Abandoned PHC: Badagry community at mercy of preventable maternal. infant deaths

Chijioke Iremeka

Daily, residents of Gberefu Community, a fishing Island in the Badagry Local Government Area of Lagos State, count their losses as the only Primary Health Centre built and equipped to make healthcare easily accessible under the Millennium Development Goals Project, 2012, rots away, leading to preventable deaths. Pregnant women on this island still plagued by cringing slavery history look forward to childbirth in trepidation as CHIJIOKE IREMEKA writes

At 22, Sidin Oyeleye, was content being a fisherman and looked forward to settling down and raising a small family. But that dream was cut short when he was unable to access prompt medical intervention in the only primary health centre located in his community, Gberefu after being involved in a boat accident on the high sea.

He breathed his last immediately as soon as some frantic, concerned community members got his blood-soaked body to the Badagry General Hospital, after facing several hurdles.

PUNCH Healthwise learnt that Oyeleye would have been alive if the fully equipped Gberefu Primary Health Centre had been functional and first aid was administered to him.

He sustained gaping wounds and internal bleeding and according to his fellow fishermen, the sad incident occurred after he had toiled throughout the night and was about to return to land in the early hours of the morning when a heavy storm capsized his boat.

It was learnt that Oyeleye was flung overboard and he hit his chest on the edge of his boat resulting in the life-threatening injuries he sustained.

Our correspondent gathered that a resident of Ilaje, one of the riverine communities in Gberefu, who witnessed the incident, hauled the unconscious fisherman into his boat and sailed back to the shores.

Rich in history, lacking healthcare facility

Oyeleye’s death could have been prevented if the Gberefu community with a population of over 16, 000 had a functional hospital. The only PHC in the community lay in ruins, with all equipment rotting away due to a shortage of manpower and the alleged government’s negligence.

Based on history, Gberefu played a prominent role during the slave trade era and was dubbed the ‘route of journey to unknown destination’ in Badagry.

PUNCH Healthwise learnt that while in this coastal community, heavily chained slaves are forced to drink water from the ‘Attenuation Well’, which erases their memories and then they trek to berthing ships and taken on a long, torturous journey to Europe.

According to the Regent of Gberefu Community, Chief Kotopa Komi, who told our correspondent that the late Oyeleye was his cousin, his death was quite painful because they could not get immediate medical intervention required.

Looking pained, he recounted, “We were here one morning arranging our nets for the next fishing trip, when Oyeleye, who had gone for an all-night fishing expedition was brought back with blood on his chest.

“On seeing his condition, people rushed towards him but as he wanted to talk, blood came out of his mouth. His assistant said they encountered strong waves which tumbled their boat.

“He lost all his night catch and the impact of the accident was severe. We quickly gathered to take him to Badagry General Hospital for immediate medical attention as there was no medical centre in this community.

“We faced a big challenge of how to carry him to the hospital because there was no vehicle to take him to our small jetty where he could be ferried to the Pathfinder Jetty, from where he would be driven to the hospital.

The traditional ruler said another option would have been to use a motorcycle but it would be difficult riding through the sandy terrain to the point where a boat can carry him out of the Island.

“Finally, when we managed to carry him out of Gberefu, he gave up the ghost as soon as we got to land,” Komi said with bloodshot eyes.

“The health centre that would have offered him first aid was not working. If it were, I’m sure he would have been stabilised before being referred.

“He was certified dead by a doctor on duty. The doctor said he died of internal injury and excessive bleeding. We cried and mourned him. He was a victim of government negligence and inaction.

“We thought the government would act after his death, but till now, the health centre is still abandoned. This is the only health centre in a community that has over 16, 000 men, women and children. We are farmers and fishermen; we need health care.

‘Our pregnant women, children are dying’

“Not having a functional PHC has caused us preventable deaths. My people don’t have any hospital around to go to when there is an emergency. Even pregnant women don’t attend antenatal here, they make use of traditional birth attendants. They also can’t go to Badagry for antenatal because of lack of money and the distance. Our pregnant women and babies are dying. Women here usually lose their pregnancies.”

According to the United Nations Children’s Fund, the antenatal period presents opportunities to reach pregnant women with interventions that may be vital to their health and well-being, and that of their infants.

“Receiving antenatal care at least four times increases the likelihood of receiving effective maternal health interventions during the antenatal period,” UNICEF stated.

‘TBAs can’t save our women, babies’

PUNCH Healthwise learnt that not long ago, 33-year-old Bukola Aiyeolowo and her newborn died due to the inability to access prompt healthcare.

The mother of two, died while being helped by TBAs in the community to birth her third child.

It was gathered that she went into labour at night and developed complications, which the TBAs were ill-equipped to manage.

According to a resident, Mrs Tanimola Ogunbiyi, who narrated what transpired to our correspondent, when all attempts failed to have her deliver the baby, a nurse was invited but before the woman could arrive, they lost both mother and baby

“The baby was the first to die in the womb. As soon as the baby died, Aiyeolowo started coughing and eventually gave birth. She died afterwards. This is what we experience in this community,” she lamented.

Preventable maternal deaths

800 women die daily from preventable causes related to pregnancy and childbirth, according to the World Health Organisation.

The WHO noted that care by skilled health professionals before, during and after childbirth can save the lives of women and newborns.

In a similar development, another resident, Sola Abu, Told PUNCH Healthwise that she lost her child while being attended to by TBA’s delivery. She, however, counts herself lucky to have survived the ordeal that left her incapacitated for months.

According to her, going to Badagry to give birth means arranging with a bike man and a boatman ahead of the due date, which she noted may not always work as planned.

