By Gabriel Olawale

UNIVERSALLY, the Primary    Health Care, PHC,  is a form of essential service that is based on scientifically sound and socially acceptable methods and technology to make health care accessible to all individuals and families in a community.

Although considered the  cornerstone of universal health systems, PHCs have often been neglected in terms of funding and other areas of operations in many states across the nation. The long neglect of this level of care has in turn brought grief on the  secondary and tertiary facilities.

Standard healthcare

Lagos is one of the states that recognise the need for functional PHCs as evidenced by the renewed focus, lately,  within the Local Council Development Areas, LCDAs, of the state  under the watch of the  Special Adviser to the Governor on Primary Health Care.

MATERNAL HEALTH CARE: From left – Mrs. Emmanuella Emma being attended to by a Traditional Birth Attendant, TBA, Mrs Aina Abiodun while the Agboyi Primary Healthcare Centre (right) is under lock and key.

However, efforts geared towards prioritising healthcare at the grassroots through this most basic level appears not to have been stretched wide enough as some areas appear to have been missed out the new agenda to provide  access to standard healthcare for the rural dwellers in the various localities.

The Lagos State monitoring team set up to oversee the functioning of PHCs would do well to make a scheduled visit to the PHC at Agboyi Ketu community in Alapere, a suburb of Ketu, in the state.

Any visitor to the community would agree that it is certainly one of the under-served areas.

The community which has been in existence for more than 600 years is completely surrounded by water and sandwiched between Ogudu and Alapere in  Agboyi-Ketu Local Council Development Area.

Inhabited by an estimated 40,000 people mostly Aworis and a handful of other tribes, Agboyi accommodates those dislodged from the city who seek refuge in it.

Peculiar location: Its peculiar location would have made it a good getaway, typically favoured by nature, but a stranger to modernity, Agboyi is not different from most rural communities across Nigeria lacking in basic amenities. To get access to potable water, the  residents go as far as Makoko, Oworoshoki and Bariga, A 20 litre keg of water costs N100 while a bag of pure water is sold for N170 to N200. Although connected to the national grid, there are no motorable roads or viable means of transportation to the outside world.

But for  wooden boats seemingly made in a hurry, the residents would be cut off from the larger Lagos. However the residents, determined to make a living out of nothing, are not giving up on life yet. Every day, they make risky trips on rickety wooden boats, men and women, old and young, across the Agboyi River to Lagos; either to school or work; and as often is the case, to carry out sundry business activities. For the residents, perhaps, it would be safe to say they know what constitutes risk and happily partake of it, not that they have much choice anyway.

When Good Health Weekly visited the PHC last week, the decrepit-looking building was deserted and under lock and key. The unfenced facility, located in a swampy area, apparently was not open for services on that day.

Nearby residents told Good Health Weekly that on week days, two staff of the centre are usually available to attend to patients.

“They have one midwife, and one other woman that takes care of the registration of patients. There is also the cleaner. They render services from 8am to 4pm only on Monday to Friday and close the PHC on Saturday and Sunday,” the source explained.

Good Health Weekly also gathered from another source that many of the residents are often compelled to patronise Traditional Birth Attendants, TBAs.

Narrow escape: When Justina Idowu, a private school teacher in Agboyi Ketu community went into labour in the wee hours of a rainy  night, there was palpable anxiety within the household. The heavily pregnant mother of one narrowly escaped death by the whiskers, no thanks to the lack of accessible roads  absence of a functional healthcare centre and fear of the Traditional Birth Attendants, TBAs,  that reign supreme within the community.

Justina had registered for her antenatal care on the other side of the community across the river. She went into labour at midnight, two days earlier than her Expected Delivery Date, EDD.

Justina’s husband owns a car but because there was no bridge linking the community to the mainland, he is compelled to park the car on the Ketu  side of the river just like other car owners within the comminuty.

“Around midnight, I began feeling the pains of labour. My husband who noticed my discomfort inquired if it was time to go to the hospital, but I did not answer him because I was not sure.

However, 30 minutes later, the labour pains were becoming stronger and more frequent, and my husband was pleading that I should try to endure till morning because the canoe man would be in bed and there was no way to cross to the mainland side of the river.

Distance to board the canoe

“For about four hours, I was in pain,and my husband was praying all through this time.”

It was not until 5am that Justina, supported by her husband, could leave home. She recounted how they had to trek a very long distance to board the canoe to cross to the Alapere side of the river.

“I trekked for about 20 minutes to  where the canoe was situated. Anytime the contractions became too intense, I will have to wait until I was relieved before continuing, when we got to the spot where the canoe was tethered, there was nobody to take us across.

