The Agboyi-Owode community, one of the communities in Agboyi-Ketu area of Lagos State, has been in existence for 600 years. Comprising six communities with about 30,000 people, the community has been burdened by an almost non-existent healthcare given that only one Primary Healthcare Centre caters for all pregnant women, nursing mothers and their children, among others. Rebecca Ejifoma who sought the opinion of 14 pregnant women and nursing mothers in the community, report that they were unanimous in their quest for a decent primary healthcare centre, a standard hospital, and orthodox medicine, among several other demands, all geared to save mother and child given that the community is also bugged with lack of access roads, quality education, portable water and even employment opportunities
The time was 6am on a certain Friday and the sun was just peeping through the horizon when this reporter set out from her Agbara residence to the Ketu area of Lagos State. The quest appeared simple- sample the opinions of nursing and pregnant mothers of Agboyi-Owode community, one of the communities in Agboyi-Ketu area of the state.
But as cliche as the saying that ‘things never appear as simple as they look’ is, that certainly rang true in this sojourn to seek the truth.
From Ketu junction, it took 10 kilometres bike ride for N500 to the shore of the murky lake that sandwiches community. With no life jacket in view, about eight passengers mounted the rickety canoe at N50 per person. The five minutes trip led us to the Agboyi III community, and we began to find our way gradually.
Makeup of Agboyi-Owode Community
Agboyi-Owode is the lagoon part of Agboyi-Ketu area of Lagos State. It comprises six communities with about 30,000 people. The communities include Agboyi I, Agboyi II, Agboyi III, Okunagbon, Papa, and Ilaje. Agboyi-Owode has existed for about 600 years with only one Primary Healthcare Centre (PHC) for all pregnant women, nursing mothers and their children among others. While THISDAY toured the communities, which are majorly filled with sprawling old buildings, residents summoned zeal to air their plights, having given up hope of ever getting succor or attention to their medical and basic needs.
Predicament
For the people of Agboyi-Owode, their predicament sticks out a mile. First, pregnant women in labour at midnight resolve to self-medicate, using paracetamol to kill pain. Others range from the 30 minutes drive from the community to Alapere to access a hospital every time a pregnant woman is in an emergency situation, absence of a standard hospital and health centre, absence of potable water for drinking, bathing and washing which they buy across the lagoon at N100 for a 25 litre-gallon. They also battle unstable and pricey antenatal and immunisation care for some mothers and babies, zero benefits of exclusive breastfeeding, to major use of Traditional Birth Attendants (TBAs).
At the community, the opinion of 14 pregnant women and nursing mothers were sought and they were unanimous in their quest for a decent primary healthcare centre, a standard hospital, and orthodox medicine, among several other demands, all geared to save mother and child.
Oreoluwa Olajide is heavily pregnant with her first child. She patronises the TBA in Agboyi II, the only herbal centre in the entire community. “I use Iya-alagbo (TBA) for antenatal. That is where I registered,” while explaining softly her preference for the herbal centre, she added, “I like it there and I’m more comfortable with it. They give me concoction, not oyibo (orthodox) medicine”.
Olajide also revealed to THISDAY that she paid N500 or N1,000 for antenatal at the TBA whenever she was to take something special, otherwise it is free. “I go daily, they haven’t told me how much for delivery yet.”
Ayomide Olabintan is 26 years old, and pregnant with her second child. Although she had her first child at the TBA seven years ago, she plans to have her second baby at the health centre. “I changed the place because the Iya-alagbo (TBA) woman that delivered my first baby has moved out.
“Iya-alagbo (TBA) and the health centre collect the same fee of N5,000 for registration,” she chuckled. However, Olabintan revealed that she paid N15,000 at the TBA for delivery whereas the health centre charges N20,000.
“If I fall into labour at night, I will go to the TBA. Health centres don’t work until evening, much less at night. I’ve made preparations,” Olabintan explained, smiling constantly.
