My binoculars:Borno Health Sector coordination and the challenges of the risk communication pillar against emergencies

My binoculars:
Borno Health Sector coordination and the challenges of the risk communication pillar against emergencies

By: Bodunrin Kayode

Sometimes the speed at which we journalists poke our noses into important matters that concerns the truth when government authorities are involved is welcome. Especially when it involves sensitive sectors of the economy like health and the welfare of the people. And we do so when any public officer is obviously economical with some truths. And this nosing around usually annoys such powers that be like Principal Medical Officers (PMO’s) where such practitioners are civil servants. The lack of deep understanding of the essential biostatistics by the every day manager of our hospital systems equally forms a clog in the wheels of progress in elimination of dangerous emergencies in real time.

Most top civil servants in government in Nigeria usually do not like being challenged when they do wrongs regardless of their professional learning. They want to be the last to speak and it should be the final like we had during the likes of a former health minister, name withheld who always wanted to assert his weight in spite of his small stature on the union leaders who refused to be intimidated by him. He turned out to be one of the worst in the history of this country because his tenure was spiced by several strikes. Speaking after his ilks have vomited their sometimes inadvertent mistakes in a emergency meeting, is a taboo especially in the medical sector where life is involved directly. Even within themselves, a pharmacist who tries to correct the mistakes of a medical doctor is frowned upon as being insubordinate. This is because the general practitioner no matter his years of experience has been given the tag leader of the medical team because he is the doctor. This reporter was reliably informed that this dominance was given to the doctors by late Prof Olikoye Ransom-Kuti who felt strongly that the entire health family should have a team leader if it must succeed. The entire national health policy he enacted gave a strong emphasis on preventive health especially at the primary health level. And you know preventive health cannot stand properly without massive enlightenment and mobilization of the locals to see sense in all the screamings of the epidemiologists. That is why I find it amusing when some people give certain levels of reverence to world bodies ass if they are so perfect that they don’t make human mistakes.

A journalist contributing to make things work effectively in the public health sector team by trying to rectify their excessive misuse of acronyms, for instance makes some of them angry that someone is interfering in their business.These hospital practitioners rather prefer to remain conservative and seemingly mystical because that is what it should be. And with this other partners can easily shut down and remain docile maintaining the necessary amoebic tendencies needed to survive. And with this, the obvious disunity within the medical sector will continue to linger instead of moving as team players as is the case in saner climes.

Sadly the world does not work that way anymore. Some of those who express these worries hardly want to think outside the books especially when it comes to their turf even when the world has gone far in the realm of “public health communication” for instance. And most times big mistakes are made as a result of wrong communications from the so called experts from the world bodies charged with fixing health. And that has been the bane of the “risk communication pillar” of the Borno Health sector partners during coordination meetings. But thank God that for the first time in the last decade, 14 pillars have been created and public health professionals in the meeting are meant to think in one accord which is very important for the progress of the “emergency health sector machinery” which Governor Babagana Zulum is interested in. We now have these pillars firmly rooted including the sensitive “surveillance” who are the epidemiological ” “secret service” going around hunting down emergencies and hinting the clinicians before ensuring that the house is fully briefed. The risk communication or state health educators are also being straightened up to meet emerging emergencies as they come. They are collaborating with the surveillance and security which I had suggested should be made a pillar in one of our public meetings and that the head of the police hospital should be given that task. Whenever he is busy, he can always send a representative to be physically present before critical campaigns against stubborn diseases like polio for instance. Sadly the policy makers and some of those above have not seen any reason to include a uniform medical person even as observers in such regular meetings. They only look for them when they are done with their inner meetings and it’s time to send urgent vaccinations to dangerous areas in the lake Chad. The troops vaccinate the victims and return their containers. This sadly can be corrected if there is a will to apply the right courage by thinking outside the box away from the stereotype of the civil service.

