I arrived Jigawa, northern Nigeria in the dry season. The vegetation then was sparse and dry and one could see miles and miles ahead of the arid Sahel, although occasionally, one’s vision would be blocked by rocky hills that dot the landscape. The land was hot and the heat was very oppressing during the daytime. As evening came the weather would become a little clement. Some evenings and nights though, were also very hot. ‘Welcome to a new world’ the Jigawa road side land mark said, as we entered the state capital. Jigawa was indeed a new world to me. What would I discover? I wondered.
I resumed at the Primary Health Centre in Gwaram and though work was punctuated by the occasional difficult case, the occasional loss of patients, life was very normal. Being a doctor was quite rewarding – most patients went home better. Alive. But this was before the rains came. Sandra, a health worker who had served seven months already before I turned up in Gwaram had mentioned that the number of deaths increased alarmingly during the rainy seasons. She had in the past said some unpleasant things about the local people, so I did not take her words as true, or as important. When the rains came, the weather changed. Green, lush-looking grasses grew everywhere. The people planted millet, rice and maize. The hunters would pile up in a very dead pick-up truck and move about the town at breakneck speed, with the people cheering them as they moved along. Grasscutters would be abundant soon; hunting season was close. If you rode the public transportation motorcycles from one settlement to another, you would see scores of women on open fields doing what seemed to be an esoteric choreography as they planted seeds into the ploughed soil and dug them in with their feet. There were many lively activities, and people were happy with the cool beautiful weather. Jigawa was almost more beautiful during this season than during the dry season. But in our hospital we began to experience an increasing number of deaths. But what was the cause? It couldn’t be the rains. I had to find out.
In medical school, I was taught that malnourished persons and non-immunized children stood a very poor chance of fighting diseases. In practice as a doctor in southern Nigeria, all that was just textbook stuff. Almost all children there were immunized, and even if protein intake was not as much as in the Western world, people had at least the lower ranges of the normal blood protein level. In Gwaram, and many parts of the north, women and children have a dangerous combination of factors militating against their well being. Poor hygienic practices make helminthiasis (worms) prevalent, and bad, oppressive feeding cultures make them nutritionally deficient. These two factors, along with poor response of the care giver or guardian to life threatening situations lead to a prevalence of acute severe medical situations in the hospitals.
With the rains came stagnant pools of water, and with that came mosquitoes. The blast of malaria fever was the needed flint to ignite an explosion of heart failure, recurrent seizures, severe gastroenteritis and other such terrible cases in our already nutritionally starved women and children. Many of the cases already too far gone by the time they arrive the facility. The rainy season that brings joy and increased copulation seems to turn up with winds hiding the flaps of Death’s Angel. Each pelt of raindrop becomes a beat in the macabre symphony that welcomes destruction.
While we can blame the rains for the death of women and children here in Gwaram, there is nothing that can be done to modify or negate it. What we can do however, is negate its undesirable effects. The rights of the male to all fish, meat, yoghurt and other tasty nutritious meals should be challenged aggressively by disease prevention programmes and health educators. It is not enough to tell helpless women who have no control over their choices of food, to eat highly proteinous meals. The men must be swayed towards making these foods available to their women and children. I use the word swayed because this must happen as a cultural shift, with the men being influenced by key societal figures – the Muslim Clerics and the Emirs. There also must be aggressive community medicine which must involve house visits organised to show people proper feeding, hygiene and disease prevention practices.
I have never seen night skies as beautiful as I see from my window late at night in Gwaram and as I walk home from the market in the evenings. But in the rainy season, it seems unsullied beauty lies only in the heavens: the earth is full of death and dying. Even the beauty of childbirth is driven away by near certainty of a maternal death. We cannot do anything about the rains. We cannot change the weather or our tropical climate. But we can change ourselves: we can ensure that we empower and protect our women. We can make sure that the children that come in the dry seasons do not go when the rains come.