Alaba Rago, a densely populated Lagos slum has always been in the news for various wrong reasons. However, beyond the not-too-pleasant pedigree of this filth-ridden community is a booming baby-birthing culture supervised by untrained traditional birth attendants due to the absence of a government-owned healthcare centre, Chijioke Iremeka reports.
Sitting in front of her makeshift hut, Amina Habibah, a resident of Alaba Rago, a densely populated slum in the Ojo Local Government Area of Lagos State, re-arranged her local bathing sponge displayed for sale.
She is a strong advocate of traditional birth attendants and with glee, told our correspondent that the absence of a healthcare centre in the community has made all the women see TBAs as the best and only option for safe child delivery.
The 27-year-old, who agreed to speak with PUNCH Healthwise only if her identity would be shielded as she did not get approval from her husband, said her sister-in-law, Arafat Ahmed, a traditional birth attendant, always came in handy during labour.
“I have four children and my sister-in-law has always been there to take delivery. Arafat has been my midwife and friend since I got married. She has helped to successfully deliver all my children,” she quipped shyly.
Arafat, like other traditional birth attendants, has been bridging the gap created by the absence of a well-equipped healthcare centre or hospital in the slum, and she does this amid fear and uncertainty, PUNCH Healthwise learnt.
In this slum where access to a primary health centre and potable water to support basic human activities is non-existent, Habibah and other women continue to risk their lives by getting pregnant and patronising TBAs for child delivery.
Although TBAs are said to be poorly trained and known to sometimes use unsafe delivery procedures, for most women in Alaba Rago, they are a lifeline.
Dangerous slummy life for neonates
Situated along the Mile 2 – Badagry Expressway, Alaba Livestock Market, turned residential area, is sandwiched between Lagos State University gate and Okokomiko, another densely populated area.
The presence of fairly used household items on display and wooden kiosks covered with tarpaulin which serve as homes for many, welcomes visitors to Alaba Rago.
At Alaba Rago, an unusual business booms, ‘rent a rain booth’.
While residents and business owners, mostly from the northern part of the country are used to moving freely in the waterlogged, algae-infected community, a visitor to the area cannot, and is forced to part with as much as N500, to rent a booth with which to navigate the filthy slum.
This alone speaks volumes about the deplorable, sordid state of the area. Yet, in this filth-riddled cramped community, baby booms unbridled amid dangerous infections.
According to Habibah, who said she lost a baby to postnatal infections, she had lost count of how many women had lost their neonates to preventable diseases.
However, they stand undeterred, insisting that the deaths of their children, mainly under five, will not stop them from getting pregnant and having more babies with or without a government-approved health centre.
Sadly, these women see the painful loss of their children as the ultimate price they have to pay for living in Lagos, especially in the government-neglected environment.
“We give birth here very well. Some women have up to seven or 10 children. It is in our culture to have as many children as possible. A child will die if God permits,” quipped the trader with a smile on her face.
Patronising TBAs amid HIV fears
Habibah lives with the fear of contracting HIV and other dangerous diseases from TBAs during childbirth but according to her, she is left with no choice.
She said, “After the death of my first and only son, I became afraid of contracting any serious disease like HIV from TBAs. My son died of infection from a TBA, which is why I see myself as being lucky when my sister-in-law decided to personally start taking my delivery. TBAs are not the best in this dirty environment because of infections. But the women here can’t help the situation that life has thrown at them. TBAs are the only option for us here unless the government decides to remember us.”
The wife of the Lagos State governor, Dr. Ibijoke Sanwo-Olu, during the Flag-Off of the 2020 Maternal, Newborn and Child Health Week in the state, cautioned specifically pregnant women and nursing mothers against patronising quacks for their health care needs.
Sanwo-Olu particularly frowned at the rate at which pregnant women patronise quacks who claim to be TBAs for their antenatal and postnatal care needs.
“It is sad to note that a lot of our expectant mothers still patronise quacks who claim to be TBAs while illegally practising orthodox medicine.
“These quacks do nothing but to add sorrow to our people by killing their newborns, pregnant teenage girls, under-five children and even expectant mothers who patronise them for treatment, delivery and illegal termination of pregnancies”, the wife of the governor had said.
According to a Global Maternal Sepsis study published by The Lancet Global Health in 2020 which centred on maternal infections in health facilities, infection has a much larger impact on global maternal mortality and morbidity than previously thought.
The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality.
According to the study, around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalisation.