What is risk communication or what civic servants prefer to call public health educators

We must keep in mind that “risk communication involves the real time exchange of information, advice and opinions between experts or officials and people who face a hazard or threat to their survival, health, or economic or social well being.” Having said that, we should be mindful of the purposes and reasons for the risk communication pillar which is very vital in reaching out to the vulnerable people we are supposed to protect in the Borno insurgent war theatre. We cannot stop cholera from moving like a dangerous wizard from one council area to another if the risk communication pillar is brutally divided as it was some years back in the state. The division obviously stems out of the fact that the big world players do not see eye to eye on several issues and that to me is sad. There is no reason for the typical competition spirit common in our clime for instance. Another mistake they sometimes make is that they send misfits as communication coordinators who end up brutalizing partners psychologically with their rotten egos instead of working with them. We had one name withheld who pretended to be a communication coordinator in the World Health Organization (WHO) yet lacked the requisite humility and knowledge that it takes to operate from that office. He was so full of himself that he started having trouble within his organization and was finally sent to Abuja to go start from scratch in his real field which is computer science. He worked together with the United Nations Children’s Fund (UNICEF) only when it was obvious I was a slight threat that needed to be eliminated. One of them said that he was aware I had documents that could implicate their dangerous corrupt and “grab it all mentality” when dealing with journalists in the theatre of war. What they forgot was that a big chunk of the correspondents chapel of the NUJ knew what they really were inside in spite of the facade of protectors of humanity they paraded around. They had stepped on so many toes of my colleagues. But sadly all of them failed woefully in their satanic plot to chase shadows where there were none. They are all out of the war theatre now.

Why the risk communication and health educators in world bodies must continue to work together to strengthen the Borno health sector

The WHO and UNICEF communication experts must work together as a team under the supervision of the state ministry of health and not the other way round. What we had even up to early last year before the flood was two world bodies flexing their muscles in different rooms, churning what they thought was best for Borno but which is usually confusion for the crudely trained health educators. That is a wrong and it must be reversed as quickly as possible if the risk communication should be uplifted to where it should be. You cannot because you are coming to spend donor funds treat people as if they are beneath you. It’s not right. Whatever meetings they want to hold in their respective agencies should never rubbish the risk communication pillar meeting which should have only one head from the state ministry of health who speaks for all of us during critically challenged periods of emergencies.

The cliche of he who pays the piper dictates the tune can’t work in this instance when we have a war at our backyard. It’s a boring cliche that has killed this country and brought us to the sickening level we find ourselves now where humanity is thrown to the dogs. It is not permissible for UNICEF and WHO to speak on behalf of the state at all times. That is a wrong which I believe even the state coordinators know should be corrected. What happens when that fellow is transferred? The head must be a ministry staff and both agencies must answer to him. At least that is the ideal we subscribe to. The non governmental organizations have already fallen in line. It’s only the big players that are rustling feathers as if they are infallible. Sometimes they feel they are too big to take instructions from the government. But this governor is a no nonsense man. You rather do it his way or get out.

Within the almost comatose health sector which existed in Borno from 2009 when the real insurgent war started, health practitioners had been called to account to the people they claim to be dishing out dividends of democracy to even if it is on a humanitarian level which makes it free. And I believe it’s because of this accountability that the sector partners meeting was formed to evaluate and make progress. It’s about ten years now into the rebuilding of the Borno health sector and some of us who have been around since then can gladly say well done to all the managers who have passed through the Emergency Operations Centre (EOC) in maiduguri till date injecting their own expertise in one way or the other. The world bodies inclusive and the myriad of non governmental organizations. A special dedication to Dr Simon who was holding the fort in the EOC till the Trump hammer came down on everything that makes sense to right thinking people in the world.

