Monday, July 29, 2013

Nigeria: Dangerous country to be a mother

A pregnant woman

By John Awe
The Guardian, Thursday 25, July 2013

Bungee jumping is a crazy sport where people jump off cliffs and other lethal heights with ropes tied to their ankles. You would think that is insanely dangerous, right? Newsflash: bungee jumping is several times safer than delivering a baby in Nigeria! It’s not hearsay; it’s statistically established. There is one death for every 500,000 bungee jumps, whereas there is roughly 500 to 800 deaths for every 100,000 live births in Nigeria.

A few more grim facts to pour a bucket of cold water on Nigerian husbands tonight: 11, 600 women lost their lives during childbirth in the first three months of this year according to the Society of Gynaecology and Obstetrics of Nigeria. Last year the World Health Organization (WHO), United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) reported that maternal mortality had been halved in the last 20 years in most regions of the world, but regretted that sub-Saharan Africa, led by Nigeria continued to lag behind.

In May, the United Kingdom's International Development Minister, Ms. Lynne Featherstone, on a visit to Nigeria announced that Nigeria currently accounts for 10 per cent of the world's maternal mortality. This news would absolutely scandalise us as a nation if we weren’t otherwise so busy seeing to the fertilisation of the surviving child-bearing female adults.

And these dreadful statistics are only from reported cases. How many more women die quietly of pregnancy-related complications in their homes, unregistered maternity centres, some dingy rooms of iya abiyes (local midwives) or even in some of the so called private clinics with poor equipment and poorer personnel all over the country? Many would argue, quite justifiably, that nearly as many as the reported maternal deaths go unreported across Nigeria. To provide some insight, WHO’s records for 2003 suggest that two-thirds of the births in Nigeria in that year occurred at home.

In the face of the horrible statistics, it takes the stoic fatalism of Nigerians to keep the maternities and neonatal clinics bustling with activities every day, all year round. To many, the statistics are distant and even unreal; just cold figures. But like the American journalist and author, Paul Brodeur, once famously remarked, statistics are human beings with the tears wiped off. These numbers actually represent needlessly wasted mothers, daughters, daughters-in-law, aunts and sisters of living people. They represent dashed hopes, destroyed destinies and deeply-seated sorrow and pain in many hearts scattered across the country.

To those whose relatives, neighbours, friends and colleagues have recently swelled these statistics, the import of Brodeur’s remark will ring home more stridently; as those who very nearly become part of the statistics themselves. Belonging to the latter category is one Mrs Cordelia Ifechukwude, whose story was reported in the media a couple of weeks ago. Ifechukwude had a protracted labour in a private hospital in Alakuko, a suburb of Lagos. The baby ultimately went into distress and none of the nurses on duty noticed. It ultimately died and the mother’s womb was infected. The lady was in the throes of death when her husband decided to rush her to Ayinke House, General Hospital, Ikeja, where her life was saved.

Ifechukwude’s case illustrates how very easily an otherwise healthy pregnant woman can lose the battle for life in many of the hospitals in Nigeria today. There is nobody ensuring that anyone who opens a hospital is qualified or equipped to do so. Long term hospital cleaners and auxiliary nurses have been known to open medical practices in Nigeria with no one to challenge them until they commit blue murder, literally. It is only then that there is a circus of government officials, medical authorities and policemen, threatening fire and brimstones on quacks.

Even where a doctor has the competence to open a private practice, shouldn’t there be a body to go round regularly to ensure that they have basic equipment and competent support medical personnel at all times? In Ifechukwude’s case, for instance, the hospital owner was said to be a qualified doctor, who had a regular employment elsewhere in Lagos, with the result that he was hardly available to monitor his patients. In his absence, the nurses held court, and some of them, according to Ifechukwude, were so crude that they believed assisted delivery entailed aggressively pressing the protruding belly of the mother to force the baby out.

Sad still is the fact that when there are cases of blatant medical malpractices against some of these hospitals there are no visible repercussions that others can learn from. Ifechukwude, for instance, alleged that she filed a petition with the medical council to no avail. The hospital was only in the news again after a fresh scandal was blown open by another patient. All these factors make private hospitals in Nigeria a dangerous gamble for women seeking to deliver babies.

The public hospitals are by far safer in Nigeria. For one thing, the chances of being delivered of a baby by an iron bender are quite remote. For another thing, even when you are unlucky to have an inexperienced house officer handling your case, there is always a roaming professor or senior consultant, with a dozen medical students in tow, who comes in at the nick of time to save the day.
Of course the public hospitals have their own problems. They are obviously underfunded, overstretched and over-burdened; probably the same reasons for which they tend to breed a rich specimen of impatient, grouchy, and nasty medical personnel. The nurses particularly treat the patients and their relatives as though they were some of the ailments the hospitals were set up to cure. And by some queer arrangements the nastiest of the nurses get sent to the neonatal wards. It would shock many to know that in this day and age pregnant women admitted for delivery still have to sit on straight-backed chairs overnight in the absence of bed-space in Lagos General Hospitals. They call it ‘sit-out’; their colleagues in other climes would no doubt call it shameful. But many women are opting to endure this and be alive to hold their babies than take a gamble with their lives in the practically unregulated private medical practice space in Nigeria.

How hard can it be for a government to supervise the quality of care being rendered to its citizens? How difficult is it for government to ensure that the public hospitals have the basic amenities to dispense care to the citizens? How difficult is it to set up a few world-class public hospitals that women in sub Saharan Africa can flock to for safe delivery of their babies? Why is it that no state governor has made a priority of having such a hospital till date? The Lagos State Government deserves some commendation for building new General Hospitals, but if pregnant women are still being turned back or having to sit-out for lack of bed space, it is clearly not doing enough.

Anyone who could have done something to prevent Nigeria from getting to this sorry pass has blood on his hands. So do all those who can do something now, but choose not to. It is a crying shame that a matador being ushered into an arena with an incensed 600kg bull stands a far better chance of emerging alive than a pregnant woman being wheeled into the labour room of a hospital in Nigeria.

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