INTERVIEW: How we helped Boko Haram victims manage trauma, despondency – Ex-Borno health commissioner

Salma Anas-Kolo is a former Borno State Commissioner for Health who served between 2011 and 2015, a time when Boko-haram insurgency was at its peak.

In a grim statistics by Borno state Government last year, the Boko Haram insurgency in the state led to deaths of almost 100,000 persons with over two million internally displaced.

Mrs Anas-Kolo is also a pediatrician and an internationally renowned public health expert who worked at various levels and locations in Nigeria and around the world for the United Nations System, through such agencies as United Nations Population Fund (UNFPA) and the World Health Organisation (WHO).

In this Interview with PREMIUM TIMES’ Ebuka Onyeji, Ayodamola Owoseye and Nike Adebowale, she speaks on various health challenges that befell the state as a result of Boko Haram attacks and how the state responded. She also gives insights on her ambition to run for the Senate in the 2019 elections, the challenges women face in politics, among other sundry issues.

Excerpts:

PT: You were the Commissioner of Health during Governor Kashim Shettima’s first tenure in office, between 2011 and 2015, at a time when Boko Haram insurgency was at its peak. How was the experience?

Annas-Kolo: Yes, I was health commissioner at the peak of the crisis. It was a very difficult time because it was a time that Boko Haram reached its peak. It was a time we had Internally Displaced Persons moving into Maiduguri and also moving outside the state.

Some went as far as Cameroon, Niger and Chad. Compounding health problems as of that time birthed disease outbreaks and several other challenges in terms of bomb blasts. What we did was that, immediately we set up an emergency response team and the humanitarian desk within the ministry of health.

As we receive the IDPs, we also set up clinics within the IDP camps. Inadequate health workers remained a challenge in the state even before the crisis and it became worse with the crisis. What we did was to tap on the IDPs that are health workers and immediately train them.

We embarked on massive recruitment of health workers. In 2011, we had only 35 doctors in the whole state, so we beefed that up to almost 140 medical doctors. What we did was to make the work attractive to them by motivating them with additional incentives.

I remember the governor offered vehicles to doctors that took the offers in Borno State. We were also able to ensure that we institutionalised a plan that helped increase the number of trainees cum medical doctors, nurses and midwives by giving those that are already in the training additional monthly allowances.

PT: What were the major health challenges then, and how did the state respond?

Annas-Kolo: We had major disease outbreaks during this period. It was a trying time for the Borno people. It was quite challenging, we have never been confronted with such a huge challenge in the state even in the country. We have never had such a challenge that witnessed massive displacement of people.

About 80 per cent of these are (were) women and children. We mobilised and got a lot of support from our donor partners and the government. What we also did that really helped us was that we were able to mobilise community support, we got a lot of community and religious leaders to be involved.

I also set up a maternal new born and child health task force and also advocacy crew that comprised many of community and religious leaders. So, a lot of activities were going on in that aspect. We also used women groups like traditional birth attendants to create awareness on personal and environmental hygiene within the community.

So that greatly reduced the outbreaks of diseases. We had major outbreaks, there is no doubt about that especially the cholera outbreak, but these measures were able to reduce the outbreaks in the state. If you look at statistics from the MICS survey that was recently released, it showed that there has been a great improvement in the health indices in Borno State especially maternal labour and child health.

We did a lot of work in collaborations. Partners were leaving as at that time, we only tried to encourage them to come back and some did stay back. What most partners want to see is high level of political commitment by state government and we were able to demonstrate that.

All our counterpart fundings were being paid. The counterpart funding for HIV/AIDS, UNFPA, Bill and Melinda Gates Foundation were paid and every other partners that comes. They supported the state and because of the work we did in the state, we were acknowledged as the best performing state in terms of efforts to eradicate polio.

We were able to interrupt transmission of polio in 2013. For almost a year there was no record of polio in Borno State. As at that time also, we were providing free services for women and children within the facilities and encouraging them to visit the health facility for ante-natal care and deliveries with additional incentives of mosquito’s nets. We did not allow the crisis to discourage us or dampen our spirit.

PT: Trauma was a major health challenge then? Many people were reported to have been traumatised during this period. Can you give more insight on how this was handled?

