It was a sunny Friday afternoon. Aisha Magaji, her three-year-old son, Dauda, and his little brother strapped to her back had gone to visit a relation on admission at the Health Centre in Gwaram, a densely-populated semi-urban community and the headquarters of Gwaram Local Government Area of Jigawa State, North-East Nigeria.
The trio had just entered the health facility when people started screaming. Mrs. Magaji turned and saw a dog sprinting straight towards them. Momentarily confused, she was torn between running away with the baby she strapped to her back and restraining Dauda, who was still running excitedly in front of her.
One Shehu Daniya who witnessed this said that, within seconds, the dog, which was slightly taller than Dauda, came face to face with the boy. It was dripping spittle from the mouth and made an awful snarling sound before leaping on Dauda.
“Before we could do anything, the little boy was already on the ground and the dog on top of him,” said Mr. Daniya.
It went straight for Dauda’s forearm as he cried aloud and attempted to fight off the scary animal.
The dog tore off the skin on the back of the boy’s arm, leaving a jagged line and blood. Seconds after the dog injured Dauda, it jumped off and charged towards another child, who was watching the weird drama from a distance.
As the boy took a few steps in a failed attempt to escape to safety, the dog closed in on him, pulled him down and took a deep bite on his leg.
It was at that point a mob of Gwaram youth gave chase to the dog and later killed it.
The attack by the dog, believed to have been infected with rabies, sparked commotion in the health centre, as patients and staff took to their heels while those too sick to run laid helplessly on ramshackle beds shouting for help that did not come.
Dauda’s father, Magaji Maiunguwa, gave an unsettling account of how he almost lost his son.
The nonagenarian had just returned from the farm when a concerned neighbour brought news of the incident.
On getting to the clinic, a doctor at the facility said there was no anti-rabies drug to treat the child and referred them to the Gwaram General Hospital located about five kilometres away.
In turn, the hospital referred the boy to the Federal Medical Centre in Brinin Kudu, as it did not have any anti-rabies drug. Birnin Kudu is about 56 kilometres away and it would cost about N3, 000 to hire a taxi to the place from Gwaram.
This was prohibitive for Mainunguwa, a subsistence farmer with an average monthly income of N14, 000, which is N4, 000 less than the country’s minimum wage.
So, he took the only available option that could get him to Birnin Kudu on time: a commercial motorcycle popular known as achaba.
The motorcyclist became the ambulance.
At the FMC, he parted with N15, 000 to get his son treated.
PREMIUM TIMES learned about the Mainunguwas’ travail during weeks of investigation in Jigawa, rated in May 2013 by the World Bank as the poorest state in Nigeria.
Located in the heart of Gwaram Local Government Area, the Gwaram Health Centre serves hundreds of poor residents, who cannot afford services at the General Hospital.
The 2006 National Census puts Gwaram LGA’s population at 272, 582.
A community health worker, who identified himself simply as Hassan told PREMIUM TIMES the clinic has for years been in a state of decay.
He blamed the incursion of a wild dog into the clinic on the absence of a parameter fence.
Contract paper but no renovation
But in 2010, according to Hasan, some persons came to Gwaram from Dutse, the capital of Jigawa State, with a contract paper authorising them to renovate the clinic.
“Within days, the contractor removed the roofs from four blocks at the facility, including the isolation ward, the antenatal ward, the laboratory, the male ward and the theatre.
He said the contractor carted away the roofing sheets. And that was the last the people saw of the contractor.
Neither his identity nor the contract sum could be established during this investigation. The Permanent Secretary in the state Ministry of Health, Magaji Mohammed, declined to disclose this information.
As those blocks became roofless, beds in those wards and theatre were moved to the female ward.
So, this ward, which measures less than 16 x 20 meters, now, has crammed into it no fewer than 20 beds, to service expectant mothers.
A corridor outside the makeshift laboratory at the clinic became the male ward.
Hassan said many patients who come for treatment spent days on the bare floor along the clinic verandas.
We were not able to film the clinic’s interior, but we recorded part of the facility from a distance.
The more you see and hear, the less you know
The Jigawa State Due Process Report of 2012 notes that the state government (then under the governorship of Sule Lamido) awarded a contract for the renovation of the Gwaram Cottage Hospital to Polyspec Nigeria Limited at the cost of N21.8 million.
The contract is listed as number 19 on the report and was certified 100 per cent completed and paid for on October 10, 2012.
Further down on Number 22, is another health sector contract, “Renovation Works at Gwaram,” with the same contract sum, date of completion and payment.