Twenty-eight-year-old Kafayat Atanda is four months pregnant with her third child. Although she seemed reserved and unexposed, she skipped several questions put across to her despite the interpreter helping out in the Yoruba Language.
She stood at her wooden net doorpost in a ruined building like one under arrest. “I had all my babies at Iya-alagbo (TBA)”, she whispered, staring at the unseen. “I don’t know how much my husband paid. And I use Iya-alagbo because the health centre is expensive.”
Now, despite endorsing TBA for her child deliveries, Atanda takes her children to the PHC for immunisation, which she admits is at no cost. “I even got a mosquito net when I had my baby.”
However, on the needs of the community, the mother of three exclaimed mildly in Yoruba, “Ah! We have many things to demand. The government should build a new health centre for us. We don’t want our children to be falling sick anymore, and nobody to treat them.”
For 21 years old Aminat Lawal, it is her first pregnancy. She had no idea of the charges at the TBA she uses. In her words, “My husband pays for it. I don’t know the amount.” While the decision to use the TBA is solely her husband’s, she echoed Atanda’s claim that the health centre is more pricey than the TBA.
For the nursing mothers, Kafayat Bamigbade, a 22-year-old widow, is from Agboyi III. Sitting on a wooden stool right outside a faded ground-floor building Bamigbade said she lost her husband 10 months ago when her baby was only four months old.
“I gave birth to my baby girl at the health centre. I had my antenatal there for free, but paid N25,000 for delivery. I didn’t get anything like a mosquito net. I go there for immunisations,” says Bamigbade, the vocal woman.
The young widow is determined to hunt for another health centre outside the riverine area. Speaking passionately in both pidgin English and the English language, Bamigbade lamented, “When I want to give birth again, I won’t go to that health centre. They don’t give us anything like pampers, food and all those things a new mother gets in other hospitals.
“At my former place, if a woman gives birth, the hospital would give her pampers, baby formula, mosquito net and more. But not so in this PHC. I will look for a health centre across the lake. The health centre doesn’t do us well. I don’t know if it is because of the environment.”
Listing her needs, she said with excitement: “First, the government should give me and other women money (empowerment),” she chuckled, “I’m a widow. I hawk sachet water in Ketu with my baby on my back every day just to feed. Then the government should send nurses and doctors that will treat us well.”
“Our children need healthcare. My baby has had a cough and catarrh for a long time. I took her to the health centre, and the nurses wrote a list of medicine, which she made available to THISDAY (costing N1,700 only).” Bamigbade, however, regretted that she didn’t have the money to buy it. “So since I have paracetamol in the house, I give it to her to drink. Then I breastfeed her.”
Toyinola Bode is 25 years old. She is nursing a four-month-old baby boy, her first child. She expressed, “I had my baby at the health centre. I paid N30,000. I didn’t get a mosquito net, but the health centre at Agboyi III gave me a pack of pampers,” she grumbled, “I had my antenatal there, but I didn’t go often because I didn’t have money. It was N1,000. And I haven’t started immunisation for my baby, but my friends advised me to take my baby there, that it’s N500.”
Bode’s needs are simple. She, like the others, asked that the immunisation be made free for them. “I have no work. I learnt hairdressing but I don’t have money to start. My husband is a taxi driver”.
Ewatomi Ibrahim is a first-time mother as well, with a nine-month-old baby boy, who looks rather frail for his age. “I had my baby at Iya-alagbo (TBA). I paid more than N20,000 for delivery. I like how they treat me,” she said, smiling playfully, “And I like the TBA more than the health centre.”
As a petty trader, Ibrahim pleaded that the government should empower the women of the community, improve the health centre and send them more nurses.
For Duni Abiono, she is a mother of three. Her third baby is three months old, and she had them all at the TBA. “I gave birth at Iya-alagbo (TBA) just like my two other babies. My husband paid the bills; I have no idea what it cost.”
At the TBA just like health centres, Abiono was given herbal concoctions only during antenatal. “I like TBA. I prefer it. They treat me very well. The health workers from the PHC always come out to immunise our babies at home.”