According to the World Health Organisation, maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, childbirth, post-abortion or the postpartum period.
Avoided by Lagos immunisation officers
PUNCH Healthwise gathered that during routine immunization, Lagos State immunization workers avoid Alaba Rago like a plague due to the state of the environment.
It was learnt that most children in the community survive childhood diseases by a stroke of luck, while the few that succumbed to such diseases, usually give up on arrival at private hospitals nearby.
PUNCH Healthwise discovered that Alaba Rago is filled with zero-dose children as the women claimed no routine immunisation has been carried out here.
This discovery sounds so alarming especially as the country has been battling with diphtheria and a resurgence of a variant polio virus, two diseases that can be prevented by routine childhood immunisation.
Speaking on this, a housewife and trader, who chose to be identified as Amina, said children in the neighbourhood do not get immunised like their counterparts in other parts of Lagos, as they hardly go out of the community.
“Everything we need is in the community except for hospitals or health centres. We have food, mosques and local drug stores everywhere. My first girl is four years old, the second is two plus, while the last is one year old. I’m still expecting more. None of my children have stepped their feet outside,” she said.
Asked if she was aware that antenatal services and child delivery are free in the government-owned hospitals in Lagos, she said, “I am not aware of it and I don’t even think I would go far for antenatal. Anything outside this community, I will not go.”
Sarauniya Mohammed, a mother of five in her early 30s, has been living in the slum for 11 years, and according to her, patronising TBAs and using traditional medicine during and after pregnancy has become a way of life.
Sarauniya, who hails from a village in the Shani Local Government area of Borno State, said it would not be reasonable to register for antenatal at a distant hospital, only to give birth in a facility managed by a TBA.
“It’s easier for me to access TBAs for antenatal care. Also, in my northern religious and cultural beliefs, major health decisions are taken by the husband and not the wife.
“So, since there is no hospital around here and my husband wouldn’t want me to go far for child delivery and antenatal in a far place, I have to focus on local birth attendants. In some northern cultures, pregnant women cannot make decisions regarding their health.
“I have five children but I didn’t give birth to a hospital. My husband has a specific TBA that assists me when I go into labour. Of course, I won’t disagree with my husband’s decisions.”
Dangers of zero-dose immunisation
For Habibah, recounting the death of her son, Musa always comes with deep pains and she believes he would have survived if there was a functional health centre in Alaba Rago, or had he been immunized.
“I’m still confused about what happened to him five years ago. It was like a movie to me. I was with Musa all through the day and he was playing with other children outside. There was no complaint from him.
“But at night around 11 pm, I noticed that he was running temperature and started vomiting. I thought it was a normal malaria infection that would stop with the usual medication, but after giving him antimalarial medication, he started stooling too.”
Terrified by the development, she put a call across to her husband, who sleeps in their shop as part of efforts to deter thieves.
“My husband quickly came with some medicine and gave it to him but his condition became worse. At one point, he was passing out a watery stool and grew weak. He was too weak to respond to his name. I carried him in my hand throughout the night and before daybreak, he was dead,” she said sobbing.
PUNCH Healthwise reported that the National Primary Health Care Development Agency recently unveiled a Zero Dose Learning Hub to successfully identify and reach millions of children yet to receive a single routine immunization.
In July 2017, Nigeria declared an emergency concerning routine immunization in response to the alarming findings of the 2016/2017 MICS/NICS report, which revealed a distressing Penta 3 coverage rate of only 33 per cent.
In the wake of the diphtheria outbreak in Nigeria, the United Nations Children’s Fund revealed that the disease has claimed the lives of 122 children in Nigeria as of July 2023.
It was noted that 71.5 per cent of confirmed cases were found in children between the ages of two years and 14 years, and according to Ms. Cristian Munduate, UNICEF Representative in Nigeria, “It is heartbreaking to note that only 22 per cent of the confirmed cases received their routine childhood immunisation vaccinations.
“Most of the affected children, especially those who unfortunately passed on, had not received a single dose of the vaccine. The need to reach the unreached has never been more critical.
“Many children did not receive their vaccines during the COVID-19 lockdown. We now urgently need to catch up. These `zero-dose’ children; those who have not received a single dose of vaccine, are a primary concern.
Dirty, filthy Alaba Rago
During PUNCH Healthwise’s visits to Alaba Rago, the community was festooned with filth. The drainage network was poorly constructed and debris spilled from them.
Several places were littered with faeces, pet bottles, disused plastics and polythene bags.
