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Health Tech Newsletter 2nd Edition- A Path to Healthcare Interoperability
Written By Ayo-Olagunju Muna, Faderera Adekunla, Fiyinfoluwa Sanwo
HEALTH CARE IN THE TRENCHES: THE LIFE OF MAKOKO RESIDENTS
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Healthcare in the Trenches – ‘Trenches’ according to colloquial use and street lingo is used to describe a rural and poor community, often akin to a ghetto or slum and there is no better place to experience this definition epitomised, than Makoko. Our trip gave us a brush with the daily reality of this less privileged and underserved community.
“Yevo! Yevo!” resonated as we rowed past the residents of Makoko, that is how we were addressed. Yevo in their local Egun dialect means ‘Oyingbo’ which itself is a Yoruba word used to describe a caucasian person or more aptly in this context, a foreigner.
Makoko is an inner city slum, located in the Oworonshoki axis of the most populous city in Africa. It is an informal waterfront settlement with more than a third of the community built on stilts along the Lagos Lagoon. Do not be fooled by the waterfront description as there is nothing picturesque about it. The water is characterised by its blackish colour and foul pungent smell. This sprawling community is home to over 350,000 people
who lack basic human and social amenities such as; a good road network, electricity, pipe-borne water, education, and healthcare amongst other deficiencies. What could be the ‘Venice of Africa’ now passes as the ‘largest floating slum’ in the world. The very unattractive nature of this community makes it very attractive for CSR projections and NGOs looking to deliver aid and interventions. As a result, this community is often in the spotlight and in some cases, they have become a target of unscrupulous elements looking to score cheap CSR points with ulterior motives. Despite the publicity these interventions have brought to the community, the quality of healthcare remains largely unchanged.
Hope shone its lights on residents of Makoko in 2012 when Doctors Without Borders (DWB) built the first floating clinic in Makoko. However, this light was snuffed out when the clinic was shut within barely three months. In present-day 2022, the community can count the number of healthcare facilities on one hand. We visited Makoko to find out how their living conditions affect people’s access to care, as well as how the COVID-19 pandemic disrupted things and its effect on their community. What we found will shock you!
Residents of Makoko practice communal living, with no less than 10 persons sharing the same living space, amidst an unsanitary environment and over congestion. Owing to the less-than-desirable living conditions, their environment is an ideal breeding ground for malaria, dysentery, respiratory diseases and communicable diseases. The swampy and narrow nature of the community makes it accessible only by a canoe, their definition of the popular ‘Lagos traffic’ is boats colliding with each other unable to move until one boat goes back. These unfavourable conditions create a lot of challenges for healthcare providers, as they have to grapple with accessing this community at the risk of their lives and providing care in an unsanitary environment.
The residents address these challenges by facing them head-on and taking responsibility for their healthcare through unorthodox and ingenious means. To tackle the challenge of accessibility, they formed a cleaning group that routinely engages in community clean-up which frees up the pathway for easy and unhindered passage by canoes, which poses the steepest challenge during the dry season, making passage difficult due to the low tide. They also resorted to building smaller boats that are lighter in weight and best suited for mobility in their peculiar terrain. To tackle the challenge of hygiene, their routine community cleaning serves the dual purpose of making their environment more sanitary for rendering care and also helps in keeping them less susceptible to some diseases. Through the cleaning group that was formed, they also participate in user education, educating residents on the need to maintain a clean environment and proper waste disposal techniques.
Despite these efforts, when the residents eventually get access to medical care, the quality is usually poor. These challenges are majorly the reasons for the shortage of medical personnel, talk more skilled ones, which is going to be even further compounded by the brain drain we are experiencing. They often rely on CHEWs ( Community Health Extension Workers) who are assigned to the community as
part of some outreach mission or the few from the community, who have received such training. Despite being branded as hospitals, the healthcare centres in Makoko (the few of them, barely 2 that exist) fall below the standard of being referred to as clinics. They barely have the skilled human resources, nor the basic amenities and equipment to adequately deliver primary care, yet the residents have no alternative as healthcare payments are out-of-pocket and their means of livelihood being subsistence fish farming, accounts for their meagre income. Their ‘hospitals’ like their houses are built on stilts, which means they have sufficiently high clearance, as they have to be well above water level. This would be very challenging for someone that is sick or heavily pregnant to access and they often stack boats on each other to provide a platform to support the ascent. Healthcare in Makoko is a horrid experience, which peaks at giving birth, as it is often a game of chance. The conditions described make it ill-suited for this endeavor, however as they are faced with little or no option, they often embrace it as their reality. In the eventuality of birth complications or life-threatening emergencies, they would have to go all the way to Lagos Island maternity, LASUTH, or LUTH. Imagine such an eventuality happening on a windy stormy night. They would have to battle through environmental challenges, and then financial challenges as they often lack the means to pay out-of-pocket.
Well, nature they say has a way of evening the odds. One would think that amidst the poor living conditions, ailing and lacking infrastructure, waterborne and communicable diseases will be brewing in this community. On the contrary, as recounted by one Mr Gowon Idown, a CHEW at God Bless by Faith Hospital, their disease prevalence is majorly malaria. He told us that the Makoko community did not record a single case of COVID-19, attributing it to their rugged nature from birth and the immunity they’ve built over time, though one can argue they were not exposed to sufficient testing. He recounted experiencing a measle outbreak recently, but it was quickly contained by quarantining the infected. Although we cannot further correlate this by data, It is believed that they are immune from viruses and diseases because of their deity ‘Sangbato’ and the smoke from their smokehouses used in drying fish.
The three pillars of an effective healthcare system are; access, quality and cost. Makoko residents are on
the lowest rung of the ladder because as can be deduced from their ordeal, they barely have access to care, the quality is derelict and they are too indigent to afford anything beyond the standard currently afforded them. Suffice it to say, healthcare is non-existent in this community.
The Experience
Fun Facts
Yahoo our tour guide: Makoko, despite being situated in Lagos metropolis and bordered by Yaba and Ebute Metta, a city where Yoruba is its predominant language, you will be surprised to find out that the majority of them speak Egun language and a blend of French.