Despite expressing a preference for TBA, the mother of three hoped that some day the state government would put more equipment in the health centre, and train more TBAs, too, for their healthy living.
Meeting Aminat Razaq, a nursing mother of a four-month-old baby in Agboyi II, was fun. She said, “I had my three babies at the TBA. I paid N7,500 for the first delivery, N10,000 for the second, and N15,000 for the third child.”
Although she uses the TBA, Razaq conceded that nursing mothers and pregnant women are not given insecticide-treated nets despite how swampy the area is. “No, we don’t get mosquito nets. I still use TBA because that is where I can afford,” she admitted.
She, however, wailed in the Yoruba language, as other female residents hanging around hailed her, “I would want the government to give us enough doctors,” the women echoed her words, “and equipment in the health centre. We need a hospital, too”. The women around cheered and hailed Razaq with clap ovations.
Alimat Azeez is nursing her second baby, who is four months old. Her first baby is two years old now. She had them both at the health centre.
Just like a few other women, she had no idea of the delivery bill; her husband made the payment, she revealed. Although she admitted that she was well-treated at the PHC, she bemoaned that she was not given a mosquito net. “I still take my baby there for immunisation.”
Azeez soon chorused the words of the others when she genuflected, “Government should give us health workers, put equipment there, and more doctors to help us. Government should please help us. We are suffering. We need good healthcare for ourselves and our babies”.
When 21-years-old Oluwatoyin Ademola heard a reporter was in the community, she dashed out of a worn-out structure, panting delightedly. “I want to speak,” she indicated in Pidgin English, with her right hand raised.
Although Ademola’s baby is already nine months old, she is yet to take him for immunisation, thereby defying recommendations from the Centre for Disease Control (CDC) that at one to two months old, babies should receive vaccines to protect them from diseases like Hepatitis B, Diphtheria, tetanus, and whooping cough, Haemophilus influenzae type b disease, Polio, Pneumococcal disease, and Rotavirus.
She recalled: “I gave birth to him in my village then brought him here. I’m breastfeeding and giving him food. But when the next immunisation session begins, I will take my baby to the health centre,”. She further pleaded to the state government to come to their rescue before they get consumed in the flames of agony.
Swiftly on the heels of Ademola’s interview came Nofisat Babatunde, whose third baby is one year and two months old. Although the 28 years old swears allegiance to PHC, she doubts their plea for a better health service would be given any attention.
She recounted: “I had my three children at the health centre. I paid N20,000 for each of them. I often pay N500 for antenatal every Thursday. But immunisation is free. I was not given any mosquito net when I had my babies. So, the government should give us doctors and health workers to treat us morning and night. We struggle to feed daily. We need help.”
Another nursing mother, Rofiat Abdulrazaq is anything but reserved. She was ready to air their tales of woe. “My baby is one year and two months old. He is my first child,” she chipped in. “I gave birth to him at the health centre. I don’t know how much my husband paid for delivery. But I pay N500 for immunisation.”
And again, Abdulrazaq beckoned on the government to equip the health centre for them. “They should put a lot of equipment in it like the ones outside this river place (township).” Describing her daily struggles, she pointed out, “I hawk bread in Ketu to feed even though I trained as a hairstylist. We have no money to begin any trade. We need government empowerment so we can start small businesses.”
Abiola Michael is a nursing mum. While her first child is five years old, her second baby is a year and three months old. She explained, “I had my babies at the health centre. I paid N20,000. I was given a mosquito net, and I had my antenatal and immunisation there – both for free.”
On what her hopes were, Michael said, “The government should make the health centre better like the ones we see outside”, she switched deliberately, “I’m a trader. If the government can empower us as women, we will work hard and earn a living.”
Indeed, seeing their health needs and the challenges they face to access quality health care for the women and children, residents of Agboyi-Owode settle for TBA, who deliver pregnant women at night, and at midnight. Alternatively, pregnant women in labour or emergency cases get help from the only resident, who owns a car in the community, to drive them 30 minutes to Alapere to access a hospital.