Gwaram folk, who spoke to PREMIUM TIMES, claimed no such projects were carried out on the facility.
They insisted that while Governor Lamido upgraded the dilapidated health centre in Gwaram to a cottage hospital in 2012, no renovation work had been undertaken.
The situation is not different at the Primary Health Centre, at Buji in the local government with the same name, where PREMIUM TIMES found only four community health workers attending to dozens of patients.
Apart from the buildings that are dilapidated, one of the community health professionals at the centre, who pleaded not to be named because he is not authorised to speak on the matter, said majority of cases brought to the facility were referred to the General Hospital in Dutse, because the Buji PHC lacked even the basic equipment.
He said the two microscopes supplied to the clinic were no longer functional while most of the equipment at the theatre had packed up.
He said some patients died while being transferred to the General Hospital in Dutse, a distance of about 250 kilometres.
“There was this pregnant woman who reported here with some complications and we referred her to Dutse. But because we do not have an ambulance to convey our patients, she couldn’t make it on achaba (commercial motorcyclists) to the hospital,” the community health worker, who preferred anonymity, said.
The situations at the health facilities in Birniwa, Babura, Sule Tankarkar, Gumel, Kafin Hausa, Maigartori and Ringim local government areas of the state were not any better as observed by this newspaper.
In Dutse, the capital city, the Zobiya Health Centre located less than 10 minutes drive from Government House where former Governor Lamido held sway for eight years looked like a broken down mausoleum when we visited.
From 100 meters away, one could perceive the putrid odour of bat faeces oozing from the dilapidated building, leaving our reporter wondering how the staff there coped.
PREMIUM TIMES found an expectant mother, Ladiyo Umar, lying in one of the stinking rooms at the centre.
A health worker said Mrs. Umar lived in the neighbourhood and had come for checkup but lamented that as the clinic could not handle her case, she would be referred to the Dutse General Hospital, another five kilometres away.
“She is having pains in her lower abdomen which is a sign of labour. We have asked her to go to the general hospital immediately the pains subside and she can’t walk on her own,” said the clinic staff.
With no ambulance, and in critical condition, the lady had to trek along a narrow footpath to where she could get an achaba to the General Hospital.
Based on the chart posted on its wall, attendance of out-patients at the time of our visit was in the region of 300 every month.
“We have no light in this area but there is a solar-powered borehole nearby,” the community health worker said.
If a health facility located close to the state’s seat of power could be in such a deplorable state, the situation in rural areas must be cause for concern, one activist told PREMIUM TIMES. He requested not to be named for fear he might be attacked by supporters of the past administration in the state.
At the Comprehensive Healthcare Centre in Kazura, the village head, Suleiman Abubakar, said there were no qualified medical personnel to run the facility.
Even so, people from neighbouring villages and hamlets still had to come for treatment at the run-down Centre.
“We don’t have qualified medical personnel to operate the health centre,” Mr. Abubakar said.
“Most of the patients here are referred to the General Hospital in Hadejia and other places. People from over 53 villages and over 100 hamlets, made up of six wards, patronise the facility.”
The distance from Kazura to Hadejia is about 100 kilometres.
“We don’t have roads here,” Mr. Abubakar said. “For instance, if someone is sick and you want to carry him to the hospital, the road is not good, sometimes the vehicle get spoiled before we get to the highway.”
Because of the bad state of the roads, Mr. Abubakar said many people resort to using carts pulled by donkeys to get to the main road.
“We have lost many of our loved ones in the course of taking them to Hadejia General Hospital for treatment,” he told PREMIUM TIMES.
Based on current estimates by the Nigerian Bureau of Statistics, NBS, the population of Jigawa state is approximately 5.28 million, divided almost equally between the two genders.
The state has 27 local government areas which are further divided into nine integrated and decentralised Gunduma Health System councils.
More than 80 per cent of the population is engaged in subsistence farming and animal husbandry, with over three quarters living in rural areas.
With over five million people, records obtained from the health ministry show that the state has a total of 646 health facilities including 11 private healthcare facilities.
The public health facilities consist of 12 hospitals, and 623 public primary health centres, health posts and dispensaries.
A senior health official told PREMIUM TIMES that over 70 per cent of these facilities were underfunded, understaffed and in pitiable levels of disrepair.
The official said they grappled with shortages of essential health personnel, equipment and structures, leaving patients and medical personnel wondering what happened to the billions received from the federal account and internally generated revenue.
Based on records from the Federation Accounts Allocation Committee, FAAC, the state received in excess of N400 billion from May 2007 to May 2015 when Mr. Lamido was governor.