There was a total absence of potable water supply in the community, which PUNCH Healthwise learnt houses roughly two million people.
Though our correspondent sighted a borehole, it was, however, learnt, that it had been out of use for a long time.
Meanwhile, the two miniature water tanks sitting on two algae-infected concrete slabs were stained with dark, silver-looking patches, which most times have been associated with the presence of heavy metal in water.
PUNCH Healthwise learnt that presently, the only sources of water relied on by the huge population for domestic purposes are wells and rainwater.
When our correspondent peeped into one of the wells, he noticed that it had been taken over by thick mounds of algae.
Whilst still there, a woman backing a baby came to fetch water and scooped some to drink.
PUNCH Healthwise discovered that aside from the foodstuff and livestock sections, viewing centres and brothel businesses fetch good money, and this was evident by the high number of cubicles built with corrugated iron sheets and woods that lined a part of the slum known as Kango.
Kango, PUNCH Healthwise gathered, remains the most notorious section of Alaba Rago as all types of banned alcoholic drinks and illegal drugs can be found there.
It was also observed that as both old and young people indulge in narcotics in this section, scantily dressed ladies of all ages, shapes and forms; with unevenly toned bodies, openly solicited for male patrons.
“Sex enhancement drugs are in high demand there,” an open-market drug seller, Malaki Adamu, said.
The use of banned drugs and crimes were the reasons for which Alaba was marked for demolition in 2022 by the Lagos State Government after the National Drug Law Enforcement Agency seized about 8, 381, 600 capsules and tablets of Tramadol, and 56, 782 bottles of codeine.
However, from all indications, evicting residents of this slum has been a mission impossible.
‘Government hospitals far for residents’
During PUNCH Healthwise visits to the slum, it was discovered that the nearest government-owned hospitals to Alaba Rago are Ojo General Hospital, Okokomaiko Health Centre and Alimosho General Hospital, Igando, but according to residents, they are too far from them.
Nevertheless, a small private hospital, ‘Alaba Rago Hospital’, owned by a Hausa surgeon, who claims to work with the Badagry General Hospital, Dr. Sani Mohammed, was discovered to come in handy during emergencies.
The small facility has a section labelled pharmacy, a consulting room, two small rooms that serve as wards and a small labour ward.
PUNCH Healthwise discovered that the environment of the self-styled hospital is no different from other parts of the slum as it was dirty and also algae infected.
When our correspondent visited, a male patient was seen on admission. It was gathered that he was recuperating from an unspecified surgery.
Plagued by malaria, typhoid
In a chat with the owner of the hospital, Mohammed, it was learnt that three major diseases are mostly presented by residents – malaria and typhoid.
He also said tuberculosis and HIV are sparsely detected but that such patients are always referred to the Alimosho General Hospital, Igando, for better and free treatment.
Corroborating Dr. Mohammed’s position on diseases prevalent in Alaba Rago, one of the drug store owners, Usman Danbara, who, from all indications enjoys good patronage from residents and traders alike, affirmed that Malaria, typhoid and infections were the major cases for which he dispenses drugs for treatment.
He, however, added sexually transmitted infections and diarrhoea in children, to the list.
I inherited birthing skills from my late mother – TBA
When our correspondent met with one of the TBAs who usually assist with child delivery, Mrs. Arafat Ahmed, she revealed inheriting the skill from her late mother and had lost count of the women she helped.
The 54-year-old grandmother from Adamawa State said she has been a TBA for over 27 years and boasted about not recording any complications.
She, however, recognised the place of government-owned hospitals manned by trained healthcare workers when it comes to maternal/infant care.
She said, “I help women to have their babies. Sometimes, it is easy and sometimes, it is not. But I have mastered the job. When I suspect complications in any pregnant woman that I can’t handle, I will send the woman to the hospital. Not because I don’t have the skills, but because the hospital has more equipment to help the woman.
“My mother warned me not to handle any job that is too complicated and assured me that nobody will die in my hands. I have been doing that and when there is a complication, I will advise the person to go to Ojo or Alimosho General Hospitals.
“I am a Muslim and I am married to a Muslim too. I am the major birth attendant here because there are no hospitals within this place. In case of emergency delivery, it may be too late for the mother and the child. So, the people here come for me.”
Also, speaking on the frequency with which the women in the slum give birth, she said, “The women here are very fertile. It is Allah that gives children. I get plenty of jobs from them. At least, I normally have two deliveries every week and sometimes, more depending. Some of them have five children; some have less and some more.”
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