Community Voices
Speaking with the chiefs and elders in Agboyi communities, Chief Bilaminu Adeniru Oguntola, the Olugbede of Agboyi III, lamented: “We have one health centre in Agboyi I, but it is the same old PHC. It has been for ages and that is the one the communities are using.”
Now, Taiwo Bankole is a youth and resident in the community, very eloquent and well-informed. He is one of the over 100 youth who have successfully graduated from various universities across the country. He has also witnessed the anguish of nursing mothers, pregnant women, children, and the general anxiety of his people.
His worries that “the children go to secondary school at Bariga, and Mile 12 among other far away places. Many of the youth here are unemployed despite being graduates, and that discourages the younger ones. The youth need employment, too. We need health care. Our women and children need better health care services, too to keep them alive.”
Near Death Experience at Midnight
According to Oguntola, in spite of the presence of health workers and necessary medical instruments at the health centre, it would not be like the hospitals out there.
“It is just first aid we are given at the PHC. The personnel refers patients to the hospital if they don’t have the capacity, depending on the situation of the patient. Yes, they accept pregnant women; no, they don’t have the wherewithal to do CS; and the health centre does not operate 24 hours service,” he highlighted.
In the words of the honourable, when a pregnant woman is in any emergency, “We cross the lake, then drive 30 minutes (three kilometres) to access the nearest hospital at Alapere.” He reminisced about an obnoxious incident of a pregnant woman. “I heard a heavy knock at my door around 2am. I rushed out quickly and had to take her to Alapere. If not because I have a car, ah, the lady would have died.”
There are some patients, he narrated, that do self-medication, using paracetamol to kill pain when in labour at night or midnight. Still, he expressed gratitude, “We have not recorded any deaths since we have been having the emergency cases, luckily.
“Most pregnant women fear going to the hospital because of the amount of money. In the process of trying to attend to a pregnant woman, if the case is beyond their strength, they would quickly refer the woman to the hospital.”
Health Needs
Oguntola’s list includes an urgent need for a standard hospital and medical equipment that will meet the demand of the dwellers. “Most importantly, the health workers should operate 24 hours to help us. There are some minor problems that don’t need to be taken to the hospital.
“To access hospitals, residents must first go across the lake with the help of a canoe, then take a bike or a tricycle if the sick person is too weak. We need a bridge. We have a primary school: form one to three is in another area while form four to six is somewhere away. So, we continue to clamour for a secondary school.”
Common Disease among Children
With several children under five missing out on immunisation and proper health treatment, the chief disclosed that the common diseases among children are malaria and cough.
Meanwhile, Oguntola decried lack of water and its high cost. “The major problem in the whole community is water. We buy water at N100 for 25 litres. When the former Governor, Akinwunmi Ambode, was there they did the cost for a bridge, but when the current Governor, Babajide Sanwo-Olu, came in he promised to build the bridge.
“We are suffering because of water. We were drinking, cooking with this lake water over 57 years ago until the government came with channelisation of the canal and polluted our source of water.”
Venting his displeasure in a most coordinated manner, Mr. Ogunseye Ebenezer Babatunde, a chief and Secretary of Agboyi III, divulged their yearnings.
“Any government in power is only there for a limited time. The problem we have is continuity. Once the bridge is done, other development projects will come in which will benefit the people,” he suggested, “If they do the bridge, they can connect a water pipe to the community. We experience the problem of moving building materials into this place because there is no bridge.”
Babatunde soon harped on the significance of education, which he described as key. “The current government we have –”, heaving a deep sigh and a pause, “God help us. Sometimes, they accuse us of not cooperating with them. One PHC is not enough for the entire population. One well-equipped general hospital for our women and children, especially during pregnancy.”
