Journal Entry 10 - 'White Mary in Africa.' WORK.

March 2010 and two years since my last journal entry! Some years ago we stopped giving Christmas Cards to other club members and, instead, put money into a box, each of us electing a charity to receive the total, and drawn at the final shoot before Christmas. This year we decided to give the money to Mary who would be going to Africa for the spring push to eradicate Polio in Nigeria...... and this is part 1 of her story! Part 2, the leisure side is covered later. Now I must add that Mary is rather...... sun sensitive!

What an amazing experience to be part of the polio immunisation program in Lagos State. To have helped with the immunisation of 4,396,651 under 5 year old children in just 5 days is something I will never forget.

I was met at the airport by Vicky (known in Lagos as Mama polio) who went with me on almost all my visits throughout my stay in Lagos, BJ a GP who ferried us around a lot during the first half of my stay and Ayaba a headmistress who made me very welcome in her home and school.

Lagos is a very noisy, overcrowded; dirty, polluted city compared with a typical English city, with a population of approximately 12 million. During my stay I met with nothing but friendship, smiles, gratitude and respect. The local greeting of “you’re welcome“, a curtsey or quick ‘bob’ from the woman and a solemn handshake from the men met me everywhere I went.

The cry of “oyinbo oyinbo” (white lady) with the occasional tears of fear from the youngsters when I visited nurseries, schools and the river villages to give out the polio drops will stay with me for a long while.

The campaign was launched with a press conference the day after I arrived, I sat at a table with the dignitaries and much to my surprise was asked to say a few words to support the campaign. There had been rumors that the polio was contaminated with HIV and questions were asked about the safety of the vaccine, I later appeared on local TV after being interviewed by 2 camera crews.

Lagos State is divided into 20 districts, on the following day (the first day of the campaign) I went to Amuwo district health centre to join the teams going on house to house visits. Here I was shown the storage freezers for the polio vaccines and the thousands of ice packs needed by the teams to keep the vaccines at a safe temperature when out and about.
This room had to have constant electricity to keep the freezers at the correct temperature, however the electricity supply in Lagos is very intermittent and can be off for several days at a time. This vaccine storage room not only had 2 support generators but also solar panels to ensure the supply was constant. Homes that can afford it have their own generators; otherwise they manage with lamps and candles.

An immunisation team consisted of 4 people, each with their own role, one to carry the vaccines, one to give the vaccine, one to keep a log of the age and gender of the child receiving the vaccine and where it was given. The final team member marked each child’s little finger nail, on the left hand, with indelible pen to show the child had received the vaccine. This helped with the monitoring of the teams’ coverage and for the mop up teams that went round at the end of the campaign.

I spent the next few days going to Sunday schools, nurseries and homes giving out polio vaccine. Outside each house, school and nursery visited the wall was marked with chalk to show that it had been visited, if all the children had been immunised or if there had been any “non compliance”. The initial campaign was followed by monitoring and mop up re-visiting the non-compliant homes and schools and checking for missed children as noted by the original teams. During these days I was taken with a doctor and the chief nurse to several centres to discuss non-compliance and to try to persuade parents to allow their children to be immunised.

The most exciting day I had was when I joined my hostess Lara and other volunteers to visit villages up the river where there is no access to health care. We went by fast boat travelling for ½ an hour up river. Travelling in the boat was possibly the coolest I had been through out my visit, but boy was it hot whenever we stopped and went ashore.

We sent teams to 12 villages, I went to 4 villages giving out the vaccine and also giving mosquito nets to expectant mothers and mothers with young babies. Here the children were very amazed at seeing a white lady, they were keen to touch me and one small boy tried to rub the white off to see if I was black underneath. The poverty in the villages was great, their homes made from branches, but the children were happy and appeared cared for despite the poor conditions.

A week after the polio campaign had finished I attended the review meeting where each district gave a report on the number of children immunised, the number of non compliant cases, positive as well as negative aspects of the campaign. Time was spent discussing suggestions for improving the campaign. It was alarming to hear that some of the teams had been threatened and one team had actually been attacked and driven out of the area they were visiting. Lara gave the summary of the campaigns effectiveness and they then went on to discuss the next round of immunisations due to start at the beginning of March. I was asked to say a few words, I told them what a wonderful job I thought they were all doing and thanked the teams that I had gone out with. I said that I had gained a tremendous amount from working with them and encouraged them to continue their essential work not only for the sake of their people to help eradicate polio from the whole world.

