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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

By: Michael Mike

In the bustling emergency ward of Jahun General Hospital’s maternity department, the rhythm of activity beats with urgency and determination, like a pulse in the air. In this hospital, Médecins Sans Frontières (MSF) collaborates with the Jigawa state Ministry of Health to provide comprehensive emergency obstetrics and newborn care and fistula care. Since commencing services in 2008, MSF teams have assisted 90,000 deliveries.
Nigeria is the third country in the world, after South Sudan and Chad, where a woman is most likely to die giving birth, according to the World Health Organisation. With an average of more than 1,000 maternal deaths per 100,000 live births each year, Nigeria is far from the global target for 2030 of less than 70 maternal deaths per 100,000 live births, as set under the UN Sustainable Development Goals.
Maternal mortality rates far exceed the country average in northern Nigeria, where more than half of the country’s estimated 200 million people live. In Jigawa state, the most significant factor is the limited access pregnant women have to antenatal care and delivery care for complications in childbirth, which frequently occur.
Unity Enuebuke, MSF Nursing Activity Manager, has been working in Jahun General Hospital for more than 10 years. “We see a lot of women with serious complications, with the most common ones being anaemia, haemorrhage and eclampsia,” she explains. The high number of patients means the maternity wards are often fully occupied, if not over capacity. Unity says, “We regularly have up to two women sharing a bed, and depending on the type of complications we see, things can escalate very quickly.”
Ramatu
Ramatu, a mother of two, suffered life-threatening eclampsia—seizures due to high blood pressure—when she delivered her first baby in Jahun hospital. This is her second time here, overcoming the considerable distance from home. “I live five hours away from Jahun General Hospital. There is no hospital where I live, and the closest one does not open at night,” she explains. In Jigawa state, many of the estimated 749 primary healthcare centres do not have the drugs, healthcare workers and medical equipment to serve the thousands of women of childbearing age, despite efforts from public health authorities, the current healthcare infrastructure does not come close to meeting the needs of the population.
This dire situation leaves pregnant women who want to attend a healthcare facility with limited choices such as giving birth at home, and if complications arise, embarking on a treacherous journey to try to reach one that is functioning.
It is also not enough that healthcare facilities are available, they must also be affordable. The economic reality in this region, worsened by soaring inflation rates, makes it difficult for people to afford hospital fees, drugs or even transportation to health facilities.
The result is that women become hesitant to go to the hospital, preferring to give birth at home with the help of more affordable traditional birth attendants, hence increasing the risk of experiencing complications.
Khadijah
Women have given birth at home for centuries, but mother’s and baby’s survival can hinge on preparing and planning for managing complications, which may also occur without warning. In Jigawa state, health professionals and facility-based delivery rates remain low with up to around 80% of deliveries occurring at home.
Nurse Unity says, “Most times, family members don’t bring the mother to the hospital until they see that the baby is not coming out and the mother herself is having seizures.”
Khadijah, a 58-year-old traditional birth attendant in Aujara community, Jigawa state, understands the value of hospital care if she can’t manage a complication, but has experienced women’s hesitation firsthand. “Some women take my advice when I say they should go to the hospital, while some refuse to go to the hospital because they say that they are used to giving birth at home.”
In many communities in Jigawa state, pregnant women often require permission from their husband or mothers-in-law to visit hospital. This practice is compounded by a trend of early marriage, at an age when women are not fully informed about pregnancy and are not physically ready to carry a child.
Khadijah explains that for some, “it is their husbands that prevent them from going to the hospital. Some men don’t see the relevance of antenatal care, while others don’t want another man to treat their wives.”
1.