The Birth Attendants
Owing to the fact that the only PHC in the community closes at 4pm every Monday to Friday, residents have ensured that there are birth attendants to cater to the needs of pregnant women especially at night. One of the five TBAs is Mrs. Aishatu Jimoh. She operates in Agoyi II. Although she regretted that she wasn’t sure of her age, the elders around confirmed she is in her 90s. Despite her deem eyes, quivering voice, Jimoh, who is petite in nature, seems agile in carrying out her duties. She climbed the foot paths gently to access a chair, and we kicked off the interview.
Bending forward on the armless plastic white chair to ensure this reporter recorded her voice clearly, she recalled cheerfully in the Yoruba language, “I have been delivering pregnant women for over 10 years now. I attend the Lagos State training for TBAs at the council for training for more traditional education, which doesn’t come often.”
According to her records, Jimoh attends to over five pregnant women in a year. “But I haven’t delivered any pregnant woman this year.” When asked if she has recorded any deaths so far, she interrupted, “Olorun maaje (God forbid)! No pregnant woman has died.”
Chief Abiodun Asipa is the male TBA in Agboyi II in the last 30 years. He is about 400 metres from Jimoh.
He offered this reporter a chair, as he settled for a wooden stool beside his doorpost. “I have been doing this business for about 30 years. As TBAs, we have a group and we attend meetings. We also visit the Lagos State government whenever we are invited.
“I have a specific day I attend to pregnant women for antenatal – Thursdays. But delivery is everyday,” he noted. “Sometimes I have more than five deliveries in a month. I am not only involved in delivering pregnant women, I also attend to other health issues such as breast cancer and other related diseases.”
Just like Jimoh, Asipa administers only herbal concoctions to patients. However, he has three apprentices Including two males. He clarified, “Whenever the pregnant women need antenatal care, I direct them to a clinic where they will give them an injection,” as he clearly affirmed that no mother or child has died since he began this business.
He, therefore, pleaded: “I want the government to help us. Here we live in the riverine area. They should assist us with equipment. Sometimes at night when they bring pregnant women for delivery they have to cross the river and it is stressful.
“This equipment will reduce stress. We are more than two that are into this business in Agboyi, but I’m the only one delivering pregnant women here. Also, the government should put a modern health care centre in addition to the one in Agboyi III. Even if they decide to employ us to work there, we are ready.”
Lagos State Training for TBAs
Now, when the Lagos State government realised how much pregnant women couldn’t do without TBAs in their communities, it flagged off a six-week training and orientation programme for over 190 TBAs in the state in 2011. This way, more skilled birth attendants would be available, thereby, reducing maternal and infant mortality in the state and in the country.
The Registrar, Lagos State Traditional Medicine Board, Dr. Bodunrin Oluwa said the training is one of the statutory functions of the board. And it will enlighten the attendants on the knitty- gritty involved in child bearing as well as challenges faced in a modern world as regards mother and child mortality, adding that.
Maternal Mortality in West Africa
Today, Nigeria maternal mortality rate (MMR) according to the Nigerian Demographic and Health Survey (NDHS) of 2018, when 100,000 women go to have babies, 512 of them die in the process. This is a significant reduction from the estimate in 2015 by the World Health Organisation (WHO) which recorded 800 maternal deaths per 100,000 live births.
In a 2017 data analysis by the World Bank, it shows that while Ghana’s current MMR declined from 760 per 100,000 live births in 1990 to 308, Togo is currently at 396. Regrettably, others with leading MMR are: Guinea-Bissau at 667, Gambia at 597, Guinea at 576, Cameroon at 529, Benin Republic at 397, and Burkina Faso has the lowest at 320.
Sadly, this shows that these West African countries including Nigeria are yet to achieve the Sustainable Development Goal (SDG) target of 70 per 100,000 live births in
Truly, dwellers of Agboyi-Owode have a unanimous need – to enjoy equal access to quality health care services like other citizens in the township. If the state government would build one more health centre, and replicate the same energy as seen during political campaigns in their community, then Agboyi-Owode residents would be sure of improved maternal and child care.