Delivering healthcare in Ilaje Riverine communities

One of this writer’s magazine reports 46 years ago was headlined ‘A Date With the Swamp-dwellers’. It was based on the life of the Ilaje people in the coastal and riverine area of Ondo State. A rather romantic piece it was. It celebrated the aquatic splendour and culturality of the people.

But that was how far it could go, as official neglect began afterwards to compel a shift of focus towards the sordid realities of environmental degradation and existential trap where the people are living and partly living.

The sea encroaches on the habitat virulently. Oil exploration in the region, like other parts of the Niger Delta, exacerbates the dire situation. It impacts negatively on people’s means of livelihood. Fishing and farming, the major economic activities of the inhabitants are adversely affected, leaving them more vulnerable at the subsistence level than ever.

One of the consequences of this deplorable condition is that people’s health is jeopardised.

The book, Healthcare Delivery In The Riverine Communities Of Ilaje, by Dr. Omolade Joseph Ayelaje, gives an account of the bold efforts by medical practitioners to mitigate the situation against all odds. Basically, the terrain appears insufferable to medics who are formally trained in ivory towers and used to the luxuries of urban centres. Only the dogged and empathetic have the resilience of spirit to practice in such an area, which, more often than not, lacks basic social amenities and is characterised by onerous ecological challenges.

In Chapter One, the author opens with a vivid portrayal of Ilaje and her creeks of mangrove swamps as well as a shoreline of 180 kilometres, being the longest coastline in Nigeria. Most parts of the community, according to him, are inaccessible by road. Travellers rely more on water transportation.

With a population of 289,838 (2006 National Census), the location currently has only seven doctors in the public service and two in private practice. Nurses and midwives are only twenty. In Ayelaje’s verifiable estimation, one doctor services 31,000 people, with 14,000 people by a single nurse. Pitiable reality, this!

Ayelaje goes on to present a profile of Ilaje, especially of the people’s history and socio-economic activities. One significant point he raises in this connection is that oil was discovered in Araromi, Ilaje in 1908, before the First World War. This was long before it was discovered in commercial quantity in Oloibiri, Bayelsa State in 1945.

Of course, the author cannot but draw attention to oil for whatever it’s role is in determining the quality — or otherwise — of the lives of the Ilaje people in particular and the Niger Delta in general. He also deals with the oil factor objectively both as a physician and a member of the Ilaje Development Summit Group (IDSG).

For instance, the activities of the Ondo State Oil Producing Areas Development Commission (OSOPADEC) are exhaustively treated. In terms of healthcare delivery, the author enumerates the Commission’s landmark achievements which include: the employment of ‘special health workers’, procurement and distribution of free medication, medical consumables and equipment of various health facilities, sponsorship and organising of free surgical and medical services, the building of new health facilities as well as the monitoring and evaluation of performances of medical workers.

Going further in Chapter One, the author devotes a whole section to the history and workings of the Comprehensive Health Centre (CHS), Ilowo. The Niger Delta Development Commission (NDDC) around 2003-2004 built it. But it was not without its own pitfalls. Medical staff deployed to the facility either failed to turn up or summarily abandoned the Health Centre due mainly to the backlash of the Ilaje-Ijaw communal crisis of 1998 to 2001 as well as supposedly unbearable conditions.

The author concludes Chapter One by highlighting some sociological, administrative, logistical, economic, infrastructural and other challenges facing healthcare delivery in the riverine areas. These include the difficult terrain, low patronage, poor telecommunication network, non-availability of pharmaceutical services, pharmacy or drug-store and non-access to blood-banking. Others the non-availability of power supply and basic amenities of life including, ironically, the absence of drinkable water in a place almost totally sorrounded by water, as in Samuel Taylor Coleridge’s ‘Rhyme of the Ancient Mariner’ where the persona laments: ‘Water, water everywhere and not a drop to drink.’

Of particular interest in the book is The Health Seeking Behaviour of the People. This is the title of the Second Chapter. The author himself scores the health-seeking behaviour of the people ‘very poor’. On the one hand, the creek and river dwellers do not know the difference between the Comprehensive Health Centre – a form of primary healthcare facility and the secondary (as in district hospitals) and tertiary (as in teaching, specialised or research health institutions). The misconception leads to the flawed presupposition that the Comprehensive Health Centre handles terminal cases. The folks, therefore, seek healthcare preliminarily from herbal homes or with quack nurses until the ailments get to very critical stages with attendant complications.

Malaria is said to account for over 50 per cent cases of admission. Next are complications arising from childbirth whereby, in the words of the author, ‘Majority of the pregnant women prefer visiting the Traditional Birth Attendant (TBA).’

He itemises 16 diseases which the rural, or even urban dwellers of low cognition, believe are within the therapeutic competence of traditional healers. Malaria, as stated above, tops the list, followed by febrile convulsion, hypertension, cardiovascular accident, congestive heart failure with pedal oedomic, which is superstitiously linked with the goddess, Ayelala, among others.

The issue of superstition and the essence of educating the people against its counterproductive nature is of special concern to the author.

In fact, one’s earlier encounter with him in this regard was a television programme where he treated viewers to details about certain ailments and their relevant curative processes with the pedagogical skill of a teacher.

It is that same spirit that he carries into Healthcare Delivery In Riverine Communities Of Ilaje where the emphasis on mass education of the people is copious.

The issue of body scarification, for instance, is explained to such a point that it varies from age to age and sex. The author elaborates on the average quantity of blood in the human being according to age. And it is stated not only in grammage but also illustratively with the content of common objects like bottles of popular drinks.

He sums up the effectiveness of his methodology as follows: ‘These explanations, as cited above, made the subject of discourse very simple and clearer to them and majority have desisted from the habit of making incisions unto the bodies of mostly the younger ones.’

Along this line, guidelines for paediatric blood draws with quantum volume and appropriate timing according to the age and weight of the child are also revealed. This is backed up with a table serving to explain in a graphic way the maximum amount of blood to be drawn from patients younger than 14 years.

The Third Chapter of the book is about Patient’s Patronage. Here, the author admits that patronage of the Comprehensive Health Centre is generally low. This is due to the terrain and problems of conveyance to the facility. Poverty is also a disabling factor. It is indicated by the fact that whenever there is a free health programme, there is a surge in patronage. And this is credited to the interventions of agencies like OSOPADEC and NDDC. One of such, which was supervised by the author, was the NDDC/NELPAN KOREA Free Medical and Surgical Programme of October 2008. OSOPADEC also funded the massive free distribution of Insecticide Treated Mosquito Nets ‘to every family, homes and villages’ in 2010.

This testimony comes from a medical practitioner, perhaps in tribute to his compatriots who are at the centre of the action; treating, educating and motivating the rural folks in the western flank of the Niger Delta.

Ayelaje, as disclosed earlier, is also a member of the elite Ilaje Development Summit Group (IDSG). The organisation has established various Strategic Committees (STRATCOMS) with multi-pronged development agenda for the wetlands.

A blueprint from the Stratcoms on Health with the analytical breath is the subject of Part Two of this book. Though largely futuristic, it is all the same a vital torch beamed at healthcare delivery in the riverine communities of Ilaje to improve the well-being of the people on a gargantuan scale, even as a case study for the whole Niger Delta.