Medical Care: The Good, The Interesting, The Dusty

I have had the occasion to visit hospitals in three states here in Northern Nigeria- Bauchi, Kano and Sokoto.  Each state, Bauchi the most recent, has a teaching hospital where according to our insurance provider, a higher standard of care is given. Medical care and facilities here are different in many ways than at home. Some differences are cultural, others local procedures and requirements, lack of adequate power and sanitation, and others, I just don’t have a clue as to why.

Bedside manner and ease of access is definitely a plus for the medical personnel with whom I have had to interact. Of course, since there are no landlines in these parts, one must call the doctor, physical therapist, radiologist, pharmacist, nurse on his/her handset (cell phone)..and they answer! You’re not forced to cue for office visits when a phone discussion can address the problem.

Punctuality is a concern, but its best to be in place before the stated hours because the time of your appointment matters less than the time of your arrival. Get there early and make the cue. I’ve also learned the cue protocol whether at the clinic, bank  or store—just ask who is last in line (usually there is no actual line, just people standing around, but the system works).

Privacy as we know it back home does not exist. I have been in exam rooms where as many as three doctors are seeing patients. Medical staff, nurses, clerks and sundry individuals are in and out of the room. Just knock on the door and enter (you don’t have to wait for permission). Examinations, consultations, related and unrelated problem solving all occur at the same time—it’s amazing. HIPPA infractions abound!

Hygiene and sanitation are different. Sometimes exam gloves are worn, but take your wipes for tables and other equipment. Many places have jalousie windows and are open to the elements so there’s always a layer of dust on everything!

Finally, the cost of medications is very attractive. There is some concern about fake drugs, but certified international drug brands are much less expensive.

"Girls and Women’s Education: It is a RIGHT—Make it RIGHT" Global Action Week

The theme for the 2011 Global Action Week Celebration is no more appropriate to any other developing region I have visited than northern Nigeria. Women and girls occupy the bottom rungs of this complex society whose traditional cultural and religious mores and dire economic conditions conscript women to lives of illiteracy and second class citizenship.  Girl children are denied education and often sent out on the street to ‘hawk’ or sell goods to help support their family or are married off for the dowry.  Marriage is arranged for girls as young as 12, 13 and 14 years of age as a first, second, third or fourth wife in the Islamic community and sometimes just as early in the Christian community. 

In the two states in which this project operates Sokoto and Bauchi between 34% and 39% of girls attend primary school. About 88% of girls between the ages of 6 and 15 are illiterate.  According to the World Health Organization, the HIV/AIDS rate in Nigeria is one of the highest in the world with Nigeria accounting for about 10% of world wide rate of infected persons. Of course the rate among women and girls is soaring.  A number of national and international organizations have health and education programs aimed at shifting attitudes toward education for girls.

I’ve had a number of rewarding experiences during my stay in Nigeria; among the most rewarding was the opportunity to participate in one of the Global Action Week activities coordinated by one of the project’s state partners.  Helen, Desk Officer for CSACEFA (Civil Society Action Coalition on Education for All) planned a series of community engagements around the international theme.  Women from all walks of life were organized in teams and went to schools in towns and villages to share personal stories about how education has impacted their lives.  I told Helen I wanted to support this effort in any way possible.

We arrive at Yilwa: Anita, Maryam, Helen , Ernestine,
the reporter and driver Ephraim

 The presentations had to be delayed as a result of continued unrest in the state.  Project vehicles were still being restricted to the compound, so ‘car hires’ had to be arranged in order to carry out events. I was not able to attend the first presentation in Alkaleri, but was pleasantly surprised when I was asked to attend the program in the village of Yilwa in the Dass local government, instead of another meeting.  One hired car was not adequate for 6 adult passengers, including a local reporter, so Helen decided to take her personal vehicle which was driven by a project driver.  The village was a little more than an hour’s drive from our office.  We stopped along the road to pick up Ernestine, a founding member of the Women's Commission Club of Bauchi. (It's so cool. They wear specially designed wrappers that include their logo.

We veered off the main road and travel along a narrow dirt road, past farming plots, mango groves and through a wooded area before coming to the village.  A crowd had gathered in anticipation of our visit.  Though the program targeted 45-50 girls, it seemed most of the village turned out for the event.