Annas-Kolo: What we had then was physical trauma and psychological trauma. I will say that almost everybody in Borno were psychologically traumatised not just the IDPs or victims of bomb blasts. What we did in terms of managing psycho-social trauma was to collaborate with institutions of psychiatric hospitals in the state and we identified a lot of health workers and trained them on psysho-social support.

We also set up centres within the University of Maiduguri and also within the neuro-psychiatric hospitals where we referred patients who had come up with symptoms that could not be controlled. Apart from psycho-social trauma, gender based violence became very prominent at the time.

It was the same period we had the abduction of young girls from secondary schools. Even before the abduction of the over 200 girls (Chibok), we had such incidents happening in communities. We have had incidents where we had to do psycho-social counselling for the girls, including their parents.

Again, the bomb blasts claimed many lives, destabilised and displaced many families. Many people were disabled. All these contributed to the trauma we felt. Unfortunately, the human resources to face these challenges were so limited.

The hospitals we relied on are the general hospitals, the teaching hospital is managed by the federal ministry of health so we tried to strengthen those facilities. We set up emergency centres in the trauma centers and we started providing treatment for patients.

We also procured about 25 to 30 ambulances that were providing 24 hours services to victims of insurgency, especially victims of bomb blast. When I left Maiduguri in 2015, I came back to the federal ministry of health as a director and I was lucky I met a permanent secretary who is also very passionate about victims of bomb blast.

Then, we had another minister of health, Professor Isaac Adewole, who is also passionate. They both supported me and I set up a humanitarian response desk in the ministry of health under the directorate of special duties.

So I was heading that department. And under the department, for the first time, we set up a coordinated response to humanitarian services with special emphasis on the insurgency happening in the North-east. It is still functioning till date. We were able to work with the presidential committee for the North-east. We submitted a proposal of support which was later approved.

PT: What was the feeling within the state when the Chibok girls were kidnapped?

Annas-Kolo: Even as the commissioner of health, when the over 200 girls were adopted, I was psychologically traumatised because it is a reality but we had denial at the national level that it didn’t happen. We tried to convince the government that it happened in Chibok community.

I am in contact with the Chibok community up till now, I am in contact with the health facility in Chibok that treated the girls that were rescued within the first week. We identified parents and families of the girls that were abducted, brought them and did a lot of psycho-social counseling for them.

We set up a system for them where we established a referral centre and set up psycho-social centre within Maiduguri town. It went on for some time but after I left office, it didn’t continue. Yes, in terms of physical trauma, the shock of the Chibok girls abduction is still felt across the state.

PT: Many families were displaced at the peak of these attacks and are yet to be reunited. What has the state done in this regard?

Annas-Kolo: There are challenges in the coordination. I think the major challenge is having a coordinated approach to coordination of humanitarian crisis. I cannot talk much of the humanitarian committee because I am not part of that committee but I know there are other committees working in parallel.

At the state level, there is limitation in terms of coordination. I know the state government has made lots of efforts yet there are some families that are yet to be reunited. It is a sad reality, it is not something that can happen fast. Some children have lost their parents and they do not know anything about where they come from.

Some have been physically and psychologically traumatised, that resulted in mental illnesses. So the burden is still enormous and we have to keep advocating for better approach for a better way of coordinating the response.

We have over 100 partners in Borno state but the coordination is still not too effective. It should be run by the state government, it should be led and driven by the government.

NEMA is currently stepping in more aggressively to improve the coordination from the federal level up to the state level. They have a zonal office and state focal persons in their offices. The state has also set up similar structures as NEMA at the state level, which is also functioning well.

PT: Your reappointment as the commissioner of health in 2014 was rejected by your party because according to them, you refused to ‘support’ politicians running for offices. Can you shed more light on that?

Annas-Kolo: That was very interesting. I came to Borno as a technocrat in 2011, I was appointed as a technocrat. But once you are in a political position, you adapt to the situation.

The state house of assembly and the politicians acknowledged the works that was done in the sector. What is strange about me that they did not see happening is maybe ‘dashing’ out money? I ensured we follow all the due processes. I never awarded contracts, it goes through the due processes and is then approved by the government.

I followed every work to conclusion, maybe that was strange to them. So maybe they were not comfortable with it, so when we came back after the reshuffling, the governor posted me again to come back and continue the good work we were doing in the state but the state house of assembly rejected that.