The paddler wasn’t up yet so my husband had to run down to his house to rouse him, before he came and ferried us across. “Had God not had His way that day, Perhaps I would have given birth on the road. We arrived the hospital around 6am and gave birth less than five minutes afterwards.”

Justina was lucky, but several others have not been so lucky.  “In 2015, there was an electrocution incident in the community. Despite spirited efforts to rescue them, they gave up the ghost before the canoe man could be summoned to ferry the victims across to the other side.”She added

An encounter with  Emmanuella Emma at the house of one of the Traditional Birth Attendants, TBAs, was an indication of loss of confidence in the only PHC by the residents.

Emmanuella, an expectant mother, said the inconsistencies in healthcare delivery services make the community residents to lose their confidence and patronise TBA.

“Prior to my visit to the PHC, people told me that their services  for pregnant women were free, but it surprised me that I was charged for all the services. Registration card is N500; scan is N1,500. For normal delivery, the TBA charges N10,000 while at the the PHC is N20,000.”

Further, Emmanuella said  the kind of service rendered by the TBAs in the community and their consistency encouraged her to gain their confidence.

“The PHC opens at 8am and closes by 4pm, so if you  registered with them and you fall into labour in the middle of the night, the TBA  may not want to attend to you because she would say you did not  register with her. So we have no option than to register with  them. They are our saviour because they render 24 hours service which the PHC does not.”

Fatia Olosho who Good Health Weekly observed as she was taking a herbal potion at the TBA house, remarked  that the hospitality enjoyed at the TBA house is incomparable.

“Anytime you come here, they will tell you sweet things. Even if the baby is not properly positioned in the womb, they will reassure you and put your mind at rest. You would be happy. Once your pregnancy is eight months, the TBA has a special room dedicated for pregnant women where you can relax in case your husband is not around or when you are feeling contractions.

“Their charges are okay by me. They allow instamental payment, they listen to us and share different experiences with us.”

Speaking on how she gained the confidence of pregnant women in the community, one of the TBAs , Mrs. Aina Abiodun, said  her ability to render 24 hours service utilising  local herbs gives her the edge over the government hospital.

Referral of patients: She hinted that she has benefited from trainings organised by the Lagos State Board of Traditional Medicine and agencies such as PATHS2, so she quickly refers the patients once the situation is beyond her control.

“Most times I work hand-in-hand with the PHC in this community, I do send pregnant women to them for scanning because they usually register with me here. But in case of emergency when the PHC has closed, for our patients to cross to  the other side of the community is a difficult task.

“In this my vicinity, we are only two that render services to pregnant women, children and the community at large. We give some people local herbs while others receive orthodox medicine.”

According to Aina, “The commonest sickness among the children is fever, cough, malaria, stooling and vomiting, and once it’s getting out of hand we refer them to the PHC and from there they can be referred to another hospital outside the community.”

Aina revealed the level of patronage is very encouraging and on daily basis she is stepping up her service delivery.

Service delivery

“In one month I attend to about 20 pregnant women and take delivery of not less than 100 pregnant women in a year, while also caring for some elderly ones  in the community.”

Aina who claimed to have been in the profession for more than 15 years, refers patients to the PHC during the immunisation or distribution of free mosquito nets.

Findings by Good Health Weekly, show that the absence of  24 hours service at the PHC and lack of motorable road network is a real challenge.

The situation has caused  fatalities  to be  recorded . There have  been instances in which pregnant women go into prolonged labour before being referraled to Ketu Mascara PHC on the other side of the river, because the one in the community is closed. There are complaints that  there are no drugs in the PHC and even when drugs are prescribed the people are unable to purchase the drugs due to high poverty level. Quite a number of them said they prefer  local herbs.

Expressing worry about the trauma experienced by the people, the Chief Osolomade of Agboyi 1, Mr. Jelili Salau, said  a community without access road is bound to suffer.

Salau  pleaded with the Lagos State Governor, Akinwumi Ambode, to come to their aid by helping to ensure the PHC in the community works 24 hours.

He recalled that the Governor should fulfil his promise to provide the community a link bridge, noting that majority of the settlers find life unbearable due to their current predicament.

“Why majority of residents are patronising TBAs is because the only PHC in this community opens eight hours daily, between 8am and 4pm, Monday to Friday. It is shut weekends, so when children fall sick or pregnant women go into labour weekend or in the middle of night, what do they do?

“Even if we make effort to paddle the canoe in the middle of the night, the road along Ogudu and Alapere would have been  closed.

“In March this year, the State Governor and our House of Assembly representative, Tunde Ibrahim, came on an inspection visit and promised  that the bridge would be constructed. Our prayer is that we will not be forgotten.”

We are confident that once there is a road, our woes will be a thing of the past.”