“Labour comes unannounced, which is why I invited TBA to help me with the delivery. It is the same with other women here. The majority of us are now scared of getting pregnant because of what we see and hear. Many Gberefu mothers don’t get proper antenatal care, apart from a few that occasionally go to Badagry General Hospital.

“We want our health centre to be re-opened and equipped to save our lives. We need trained midwives and doctors to lessen our burden,” Abu appealed.

Accident victims taken to Benin Republic for immediate response

Speaking further, the Regent revealed that they usually do not get prompt emergency response in Badagry General Hospital, and so, they are left with no choice but to take critically injured accident victims to Benin Republic for treatment.

He said, “We spend more going there but their response time is short. We have had experiences that shaped our decision. Apart from Oyeleye’s death, there are other cases. We gained some and lost some. Gberefu Health Centre is all that we need right now.

An abandoned, rotting PHC

PUNCH Healthwise learnt that Gberefu PHC is a non-flagship comprehensive PHC, meant to operate for eight hours without doctor’s coverage and can be best referred to as a health post that operates two shifts – morning and afternoon.

According to the residents, the PHC was commissioned by a former Local Government Chairman, the late Moses Hosintode, in 2012, but became non-functional shortly after.

The only visible equipment that is standing, aside from the dilapidated structure is a rusty 400-capacity power generator.

During PUNCH Healthwise’s visits to the centre, it was discovered that the building itself had been taken over by bats, reptiles and thickets.

A resident, Miss Bose Komi, who was among the Community Health Extension Workers that carried out routine Immunisation when the facility was functional, blamed the community members and health workers for crippling the place.

She said, “The health workers complained that people were not coming to the centre, but the women said anytime they visit the centre, the nurses were never around

“This was their reason for always going to Badagry for antenatal services. Others started patronising TBAs.

“The women also complained that the nurses don’t stay in the facility at night and that they are scared of coming there and not meeting anyone if they go into labour at night. This made them not bother going there at all when they go into labour.”

Speaking on the state of the abandoned PHC, a youth leader, Mr Jimoh Salako affirmed that the facility is rotting away.

He said, “Some time ago, some nurses came to the late traditional ruler and complained that women weren’t coming for antenatal. This made him hold a meeting with all the BTAs in the community and ask them to stop treating pregnant women. This pushed the women back to the centre.

“At some point, the villagers also complained that the nurses stopped coming and they also stopped going to the PHC.

“However, we are appealing to the state government to put the PHC in good shape to reduce the cost and stress our people are going through. The government should revisit the place and increase its capacity to accommodate more people as the population here keeps expanding.

“We no longer want the three-room health centre. We need something bigger that would have a hostel to house the nurses, midwives, doctors and other professionals that will be working there. I know that transportation was among the challenges that made the health workers stop coming.

Chief Nursing Office unaware PHC not operating

Also, when contacted, the Chief Nursing Officer, Patience Ogunbiyi, who headed the team that worked at the PHC, claimed not to know why the place was no longer functional as she left nine years ago and now works at the Amuwo-Odofin Health Centre in Festac.

“The only thing I would say is that the people there don’t like going to the health centre. Maybe because everything was free. But they have a supportive traditional ruler who usually visits the centre. I can’t say much,” she said.

No doctor to 16, 000 residents is against WHO standard – Physician

According to a Consultant Gynaecologist and Obstetrician at Epe General Hospital, Epe Lagos State, Dr Cynthia Okafor, the WHO standard recommendation on doctor to patients ratio is a doctor to 600 patients.

She noted that in a situation where over 16,000 residents of Gberefu, especially pregnant women do not have access to a single doctor, will increase maternal/child mortality.

“Without medical doctors attending to pregnant women in this community, any little complication can become fatal. Our government need to do something about the status of the PHC in Gberefu,” he said.

Doctor’s presence attracts patients to PHCs – Gynaecologists

A Consultant Gynaecologist and Obstetrician at Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Dr Babatunde Rosiji, said if patients know that they will not see a doctor at a PHC, they would not go there to avoid wasting time and money.

He noted that patients will receive better treatment in their locality because the doctors there understand the terrain, which is the reason why the government established PHC.

“It is meant to bring health care closer to the people under the Universal Health Coverage system,” he added.

According to Rosiji, who is also the South-West Chairman of the Nigeria Medical Association, “The primary healthcare system in Nigeria will work if incentives are given to health workers posted there. This will attract them.

“We need to think of UHC. UHC is meant to strengthen the primary healthcare system. But how workable is the primary healthcare system in Nigeria? Who are the health workers at the PHCs? How many doctors and nurses are there? You will be surprised that out of the 774 local government areas in Nigeria, it will be a luxury to have 200 doctors covering these 774 LGAs.

“If we want PHCs to be close to the people, then health centres in the suburbs should have doctors. I should be able to see a nurse there. That is when the PHC will work but what do we have in Nigeria?”

“The point I am making is that we need to improve the quality of care that we are providing at the primary healthcare centres because of the requisite tasks that we have there.

“So until we change our priority. I’m not only looking at the money channelled to the sector and what they do with it but staffing the place with qualified workers is more important. There should be laboratory scientists, doctors, nurses, and midwives there.”

When PUNCH Healthwise visited the Badagry Local Government Council to know why the Gberefu PHC was abandoned, and how to get it back on its feet, the Public Affairs Officer, Mrs Oluwafunke Yomiojo said the major reason for the closure of the PHC was a shortage of workers and resources across the board.

“However, the Chairman, Onilude Adeniran, is working on it. It would soon be resolved and reopened. But in the meantime, we advise them to use Marina PHC, which also falls within the same ward pending when the PHC is reopened.

“I don’t know exactly when but we look forward to seeing it happening soon. Apart from doctors and nurses, other health workers would be needed for the effective running of the centre. We are on it,” Yomiojo assured.

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