What needs to be done?
To tackle maternal mortality, a multitude of factors must be addressed. State authorities and international organisations must scale up their activities and increase funding to healthcare in the region, ensuring that budget allocations for primary healthcare centres are properly utilised and thorough planning and strict implementation processes are in place. In 2023, MSF teams assisted 15,754 deliveries, performed 1,911 caesarean sections and completed 43,785 antenatal consultations. Yet, it is still a drop in the ocean when looking at the needs of women in Jigawa state.
Primary healthcare facilities, which are often the first point where pregnant women seek healthcare, need to be equipped with trained personnel, equipment and resources to manage childbirth-related complications. “Eighty two percent of the cases we receive at Jahun General Hospital are complicated cases that could have been prevented at the primary healthcare level.” says Abdulwahab Mohamed, MSF medical coordinator. “Women, especially those of childbearing age, also have to be informed about their health and wellbeing through health empowerment programmes led by state authorities or other health stakeholders”.
Pregnant women must be encouraged to go for antenatal care where they can be informed about their pregnancy journey and what to expect. Efforts must be made to mitigate cultural practices that hinder women from seeking care in medical facilities. Women should be allowed agency and given freedom to make decisions for their health.
MSF supports the Jigawa state Ministry of Health in providing comprehensive emergency obstetrics and newborn care. Our support started with vesicovaginal fistula repair in 2008, however, the project evolved into a 161-bed facility to care for pregnant women and newborns experiencing complications. MSF teams also provide maternal and neonatal healthcare in the states of Kano, Benue, Cross River, Zamfara and will open a large maternity hospital in Maiduguri in June 2024.

Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

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Ahidjo commends vigilance of security team at the UMTH gate

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Ahidjo commends vigilance of security team at the UMTH gate

By: Bodunrin Kayode

Chief Medical Director of the University of Maiduguri Teaching Hospital (UMTH) Prof Ahmed Ahidjo has commended the vigilance of the security personnel who stopped the suicide bombers from entering the facility last week.

Prof Ahidjo said that he was satisfied with the tightness of the security mounted by the personnel at the main entrance who helped save the hospital from clear damnation cooked up by boko haram suicide bombers on that black Monday night.

Prof Ahidjo who chatted casually with this reporter last week during iftah said that if the security whose name is being withheld for security reasons was not vigilant enough, it was the intention of the suicidal criminals to drive to a sensitive area in the facility and unleash worse damnation than was witnessed on that day.

” I have a strong feeling that these criminals were headed for somewhere more sensitive and busy in the facility. But God used the young man to stop them from wasting peoples lives.

“The young security was very brave because he was quite vigilant. They came with an unmarked keke napep not registered with us and were so desperate to drive into our environment by force.

” when the young man stopped them, out of desperation, they threw a food flask containing the improvised explosive device (IED) on him. But he quickly picked the thing and returned it to them. By the time the flask landed on the criminal, it exploded and sent the security boy on the ground tearing some parts of his legs.

” He sustained some injuries and we are treating him. We are happy with his performance and will surely do more for him and all his colleagues to stay alert and to continue doing more for the hospital. ” said Ahidjo

Day two, stabilizing the hospital after the daring attempt

After the entire mop up exercise in the city of Maiduguri, several people were admitted in all the major secondary hospitals in the capital city with UMTH alone treating about 100 patients with 70 on admission in different departments including the heart centre depending on where the fragments pierced into their bodies.

A youth corp member name withheld serving in Damaturu was one of those who lost his life in the Monday market explosion while several others were wounded at the third site under the post office bridge too.

As I drove into the UMTH on the second day, calm had been restored and every one went about their lives as has always being the case.

The trauma centre gate was locked and restricted with policemen making things easy for anyone who is authorized to be there for any reason.

Counting the costs through a press release

A release signed by the spokesperson of the facility Justina Anaso indicated that management was excited about the goodwill it received from well meaning Nigerians who stopped by to sympathize with them at such a trying time.

The UMTH had survived throughout the insurgency and it will not fall now.

The release went on: “The Management of the UMTH regrets to state that an unfortunate incident occurred Monday night at the hospital’s main gate involving two suicide bombers who came in with Keke Napep and were turned back twice from entering the hospital by a security guard because it was not registered.