Attracting more media practitioners into the risk communication

Colleagues, of a truth, the media practitioner is not out to witch hunt anyone but purely to ensure that every one accounts for his stewardship as leaders in the sector. A practitioner’s presence in the risk communication or health education business in the polio sub sector is to assist in disseminating the good news when there is need to do so. If Cholera has killed hundreds in the last ten years, he says so. Why? So that the people will take corrections from the way they have been living to what the health authorities have designed for them to stay alive. This is because no Commissioner of Health or trained doctor wants his patients to die out of ignorance. So they need the risk communication or health educator’s latest skills in contemporary media practice. And if one lacks knowledge of the workings of the media even if the fellow is from the WHO or United Nations Children Education Fund (UNICEF) he will surely fail in most of his plannings as it concerns the people. Media related intervention is needed in every profession that is involved in communication. From security to teaching to medicine. You cannot succeed in modern medicine without effective communication or even the media. And when I emphasize media, I am not talking about radio which is believed to be the widely used to hear from government by the northern illiterates in the country. The so called radio which is believed to reach at least 50% of the population is a luxurious instrument now in Borno because at least 40% of that 50 or 60% which could be reached if their surrounding transmitters have not been blown off by boko haram cannot afford to buy a mini radio of N1000. With the floating of the naira, this figure may even be an understatement in the market.
TV is ruled out for the most vulnerable who even if you give a free radio set to listen to cholera or covid jingles will rather sell same to buy his immediate needs. So how do we correct these lapses? Simple. Involve the media more proactively by creating of health desks in the media houses. Health desks cannot be just one person. I made this point during a round table at the NUJ in maiduguri recently and someone showed me a health correspondent in a radio station. The fellow obviously does not know the difference between an ideal health desk and just one correspondent. For maiduguri, just one correspondent covering emergencies and the entire health ministry is not right. In fact, that is a huge joke as long as insurgency persists. A minimum of three to five reporters should form the fulcrum of a functioning health desk. A senior correspondent or line editor and a bevy of reporters ready to cover the primary, secondary and tertiary centres were things happen daily. One person is just a correspondent not a desk and is grossly inadequate. You do not parade just one person to handle emergencies and non emergencies it’s a sick joke that can fly anywhere without a war but not in Borno, Adamawa or Yobe (BAY) states because of our peculiarities and mortality rates. The creation of health desks in the near future will produce a massive army of professionals ready to handle the risk communication even in the entire BAY states. That is the ideal. And it is very much possible to handle if the Commissioner visits the general managers and advocates for their creation with support from them. Getting a sound professional as information officer in the parent ministry of health will also help because it is he who will be the go between after the courtesy calls which speaks more than a mere memo. Translators in local languages will fall in line easily. Not just one or two people serving as health education officers in the entire state of 27 council areas.

The voice of the journalist as the fourth estate of the realm is equally the voice of the people. So when they call for accountability within the news managers about the health sector for instance to appear before them in the Press Centre, they are simply saying account for your stewardship before the people. They do not mean to disrespect anyone who is a “big man” who may not want to appear before the gentlemen of the media as if they are before their Lordships in a court of law as it were.

Risk communication practices within the Borno health sector

Risk communication in Borno particularly can never succeed without the major imputes of journalists within the Health sector. This pillar equally needs the massive support of the translators in the programs department which may not necessarily be journalists but media practitioners in their own rights. We cannot go to northern Borno and be speaking English with resident idps for instance. Such messages must be knocked down into Kanuri not even Hausa because these are people who do not understand the Hausa language no matter how international you may think it is. These are some of the challenges that have characterized the health sector meetings when handling urgent challenges like Cholera. The Borno radio television can boast of translators in shua Arab, Kanuri, kibaku, Bura, and margi languages any day we need them. Not this Hausa charade which I see as a lazy man’s way or handling serious issues here. Borno is not katsina or Kano. Borno is peculiar so attention should be paid to mobilization issues.
The world bodies will be harming the recipients of messages if they sit down in Abuja and draft messages for the risk communication sub sector only in English and Hausa and forgetting that there are about 15 dialects in Gwoza alone some of who barely understands the Hausa language which was virtually forced on them by virtue of recolonization. That could be applicable in the north west of the country surely not north east and central. There are always willing hands in the media ready to help out to produce these sound bites if management makes proper inquires. You do not go to Limankara in Gwoza and start speaking Hausa if you want the residents to drop some daring inhibiting habits which invites killer diseases. You look for someone who understands their dialect and make him do the translation or speak after you have spoken in Hausa. That is the trick.It would sink better than Hausa. These are the solutions which would help us from watching people die when we could help keep them alive.