After the 'polio Drive' Dr Lyabode Cole, a community geriatrician, took me out on her visits where I helped her give check ups, review medication and suggest possible solutions to some of their problems. Lasuth Hospital, a local medical centre, has been built piece by piece and is a collection of buildings of many shapes and sizes, some old some new. The clinic was in a small room in a very crowded outpatient department. 2 doctors sat side by side at the same desk seeing their patients at the same time; there was no privacy or confidentiality for the patients. I sat with Dr Shoga and his colleague for nearly 3 hours. Each must have seen at least 20 patients in that time. There was only time for diagnosis and deciding management of each patient no time for sympathy or prolonged discussion of the problems presented. I felt this most when a child of 2 who was not walking was sent for physiotherapy with no explanation to the mother that the child had cerebral palsy and what that meant for the child’s future.

During the clinic I also saw rickets, osteomyelitis, deformities from untreated fractures, horrendous industrial injuries and a 17-year-old with a short wizened leg and foot deformity as a result of polio. This young man needed surgery to correct his foot position to enable him to walk with greater ease and in less pain, he was given an approximate date in December/January for the surgery. There are 6 orthopaedic surgeons at Lasuth and there is only 1 theatre for the whole hospital, so they have one day a week in which to do their operations and that often includes urgent cases.

I visited this hospital on 2 other occasions seeing the men’s surgical ward, having a tour of the pediatric department and a tour of a new private block with every modern scanner and treatment available for those who could pay. The pediatric department was on three floors the outpatients one the ground floor, the surgical unit on the first floor and the medical unit and special care baby unit on the third floor. All the wards were overcrowded; beds almost touching each other and the majority, 65% of the children were, suffering from malaria. The special care unit had 6 incubators with seriously ill babies in and only 2 nurses to care for them; more incubators were available but not the space or the nursing staff. The mortality rate in the department was very high mostly due to malaria.

My visit to Oregun primary health centre was just as heart breaking, the facilities were very poor and very few but the clinic was in the process of being renovated. The staff hoped this would improve the care they gave but they knew that when it was finished it would still be short of essential equipment and supplies. Most health centres had a small delivery suite attached to them where women could have their babies in relative safety, many women give birth at home in some very poor squalid conditions with no nursing or medical care only the local “midwife”.

Part 2 - 'White Mary in Africa.' PLAY.

Part 2 now, I stayed as a guest in someone’s home while I was away. My first hostess, Lara Adeyemi is a doctor with the World Health Organisation and I was made most welcome with a nice basic room with air conditioning. Lara kept the generator running each night to make it cool enough for me to sleep.

My first taste of Nigerian cooking was of very spicy chicken and rice quite different and hotter than any Chinese or Indian spice I have tried. For following meals Lara kindly reduced the amount of spice she used, she had a “girl” to help in the house and I wasn’t allowed to lift a finger to help out in any way.

It was very hot reaching 36 degrees C most days dropping to 28 at night and very humid. Some days even the locals complained it was too hot. While staying with Lara she took me to a family wedding which was a wonderful noisy affair quite unlike any wedding I have ever been too. The morning was the traditional Muslim wedding and the afternoon was a more ‘westernised’ ceremony. I have never seen so much food being eaten! The music was fabulous, African drums and songs and the guests went home bearing gifts from the families of the bride and groom.

Once the polio campaign and the monitoring days were over I moved to my second hostess Dr Lyabode Cole. Lyabode is a community geriatrician. Here I also had my own room but not the luxury of ‘air con’ just a ceiling fan. The generator was only put on occasionally and we often ate and talked by candle light when the electricity failed.

Lyabode was a wonderful cook and she used all the locally produced beans, yams, planton, rice, vegetables, Irish and sweet potatoes. She used a lot of catfish as well as chicken and one day treated us to beef, none of it was the ‘western’ cuts we see at home.

When the electric was on and the pump in the yard was then working we had to carry the water into the house to be stored in large bins in the kitchen and bathroom. Even in the middle of the night we got up to make the most of the electricity when it was on, to iron, fill up the water bins and fridge and occasionally to watch TV. Both my hostesses made me very welcome, treated me as part of the family and were very concerned for my health and well being.

On the final day of my visit I went with Lara, her friend and Vicky to see the former slave trade area of Badagary. Other than a visit to the national museum this was the only “tourist” place I visited. We visited the former slave cells, market place, a small museum and the “Point of no Return”.

This was where the slaves were ferried across the lagoon to walk a trail through the jungle to the sea where they boarded ships never to return.

I was shown the place where Christianity was first preached and saw the first 2-storey house built in Nigeria. The area was in the process of being improved with the idea of turning it into a tourist attraction.

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