Hansai Umaru, 22, sits on her hospital bed, blissfully breastfeeding her baby with her mother by her side. Hansai has four children, all of whom were born by Caesarean Section (CS). Although she had previously had three successful deliveries with no major complications, her most recent delivery took a frightening turn. Just days after giving birth, she began to bleed profusely, a condition known as postpartum haemorrhage (PPH).
Unaware that Amina had PPH, her family waited for a day, expecting the bleeding to stop on its own. When the bleeding did not stop, Jummai, Hansai's mother, rushed her to General Hospital, Jahun in Jigawa state, where Médecins Sans Frontières (MSF) has been providing medical and financial support to mothers and newborns since 2008.
The journey from Dadin Duniya village in Dutse Local Government Area (LGA) to Jahun typically costs ₦2,000 and covers approximately 27.4 km. However, due to the urgency of the situation, Jummai had to charter a taxi to speed up their trip, incurring additional expenses of ₦20,000. Jummai says she went straight to Jahun's General Hospital because of the results she witnessed, and the positive feedback she received from the hospital.
"I brought her here because of the quality of their work. This lady you see right here is my daughter. She had four surgeries in this hospital. She gave birth four times. She has four children and all of them are still alive," she shared. "You return to where you are happy with the quality of service. I even refer others to this place."
The lack of access to quality healthcare in rural Nigeria makes it unsafe for mothers to give birth within their communities. According to a World Bank report, Nigeria ranks 42 out of 100 in terms of Universal Health Coverage, due to a lack of high-quality and accessible healthcare.
According to the World Health Organisation (WHO), a Nigeria woman has a one in 22 lifetime chance of dying during pregnancy, childbirth, postpartum or post-abortion, compared to one in 4,900 in developed countries.
Focus on mothers and babies
MSF also known as Doctors Without Borders has made a significant impact since 2008 supporting over 90,000 births so far across Jigawa and neighboring states. In 2023 alone, they assisted 15,754 deliveries, performed 1,911 caesarean sections, and provided 43,785 antenatal consultations in Jahun LGA.
Dr. Fatima Aliyu, Medical Activity Manager at MSF, reflects on the organisation's journey in Jigawa, which began in response to the alarming prevalence of Vesicovaginal Fistula (VVF) cases in 2008. Initially, MSF focused on addressing this specific issue, however, as they continued to work with communities, they realised that the root cause of the problem lay elsewhere -- the lack of adequate care during childbirth.
In 2012, the medical humanitarian organisation expanded its support to mothers and newborns. Since then, it has expanded its support to other aspects of maternal and child health such as delivery and surgical interventions. "MSF is not alone in this. It is working with Jigawa state's Ministry of Health to reduce the morbidity and mortality of women and newborn babies," Abdulhakeem Ali, Project Coordinator of MSF in Jahun, explained. "Through engaging different stakeholders in Jigawa at the state level."
Aside from Jahun LGA, MSF helps other Primary Healthcare Centres (PHCs) in Jahun, Taura, Miga and Aujara LGAs in Jigawa State. It also runs a blood donation campaign twice a year to ensure the facilities they support have sufficient blood for mothers and newborns.
Rest assured
In most regions of Nigeria, financial barriers, a poor transportation system,a lack of adequate drugs, the attitude of medical personnel and cultural factors have been identified as some of the major factors that hinder access to quality maternal healthcare, resulting in maternal morbidity and mortality.
Amina remembers her journey to General Hospital Jahun, which started in Mariri LGA in neighbouring Kano State, more than 130 km away. Initially, she sought medical attention at Nasarawa Hospital in Kano, but was turned away owing to a shortage of beds. Her husband's relatives who were residents of Jigawa, intervened and urged that she seek care at the MSF-supported Jahun General Hospital.
"Immediately I came, they warmly received me and performed CS on me," she said. "They have efficient medical equipment. You can only see some of this equipment outside Nigeria. Especially for someone like me who has been to Saudi Arabia."
Similarly, Hauwa'u Muhammad, another patient in the facility, walked into the hospital the day before she gave birth in the hopes of receiving free medical care, which she did. "Out of my 13 children, I gave birth to two at this hospital," Hauwa'u noted.
"I delivered three days ago, but I am feeling some pain in my chest. I have hypertension. I have ulcer. The baby is here lying down too," Hauwa'u said, adding that she is confident both she and the baby would be well by the time they get discharged.
'Babies are the future generation'
Gloria Dabit, Unit Supervisor at Jahun General Hospital, observed that the communities they serve appear to be prioritising the health and wellbeing of mothers, over that of their newborn babies. She said that she hopes that the community will come to recognise the importance of caring for both mothers and their babies, rather than focusing solely on the mothers' health.
"They [babies] are the future generation but they [community members] come [to the hospital] because of the mother. They neglect the babies because they see the babies as strangers who don't need to be cared for. If you see them present, it is because the mother is sick, not because of the baby," Dabit explained.
Perinatal asphyxia, also known as failure to breathe at birth is responsible for 900,000 neonatal deaths every year, according to the WHO. As a result of this, the Jahun General Hospital, established a 25-bed newborn unit at the hospital. "In a month, we have more than 150 admissions at the newborn unit," Dabit said "Most of the patients [babies] come with respiratory distress, meconium aspiration syndrome, and birth asphyxia from the complications of labour and delivery. So, we admit them to the unit for close monitoring and care."
However, there are days when the number of newborns admitted surpasses the bed capacity. On such days, MSF assesses the patients based on their needs and discharges recovered patients to create room for new patients. "There are days we have 35 and even up to 37, but we triage and discharge so that we have space for more emerging babies," Dabit shared.
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Plans ahead
Despite facing financial challenges, MSF remains hopeful about its initiative to empower women in various communities -beyond Traditional Birth Attendants (TBAs) -- with skills to identify mothers requiring medical attention and facilitate timely referrals.
"Sometimes women come at the point of death. During the rainy season, these cases increase. There is a need to improve Primary Healthcare Centres and Secondary Healthcare facilities," Fatima, the Medical Activity Manager stated.
Those who develop severe complications that cannot be managed at the facility are referred to tertiary medical facilities such as Rasheed Shekoni Teaching Hospital in Dutse, Jigawa's capital city or Aminu Kano Teaching Hospital in Kano, based on their location. According to Fatima, this reduces congestion at Jahun's facility.
She also stated that religious and cultural norms tend to impede healthcare delivery, as some women despite being on the verge of death, are not permitted to seek medical assistance at the hospital without the consent from their husbands or mother-in-law or in some cases the permission of their caregivers. "Most of their husbands are migrant workers. So, before they are reached [on the phone], it is a problem."
The collaboration between Jigawa's Health Ministry and MSF will support the Federal Ministry of Health's efforts to create an efficient, equitable and quality health system. Partnerships like these align with the four-point agenda and vision to see the quality of healthcare improving at all levels.
