitals/clinics/laboratories/ophthalmic/dental/diagnostic centres and an estimated 160 trado-medical centres in the state.
Yet, the solitary PHC located in Ibese, an island community, is the nearest upon entry into Oriade LCDA, with one basic access road that leads to the dock (Ijegun-Egba Jetty) from where one must board a boat The access road is marred by deep gorges and flood caused by fluctuating water levels. The state of the road makes the trip to the dock slow, long and tedious. At the dock, the commuter must wait (including pregnant women) for the boat to fill up, this could take hours.
The Governor would be interested to learn that the rough terrain and lack of access roads force the people to shun the centre, and rather, depend on traditional healers. Worst hit are the pregnant women who have no option than to patronise Traditional Birth Attendants, TBAs. He would be interested to know that for seven years, there has not been government presence in the entire community and that the trip to the PHC is far from smooth sailing.
Navigating through the murky, water-logged access road in a motorised tricycle was a challenge on its own. The journey that ordinarily should take a few minutes, dragged on for almost an hour because of the poor state of the road.
The bad road, in a way explains why pregnant women in the community patronise TBAs. At the jetty, the journey continued in a small boat of about eight passengers. It had just rained and the waters were not friendly. The boat experience was more terrifying than the road trip. Turbulence was so high one could not imagine how a pregnant woman in labour would be expected to cope under such a traumatic journey, in order to access health care.
Arrival at the PHC elicited no excitement. On the contrary, it was depressing. A first time visitor to the PHC would easily decipher that all is not well. The unhinged, rusty gate and compound overgrown by weeds came as a shock. The edifice, a dilapidated structure, bereft of the trimmings expected of a modern health facility, is largely underutilised and underserved. It has not had electricity supply for the past seven years and the only available power generator packed up long ago.
The centre is faced with chronic shortage of medical personnel, drugs, water supply and other necessary amenities. The only source of water is an old well in the compound with rather murky water, as the borehole is broken. All the 10-beds were empty and except for a few pregnant women at the antenatal clinic, it was deserted. Presently, there is no doctor, just one nurse, a ward aide and a gardener.
Pregnant women experiences
Community members say these challenges forced them to abandon the facility. The records unit showed that in one month, just two deliveries are taken out of an average of 10 pregnant women who attend antenatal clinic there.
Omolara Assan, who is eight months pregnant, considers putting to bed at the centre a risk because there is no doctor. “This pregnancy is far gone, but I have not seen a doctor only a nurse. Sometimes they invite us to collect drugs, we will come, wait and at the end of the day we go back home with nothing. I will rather visit the TBAs than the centre. I have three children.”
As a result of the peculiarity of the Centre, whenever there are complications or difficult cases, TBAs are invited to assist. Seven months pregnant Fatimoh Tawak is comfortable with the idea of having TBAs in the hospital. Fatimoh who is pregnant for the fifth time points out that her father who is a TBA, delivers her children and she believes it is safer for her.
“I usually have two weeks labour when I am pregnant with a male child, so to avoid complication I would rather allow my father deliver me of the baby.” Confirming that women in the communities have abandoned the facility, Fawusat Ali, also seven months pregnant said they prefer to patronise TBAs because they cannot afford to pay the N1,000 transport fare from places like Imore or Ibasha to the centre where there is no doctor.
“This is my third pregnancy. I have been delivering with TBAs. This is the first time I am coming for antenatal here. There is no doctor, no electricity, so they have to use torchlight. They have a generator but we were told it got damaged. We come on Mondays. On Wednesday some nurses come from town to immunise the children.”
Appeal to government
Fawusat, while calling on the Lagos State Government to build more Primary Health Centres in the area, she recalled a pregnant woman that almost bled to death after delivering her baby. She said the community heads had to arrange a boat to take the woman to Oriade PHC. The women are mandated to buy all the items required for their delivery and they are charged N5, 000.
Chairman, Ibeshe Ward Health Committee, Sharafa Amodu, blamed the low patronage on the long distance to access the centre. “This is the only PHC serving Ibeshe ward. Here there are no drugs. In the last seven years, the community has been without electricity. The power supply was only restored two days ago and developed fault almost immediately. These challenges have continued to force our women to continue to patronise TBAs.
“This type of hospital is inadequate for our people and that is why you don’t see many pregnant women here. It is too far for them. Out of 50 women who get pregnant, less than 25 give birth here.” To reach these communities with health services, Amodu explained that the committee in collaboration with the PHC and some NGOs, organise medical outreaches particularly in those far distance riverine areas like Ibasha and Imore.
He further called on the State government to urgently come to their aid by procuring boats and equipping the centre with drugs and increasing number of medical personnel. “A boat without engine costs N300, 000, an engine of 60 horsepower is N400, 000. To get a complete boat you need a total of N700, 000 and we cannot afford it. We will appreciate it if we can get one to be on standby to convey emergency cases.”
He said they are compelled to invite the traditional people to come and play their role because government had encouraged such association.
In a chat, the Founder, Festus Fajemilola Foundation, Mr. Afolabi Fajemiloa, who has been working in the community for two years, decried the travails of the people. “That is why they prefer to go to TBAs. There was time we had a community scorecard and discovered many people patronise TBAs and don’t see the need to go to government hospitals.
Elizabeth, Sowho, LADSCOP, said in places like Ibasa, where you will spend 45 minutes on the water before you get there, deliveries are taken by the pregnant women husbands. “Government should give the people adequate roads. The former chairman agreed to give them a road but today he has gone and the road is still not finished.”