We meet the tribal elders

First, protocols had to  be observed. We were greeted by the School’s Headmaster and local government representative and then taken to greet the traditional ruler. ( I was a little embarrassed.Yilwa is a traditional Islamic village. Women are required to cover their head and shoulders.)  Many other times I had carried a shawl in my backpack in case it was needed for situations such as this, but not that day! And neither of the other ladies had an extra.  Fortunately, understanding and compassion is often given to foreigners for such cultural lapses.

Seeking help for my introduction in Hausa

We introduced ourselves and Helen provided information on the program and thanked the ruler for accommodating the program.   

Maryam makes presentation to LGA official

The presentation took place outside. Desks and chairs from the school were placed in a semi-circle under a large tree for the guests, others stood around to complete the circle. Maryam, a staff member who works with the OVC (Orphans and Vulnerable Children) component and a title holder in her community, was the main speaker.

Skit: Family did not believe in education for girls

Women from the Yilwa community perform skit

 In addition to our presentations, women and girls from the village performed a skit they had put together.  It was a powerful story of two families, one who encouraged their daughter to continue her education; the other against education for girls beyond primary and focused on the economic support the girl needed to provide to help the family.  The educated girl married well and brought gifts back to her family while the economic situation of the undereducated girl and her family did not change significantly.

Helen and reporter interview student

After the program, girls who are still in school and some who had dropped out were interviewed about their thoughts on the value of education plans. Realizing they had done a disservice to their daughters by limiting their education, some older women were in tears after the program. Yet it is evident that traditional roles for women are slowly changing within the context of the cultural and religion.  Educated women make better wives because they are more capable of taking care of the home and children, is the focal message.

 Global Action Week

CSACEFA

Necessity--The Mother of Invention

Yes, I am a caffeine addict. My form of choice is coffee (though a cold Coke or Snickers are sometimes good substitutes) . I moaned and groaned a bit about having been brought Peets coffee beans with no coffee grinder to be found anywhere ...except the one I bought from a little shop in Sokoto owned and run by some Chinese people.  The gadget cost about 500 Naira ($3) but raised enough suspicion about its function and quality that I insisted on knowing the stores' return policy before turning over the cash. Sure enough, a handful of coffee beans produced less than 1/8th teaspoon of finer than espresso grind powder.  Most of the beans fell between the gears. I returned it the next day.


In my frustration, two items on the desk grabbed my attention and I thought about helping my mother make biscuits on Saturday mornings when a rolling pin was nowhere to be found..Ah ha!

Democracy Day--Bomb Blasts

Today (Monday) is a public holiday in Nigeria. May 29th, the day set aside for Nigerians at home and abroad to celebrate the  twelfth anniversary of democratic rule.  This year the day coincided with the inauguration of the newly elected president Goodluck Jonathan, for  whom many in the country have high hopes to advance democratic processes here. There is much yet to be done to overcome years of 'business as usual' according to the attached article.  

President Goodluck Ebele Jonathan @ inauguration

On the Road…..Again

Since my return to Bauchi in mid-April, my work with the State College of Education had been delayed.  Unrest surrounding national elections limited movement of project vehicles, first within the local government area, then with prohibition from leaving the compound at all.  The death of Bin Laden then generated anti-western sympathies by some in Muslim communities.  The transport limitation meant one of the projects drivers had to be sent in his private car to pick me up and take me to the office.  Staff holding activities outside the immediate area was advised to hire private vehicles.

So, about two weeks ago, the coordinator of the Teacher Education component and I headed to Azare—about a two and one-half hours drive from Bauchi.  A hatchback that looked very similar to my cousin’s first car which was affectionately known as the “bubble car” and its driver were hired for the trip. Though the make and model of the car escapes me, believe me, it was vintage!  The average daily temperature has been about 37.7˚C or right around 100˚F, so having air conditioning was one of the requirements for a hired vehicle.

Well, the bubble car was air-conditioned, I think.  There was cool air for a while and then there was just air.  Turn up the fan, my colleague directed the driver.  The air got no cooler.  My clothes were sticking by the time we got to our destination.