But in the course of traversing the five emirate councils of the state, PREMIUM TIMES found most hospitals in the state dilapidated and lacking in equipment, staff and drugs.
Even some buildings at the Federal Medical Centre, Birnin Kudu, had faded paintwork, broken ceilings and craters on the floor. The facility is one of the best in the poverty-stricken state.
The Chief Medical Director at the Hadejia General Hospital, Aliyu Abdallah, said the facility attended to over 400 cases on a daily basis, with patients coming even from outside the state. And it had only five medical doctors, he said.
Mr. Abdallah praised the government for providing drugs for the hospital but lamented the shortage of health professionals.
A top official of the state Ministry of Health, who asked not to be named for fear of being victimised, however, told PREMIUM TIMES the immediate past governor, Mr. Lamido was not committed to efficient healthcare delivery in the state.
“People still die of minor health issues in Jigawa and the worst hit are pregnant women and children in local communities,” he said.
All Plan not much health development
Shortly after he became governor in 2007, Mr. Lamido initiated an ambitious project under what he called “Strategic Health Development Plan.”
Under the plan, the government adopted the United Nations recommended district health system and named it Gunduma Health System, GHS.
The Permanent Secretary in the state Ministry of Health, Magaji Mohammed, said the new healthcare plan “integrated primary and secondary healthcare services under a single management to encourage community participation, better funding and effective human resources.”
A 2008-2014 report by the Partners for Transforming Health Systems Phase II, PATHS2, a project funded by the United Kingdom’s Department for International Development, DfID, praised the state government for adopting Gunduma Health System.
PATHS2 is a six-year programme of the DfID which was aimed at strengthening health systems and improving service delivery in Jigawa State.
“Service delivery improvements were deepened, and linkages between the availability of a skilled health workforce, complementary health systems strengthening, and community involvement were enhanced,” PATHS2 noted.
While the report claims significant improvement in the overall healthcare delivery system in the state, the reality is starkly different, a fact admitted even by Mr. Lamido and top bureaucrats from the state.
Commenting on the deplorable state of primary health facilities in the state, Mr. Lamido, in an exclusive interview with PREMIUM TIMES, said he did his best to improve the lot of his people vis-à-vis the rot he said he met when he took over the reins of government in 2007.
He said he should be praised rather than castigated for his contribution to the healthcare development in the state.
“With all sense of modesty, I am not saying I did so much but I put in my best and those who know what the situation was in the past can attest to what we did,” said the former governor.
“We were able to lay the basic foundation for the development of the state.”
Speaking further, he said his administration inherited a collapsed healthcare system, a situation he said accounted for the many cases of whooping cough, malaria, diarrhea, tuberculosis, meningitis and high maternal and infant mortality.
“In the past, before a woman could deliver a baby, she had to be driven in a cart for over 50 kilometres to a medical facility,” the former governor told PREMIUM TIMES.
“When a woman under labour is sitting on a cart to the hospital which is located very far away, then you can imagine the fate of the mother and the baby.
“Our duty, therefore, was to provide the primary infrastructure to alleviate the suffering of the people and by every standard; we were able to achieve 90 per cent in infrastructure development and even in water supply.”
Plan affected by plunder
Those familiar with the state said the so-called infrastructure development Mr. Lamido initiated were frustrated by corruption which, going by investigations by the Economic and Financial Crimes Commission, amounted to at least N10 billion.
In charges filed against him at a federal court, the EFCC alleged that the former governor collected over a billion naira kickbacks from contractors in the state, with the funds allegedly paid into accounts managed by his sons.
Investigators and activists believe that money could have been used to fix the state’s dilapidated health system, including repairing leaky roofs, providing drugs and ambulances.
“If you look at the level of poverty in that state, you cannot but weep for the Jigawa people,” said Olanrewaju Suraj, chairman of the Civil Society Network Against Corruption. “Unfortunately, the ordinary people who bear the brunt of such corruption do not appreciate the attempts at brining people like Lamido, who are alleged to have misappropriated public resources, to book.
“The last time the EFCC arraigned Lamido and he returned to Dutse, people went into wild jubilation when he landed at the airport. We need the media to investigate most of these infractions and bring them to public knowledge.
“The media must tell the people what the amount politicians steal could do for them, how many schools with quality teachers and text books the funds could have provided and how many water projects could have been provided.
“The people must be made to understand how they have been surcharged by the so-called governors and political leaders rather than celebrating them. politicians who are found to have ripped off the people must be brought to justice.”