The Borno health sector is in a critical buildup situation in which some forms of basic communications must be handled by local people who studied, communication, journalism or even some form of social science or public relations. Risk communication is not something you can handle simply because you did general studies in medical school. Far from it. Its something you must study to apply same so you save yourself from the pains and embarrassments being faced when it comes to the nitty gritty and you are watching people die from cholera, COVID-19 or diphtheria. That is why the intervention of the ministry of health into the various newsrooms by way of “lobby” for a news desk is very pertinent. No Radio general manager in Maiduguri or Biu will refuse sponsorship of reporters and translators for refresher courses in the health sector as is applied in the more developed climes. Send them abroad for three months and by the time they return, they will forget politics or sports and follow health as if it was their initial calling.
That is the only way we can attract more hands on deck to perfect further the myriads of mistakes being made by the risk communication pillar in the Borno health sector. I have tried severally to drag in my colleagues to join me in the sector meetings but they do not see the attraction to come in because of the ultra conservative mentality of some practitioners in government.
We have to create the attraction by following the tips I gave above. We are very much still in an emergency. So nothing is too big to be done to attract more practitioners in the health education sector.

Finally, now that we all know that a lot of damage has been done to most of our radio transmitters in the state rendering the capability of the old fashion radio to get to at least 50% of the populations useless, the plan B option left to the sector for emergency enlightenment especially in cases of polio is interpersonal communication and that is done by using vehicles to all the secured crannies of the state whenever there is an emergency to ensure that the people get to know what is going on. It’s obvious that less than ten percent of this 50% of the affected population can afford phones. Let’s say we teach them how to tune to their radio in their phones, how many of them will be able to listen to jingles in their native dialects? When you have at least 70% of the rural population of the residents as stark illiterates as alluded to not too recently by Governor Babagana Zulum, how then do you continue to reach out to them in English or Hausa? It is the duty of the risk communication people to size up the environment they want to penetrate and communicate in the language they will get maximum effect and not waste the scarce resources in radio stations that package programs purely for the elites. English language should be made a secondary language of communication in rural Borno until the war ends and emergencies subside. Too much English can never eliminate the stark reality of “zero dose” of which Dr Mohammed Khalid lamented in a recent sector meeting for instance is increasing. In fact he expressed the fear of new cases coming from the other side of lake Chad and how to stop this by using appropriate communication skills.

Lastly, there are many areas that vehicles may not access in the local councils of Borno State. The director of information, in the ministry of information can be drafted to work with any of the pillars he is wired to handle. As they hold their sector meetings at council level, he should be able to produce his own army of translators who will be on standby to enter any corner where strange diseases are coming up to kill people. And they should be able to feed his team or report directly to the state health educator for onward transmission if they can’t get their pillar heads directly. Trained risk communicators or educators volunteering during campaigns in the entire council areas should not be less than 54 while the state should not be less than 20 very fluent in diverse local languages and dialects of the people. That is the ideal instead of balkanizing everyone into kanuri and Hausa. The Commissioner of Health should be able to liaise with his colleague in the transport ministry to ease the stress on the resident health communicator in each council area in worst case scenarios. By resident I mean each council area should have one personnel trained for the job because all the resident media houses in Borno cannot be able to supply enough personnel for the job. The risk communication pillars should be given bikes and megaphones to get to those safe remote places and shout on top of their voices if need be. Only this change in pattern can change the narrative of any wicked emergency that dares rears its head beyond 2025. That is the drill for excellent coordination between the health educators, mobilizers and risk communication pillar in 2025 and beyond.