By Farzeen Tariq, JD Candidate at Northwestern Law
The interdisciplinary Northwestern Access to Health Project recently returned from eight days of fieldwork in Lagos, Nigeria, conducting a health and human rights needs assessment in collaboration with the Justice and Empowerment Initiative (JEI), Access to Health’s partner organization. JEI is a Nigerian non-profit focused on promoting social and economic rights through the training and support of community paralegals, provision of pro-bono legal services, facilitation of community organizing, and support for a growing Nigerian Slum/Informal Settlement Federation. The Federation is made up of over 70 different slum and informal settlements across Lagos, from which the Federation identified a Health Board to work closely with our Access to Health team to troubleshoot health issues in the informal settlements.
Our interdisciplinary team consisted of M.B.A, M.D, and J.D. students, Professors Shannon Galvin (Feinberg) and Juliet Sorensen (Pritzker Law), and Anna Maitland, Pritzker Law’s Schuette Clinical Fellow in Health and Human Rights. The focus of the assessment was on malaria, fire safety, maternal health, HIV/AIDS, and water and sanitation.
The assessment included communities, such as Oko Agbun, that are established primarily on stilts above sewage water. As we canoed through the water to reach our first meeting, we saw open defecation and waste disposal around us. A number of the partner communities are built on swamps, have no sewage system and thus use hanging toilets and open defecation, which leads to polluted water ways and illness from flooding, as well as lack of safe drinking water. Such environments are also a breeding ground for malaria and other water-borne diseases.
After observing the apparent open defecation and lack of clean water, we inquired about other existing infrastructure in the informal settlements, such as pharmacies, doctors, nurses, and access to health centers. The communities had limited medication available at “chemist’s shops” and did not have any pharmacies. Most community members resorted to herbal medication, and did not comply with dosage requirements for medications. For example, most people took herbs for illnesses such as malaria, and when they took an antibiotic/quinine to treat malaria, they stopped taking it as their symptoms got better.
Delivery rooms had no medical supplies or anesthetics. The communities lacked basic infrastructure, such as electricity, clean water, and even physical space.
Access to medical professionals is limited and sometimes impossible. For example, in communities such as Tarkwa Bay, a hospital is a 20 minute boat ride and an hour long car ride away. Most people did not own boats. Hence, a woman in labor could bleed to death before she could reach the hospital. Finally, the general level of health literacy was low. For example, there was a lack of knowledge about transmission, prevention, testing, and treatment of malaria and HIV/AIDS. However, majority of the community members were very eager for health education. As a continuation of our project, we will develop health education plans and a ground up, sustainable, capacity-building intervention, where communities will use their existing infrastructure to address their health issues and we will serve as a liaison between them and their goals.
We made many friends, such as Bimbo Oshobe, whose perseverance inspired us. Bimbo is a leader of the Federation and works closely with JEI. She was formerly a resident of Badia East, the community which was partially demolished first in February 2013 and again in December of 2015, and continues to be the subject of a World Bank safeguards process as a result of these forced evictions. She currently is staying over two hours away from Lagos near Badagry, and had to travel over 4 hours each day in public transport to help us with our fieldwork each day. On some nights she got home only to take care of her son, cook some small food, and turn around and get back on transport to come and meet us. We met paralegals like Samuel, Baba, and Sani Mohammed, who were adamant about transforming the conditions of their communities. Everyone welcomed us with warm arms and provided us with authentic information about the health issues of their communities and insights on the existing health infrastructure available to the country’s forgotten majority.
In the words of Dr. Sade Ogunsola, the Provost of Lagos University Teaching Hospital, “there is order in disorder” in Lagos. We left Nigeria with the scrumptious scents of Jollof rice and suya, the mischievous glint in Bimbo’s son’s eyes as he ran around taking selfies on our phones, the can-do determination that Bimbo gracefully exuded, the witty ways Samuel and Rasheed joked with us, the government’s ignorance, the forgotten majority’s perseverance and optimism, and the watchwords of the Federation: Information = Power; and Unity = Our Strength.
edited by Caitlin Pegg, NPHR blog manager