“On their third attempt, they disembarked and wanted to force themselves in by jumping the search queue. When the guard asked them to go back and join the queue, one of them threw a food flask he was carrying at the security guard who picked it up and threw it back at him.

“It was at this point that the flask exploded bringing the security man down and the second man immediately detonated his explosive device he was wearing.

“The explosion,which took place at about 7:20 pm Monday night, resulted in casualties and varying degrees of injuries.

“Emergency response teams were immediately activated, and all affected individuals were promptly attended to and taken to appropriate care units within the hospital.

“The hospital had over 100 victims, with 25 confirmed dead and 70 patients on admission with some others discharged. These figures are what the hospital received from the Metropolis except two who were casualties at the gate of the hospital.

“We wish to assure the general public that the situation has been brought under control. Security agencies are currently on ground, working closely with the Hospital Management to secure the premises and commence full investigation into the incident.

“Hospital Services within the Facility remain operational although access may be temporarily restricted as a precautionary measure to ensure the safety of patients, staff and well-wishers.

” The Hospital Management and the entire staff appreciates and are profoundly grateful to the Federal government through his Excellency,the Vice President, the Governor of Borno State, represented by the Deputy Governor, the Honorable Minister of Health and Social Welfare who were very supportive and in touch with the hospital throughout the night of the event.

” We thank the Secretary to the State Government, Hon Commissioners, Committee of Chief Medical Directors, Medical Directors and Security forces, our hospital workers, partners with us throughout this trying period.” Said the release.

Management condemns the attack by the criminals

The release also aligned with the Governor Prof Babagana Zulum in condemning the dastardly act which was meant to forcefully send many more souls to the great beyond at a time when they were celebrating the end of the Ramadan fast.

“We would like to state that the Management strongly condemns this act of violence and extends its deepest sympathy to the families of those affected.

“We urge members of the public to remain calm and co-operate with security operatives during this period.

“The Hospital remains committed to providing the highest level of care to all victims and ensuring the safety of everyone within our facility.” Said the release.

As the days rolled by people started coming in for treatment from all corners of the town, Umaru Shehu, Nursing home and the specialist hospitals respectively at the very centre of one of the explosion sites.

The Trauma centre became like a barracks with all the seas of white coated professionals depicting the sub sectors working as a team to save lives.

Eye witnesses told this reporter that humanity was at play because we all share a common humanity with those who had died instantly and non of the team workers wanted it to be recorded that these vulnerable people came to the biggest hospital in the country and died in the process.

As at the time of writing this report more people had fallen from the different hospitals due to lack of blood to keep them going but sources said that “they went all out to get O negative from anyone” they could get to save lives because the blood bank was overwhelmed.

While some reliable sources say the mortality figure has reached 28 as at today, others told this reporter that the UMTH has recorded only 26 from the initial figure of 25.

The big questions observers keep asking about this wicked lingering war

The big questions observers keep asking about this war now is when will all this madness stop? Can’t the security managers in this country seek for help from military contractors since we don’t have enough boots on ground? Is it shameful to seek for help in terms of boots on ground to clear these criminals away? Is it not time for the chief of operations himself to create a second office here in Maiduguri and come motivate his men here himself?

Responding to the Defence Chief Oluyede who came here last week on the orders of the commander in chief, What else have we not done to support the military to win this war? Or is it really time for the government through the minister of defence to call for a seize fire and begin talks with these insurgents? Why do we pretend to be on top of the situation as the Americans did in Afghanistan until they had to leave ignominiously?

Ahidjo commends vigilance of security team at the UMTH gate

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Report any suspicious character to security operatives, Gudi Emir tells his people.

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Report any suspicious character to security operatives, Gudi Emir tells his people.

By: Yahaya Wakili

The Emir of Gudi in Yobe State, Alhaji Ismail Ahmed Dala Ibn Madugu, has called on his people to report any suspicious characters to the nearest security agents and uphold the virtues of love, sacrifice, and tolerance beyond the month of Ramadan.

