The Challenge of Cultural Acceptance: Basic Medical Intervention in Northern Nigeria
When Mark first arrived in our crisis care home in 2014, we discovered through our routine tests that he was Hepatitis B positive. He had fled his home in northern Nigeria, Bauchi State, a year before he arrived with us when his family converted from animist, pagan beliefs, to Islam. This was a common story during this period. Boko Haram was increasing their stronghold in this region, causing widespread fear and panic. Mark fled from his family home because he wanted to freely practice his Christian faith and would not convert to Islam. He sought help from one of our organisational partners who helped him while they could, and then he came to stay with us for a longer period so that he could receive the educational support and medical treatment that he needed.
According to the World Health Organisation, Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of contact with infected body fluids. Common modes of transmission for these viruses include contact with contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
It can lead to severe liver damage and reduced immune response in those with the disease. In the West it is highly preventable through health education and treatable through inexpensive drugs. But here, in northern Nigeria, it's not such a simple fix.
Mark's story is not unique. Another boy, Pam, who joined us earlier this year was admitted into our care after the loss of his father. Fathers provide the social support systems in traditional Nigerian homes. To lose a father means to lose your chance to go to school, to receive basic medical care, to go without food, clothes and even basic shelter in many cases. If you do not have male relatives or if your male relatives disown you, this responsibility falls on your mother. In most cases women lack the social financial status to inherit, meaning that if your father left anything at all at his passing, your mother most likely will not see any of it. Due to the continued disparity in levels of education between boys and girls, your mother will usually only find labour intensive jobs that do not pay well. An average Nigerian household in the north of Nigeria has six children. Pam's mother told us that she tried to help her son treat his hepatitis, but the treatment was too expensive for her to continue.
Across our two Children's Crisis Care Homes and our Youth Safehouse we have 36 program beneficiaries receiving treatment for hepatitis. That is 11% of the people who come to us for assistance through crisis.
So what prevents widespread treatment from being administered and disease education being rolled out for this easily preventable and highly treatable disease?
As of 2019, Nigeria exceeded 200 million in population. While there has been movement to the cities, many people, particularly in the north, have agricultural livelihoods and live in highly remote villages without access to even basic needs like maternal care, medical treatment and education.
But the poverty in rural, remote villages pales in comparison to the extremes and sadness of poverty in urban centres. Parents must work, they can't take their children to the farm with them, like they would in the village, so children must raise themselves; and each other. If their family is poor, they still cannot afford school, medical treatment and health education. They are left vulnerable every day, more isolated from adult supervision in the city than in the rural village. We've seen children like this, too. They arrive with many preventable illnesses, often hepatitis - if they're lucky. HIV positive, if they're not.
Fathers, mothers, grandmothers, grandfathers who themselves have not gone to school used herbal medicine to treat their ailments. When a child in their family died perhaps from co-morbid malaria and hepatitis they were told by the herbalist that the child was a cursed child. Today, when these parents are told to give their children medical treatment, it is unfamiliar and scary. In their worldview they can fathom that their child died because they were cursed. That's how they've always understood it. They cannot understand that their child died because of a lack of sanitary health care, a lack of consistent treatment, abuses, their own lack of awareness, or, the treatment not working.
The Internally Displaced People's (IDP) Camps are often the most rife with the spread of disease and human rights violations; most especially against women and children. While most IDP camps have medical facilities, they are understaffed. Thousands of people live in IDP camps indefinitely with insufficient sanitary facilities, healthcare and privacy. Assault and rape are common violations, resulting in unplanned pregnancies for many women and underaged girls. In these cases, fear of stigmatisation often prevents the woman or girl from seeking out appropriate medical care, leading often to maternal transmissions of diseases like hepatitis and HIV.
The polio eradication efforts in Nigeria, started by the Bill and Melinda Gates Foundation in 2012 were set to see polio ended in Nigeria by 2017. They were sending teams of trained women into the rural north vaccinating children under five. But then, Boko Haram (direct translation, "Western education is a sin"), spread propaganda that the vaccine was a sterilisation drug to stop Muslim families reproducing. 13 vaccinators were killed by Boko Haram in an attack. People stopped allowing their children to take the free vaccine because of the fear and distrust they had for western medicine, and Boko Haram. Polio began to increase and today, they are still trying to recoup their efforts, although it looks promising.
These are some of the challenges we face in healthcare here in northern Nigeria. Our clinic is established to make vital medical treatment available to the extremely poor. Our slogan, "None shall be denied access to basic healthcare". The children and youth in our Crisis Care Homes and Safehouses receive full healthcare from our clinic helping them and also their wider families as they become examples to their communities in the north about the necessity of seeking consistent care. Our clinic is in the process of becoming a specialist hepatitis and HIV treatment centre. This is helping many people, too. Slowly, cultural perceptions change.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.