Safety is another condition which also means the car should be in good repair.  The bubble car ‘floated’ every time we hit a dip in the road; swayed on curves and shuddered when slowing for turns.  Now, I don’t have to submit a query to the guys on Car Talk to know there were serious, shock, strut, and maybe transmission issues with this particular car!  I agreed to go back the next day because my engagement with the COE had already been delayed. There was no way I’d travel in this car again! A different car was secured for the next day and following week of my travel to and from the college.

I leave Bauchi on Tuesdays and return Thursday mornings. Two nights in Azare. Originally the plan was for me to spend an extended amount of time there—1-2 months, which would limit the support I could provide to other  TE activities. Additionally there are security concerns regarding Azare.

 During the elections horrible violence occurred there. Dozens of young people, members of the National Youth Service Corps were murdered in post-election violence.  The Corpers, as they are commonly called, are university graduates who are required to commit one year to community service after graduation.  As I understand it, the Corpers are assigned to communities/ areas of the country different than the one in which they live in an attempt to build a sense of national spirit and reduction of the tribalism which exists in various regions. The Corpers usually work as teachers, but were assigned to work with the elections commission throughout the country in a move to help ensure a credible election process and have technologically savvy operators for the new electronic voter registration system.  Everyone I’ve spoken with in Azare, the Provost, head of campus security, students and others express repulsion and embarrassment over the tragedy. Nothing like that had ever happened.  But senseless, barbaric violence knows no bounds. Poverty, illiteracy, mob-mentality—a deadly mix for sure. 

Reassurances and additional security plans are in place.     So, I’ll pack up my things every week to prepare for the drive to Azare.  Packing up means checking out of my room in Bauchi, storing my belongings with the hotel, in addition to preparing a bag for the two nights stay.

My digs in Azare are interesting—a new structure opened for about 6 months, at which generator power is only provided from 7pm until 6am.  It’s located in the GRA, but like in most of the country there is no sustained electrical power. Even when the current flows from NEPA (the power company) it’s not strong enough operate the room’s a/c unit.  Did I mention it’s hot?  

Steve Is Going Home

One of my colleagues, the last to arrive, has resigned and tonight will be headed back to his home on the west coast of the US after a visit with friends and family in Turkey.  It appears his teaching assignments did not materialize as he expected-- and remaining tasks were not sufficiently engaging for him. In addition, he came after the rest of us because of a health challenge, so he decided to call it quits. Even though my contact with Steve and the group in Kano has been limited, he will be missed.  Steve (and his wife, I think) converted to Islam some years ago during his stay in Ethiopia and has added to my understanding of the religion. Well connected in diplomatic circles, he was instrumental in coordinating a vital security briefing prior to the elections.

Car trip from Abuja

Iso lafiya Steve.  Sai wani lokoci. Safe journey.

A Windy Mother’s Day

As I sat around surfing the net, catching up on some reading and generally “vegging out”, suddenly the windows of my 9^th floor room rattled--loudly.  The curtains billowed and the wind sounded pretty ominous, much like the winds of a hurricane at home.  I got up to look out the window.  Below the deep end of the pool was littered with pods from a nearby acacia tree.  Several trees bowed in submission to the wind.  The fiery flowers of a Royal Ponciana were snapped off in the wind. The mountains, usually visible in the distance were obscured by the sand filled wind.  I thought the Harmattan of winter was dusty, but it was nothing like this.  

The mountains have disappeared

Smells like rain, but it hasn’t appeared yet.  Leather (plastic) bags and other debris swirl through the air.  Various leaves and what looks like caulking blow into my room through the a/c unit!  I don’t want to fully open the curtains because they provide an additional barrier to the winds.  Instead, I opt to go back and forth to the window which runs more than ¾  the width of the room, peering out from the corner behind a chair.  Maybe it looks worse than it actually is.  A few young men move chairs around the pool area and the headlights of cars can be made out moving along the street.

At last the rain begins. After some time, the air clears, the mountains are again visible in the distance. Now there is thunder more wind and rain.  I suppose this has all been Mother Natures way of announcing the start of the rainy season.