The emir made the call in Gadaka, the headquarters of the emirate, in his Sallah message, which marked the end of the fasting period. He called on the people to continue to remain prayerful for peace for their leaders, the emirate, Yobe state, and the nation in general.

Alhaji Ismail Ahmed urged the community to continue supporting the policies and programs of His Excellency, Governor Hon. Dr. Mai Mala Buni CON, COMN, which he said Buni’s administration has provided us the dividends of democracy across the state, and our people were included as beneficiaries.

“Buni’s administration has done a lot for us, and we hope our people will reciprocate the gesture of the government, and the communities should live peacefully and obey the laws of the land,” the royal father said.

He charged the youths to be law-abiding for the nation and always to be self-reliant and called on all the citizens of the emirate to start preparing their land cultivation, as most of our people were predominantly farmers.

The emir also called on the people of the emirate to report any suspicious characters to the nearest security agents so that it can be curtailed in time and pray to Almighty Allah to guide us all.

Report any suspicious character to security operatives, Gudi Emir tells his people.

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Zulum Spends Night Coordinating Security in Pulka

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Zulum Spends Night Coordinating Security in Pulka

… Disburses Cash, Palliative to over 30,000 Ngoshe, Pulka Households

By: Michael Mike

Borno State Governor spent the entire Saturday night coordinating security activities in Pulka following the recent attacks in Ngoshe, Pulka and other communities in Gwoza.

This is the first time a sitting governor has slept in Pulka, a community 22 kilometres from Gwoza.

Governor Zulum held a security meeting with the Brigade Commander, military officers, security personnel, and civilian JTF to discuss strengthening security in the general area.

He said leadership is all about commitment and sacrifice which has been the hallmark of his administration since he assumed office.

“Leadership is not about living in your comfort zone and addressing people and their concerns, but coming directly to the doorsteps of the less privileged. This has been my tradition, this has been my culture since I assumed duty as the governor of the state,” Zulum said.

“I cannot remember when I lived consecutively for 10 days in my office or even one week since I assumed duty. I’m always in the remote areas attending to people, and I believe this is what we should do from now on to the end of my own administration,” he added.

… Zulum Disburses Cash, Palliative to over 30,000 Ngoshe, Pulka Households

Governor Babagana Umara Zulum has distributed cash, food, and non-food items to over 30,000 affected households of Ngoshe and Pulka communities.

The relief item is intended to provide succor to victims of the recent attack and to the host communities.

“Each male and female heads of household in Ngoshe will receive N30,000, while married women will receive N20,000. In addition, mattresses and clothing will be distributed to both men and women,” Zulum announced.

The governor disclosed that the intervention would also cover Pulka community which has been impacted by the influx of displaced persons from neighbouring areas.

He further acknowledged the support of the Federal Government and Alhaji Aliko Dangote, who donated 30,000 bags of 10kg rice to support vulnerable populations in the state.

“Out of the 30,000 bags, Pulka community will benefit from the scheme. We are distributing both food and non-food items not only to Ngoshe but also Pulka, which is also a displacement-affected community,” Zulum noted.

Governor Zulum called on residents of affected communities in Gwoza to remain patient and cooperate with security agencies, assuring them of sustained efforts by both the federal and state governments to restore lasting peace.

“They should give the necessary cooperation to all security agencies with a view to identifying culprits within the society. Information is a very valuable tool for addressing insecurity. Without the support of the community, insecurity will never end,” he added.

Items distributed include rice, maize, guinea corn, mattresses, and plastic mats.

Those on the governor’s entourage include Senator Mohammed Ali Ndume, member representing Gwoza, Damboa, and Chibok at the national assembly, Hon. Ahmed Jaha, Chairman Palliative Distribution Committee and member representing Monguno, Nganzai, Marte, Hon. Bukar Talba, member representing Gwoza state constituency; Commissioners for Local government and that of Transport and Energy; Special Advisers and other government officials.

Zulum Spends Night Coordinating Security in Pulka

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