My mandate is that whatever resources is allocated for an intended purpose, we must use the resources to achieve the purpose. It can never be diverted. The health sector deals with lives. Life is not like road constructions, so if we say we are buying drugs, it has to be drugs.

If we say we are renovating facilities then we have to do it. Fortunately, we renovated most of the primary healthcare units in Borno State. We were able to equip the facilities even before the destruction by the insurgency. At the end of the day, we came to an understanding and a lot of them apologised to me and it was later approved.

I still feel I have to come back to Borno on a political platform to continue to support our people because we cannot develop if we do not have a sincere commitment to our people. Remember we are working with limited budget, limited resources including human resources. So for us in Borno State, there is no room for diversion of anything. It has to be used for what it is meant for.

While in office, I tried to promote good governance within the health sector. I encouraged clinical governance even within the service delivery system and this is what has worked. We involved community people as our watchdogs to monitor and track us in the health sector.

Part of what we are suffering in the state today is a breakdown of law and order. First of all, dedication has to come from young people because there is a high rate of school dropouts and those in school were not getting quality education then. When we assumed office in 2011, we started putting all these in place.

When we visited the school of nursing in 2011, the governor and I shed tears because of the state of the school. No toilet facilities, no electricity, and no water supply. So how can a mother send her daughter to such a school? We immediately agreed with the governor to renovate the school and the school was upgraded to a standard one. I am glad I was part of the government between 2011 and 2015 when we initiated all changes and started addressing them aggressively.

The same thing also happened in the education sector, the quality of teachers were upgraded. I served for four years and left on my own because I wanted to pursue a career and stay with my family. That was the major reason I left in 2015.

PT: Recently, you declared your intention to run for the Senate. Knowing the challenges women face in politics, do you think you stand a chance, even at the party level?

Annas-Kolo: I will always say the window should be opened for women to participate in the development of the state. Being a woman is not a weakness, it is a not handicap because I have reached certain level of leadership.

I was a commissioner and most people within and outside Borno acknowledged our efforts because they have seen what we have been able to achieve. So it is about what we can do, not by gender. I tell them not to look at me as a woman but as an individual that can bring progress to the state.

I was appointed as a commissioner of a state by a governor who is a male because he recognised the talent in me. The political space has always been dominated by men because women have not pushed enough. There is a way politics is been played in Borno and Nigeria generally, that is why women haven’t participated in it. With the 35 per cent affirmative action, if the government and our people will allow that to happen, I think that will allow inclusion of women and that will also open opportunities.

There are challenges that are associated with the level of education of the people. When I say education, I am not talking about western education only but also Islamic education. So they see women as to not be part of it.

I am very proud to be a housewife, I stay at home and I take care of my family. But that does not deprive you of contributing to the state development. This orientation is gradually changing because we are beginning to see the impact that women have made in positions.

I believe wise men are beginning to open windows of opportunities for women to be part of their progress. The major challenge of running as a woman is financing. Women may not have much as their male colleagues in terms of finance because I know as a woman, I am objective and straightforward.

For me in my state, the challenge is not even being a woman because the people are so informed so they encourage me to go for it. The religious leaders are in support of my goal. The challenge we are facing now especially in southern Borno which I am trying to represent as a senator is that we have been caged in what we call a zoning system.

The zoning system is that five local governments have always been producing the deputy governors of the state which is under my emirate council for over 30 years. One local government out of the local governments has been producing the senator for more than 30 years. This is lopsidedness. What we are now promoting is that there should be fairness, openness, there should be no barriers in terms of zoning.

Only those capable should come out and contest not just because you are from a particular local government. So producing a deputy governor should not deprive others of their constitutional rights of contesting for a senatorial seat. And this is what we have suffered for more than 30 years and for me, I am challenging that status quo. It does not allow inclusion and diversification.

PT: You are running against a veteran, Ali Ndume, a former majority leader of the Senate who has been in the National Assembly since 2003 and is also a staunch member of the APC. How do you intend to win this battle?

Annas-Kolo: I think he (Ndume) is my leader, there is no doubt about that. He is currently sitting on the chair and he has been there for 8 years. In the Senate, he is going to complete his eight years and he was also in the house of reps for eight years so that makes it 16 years.

I have a lot of respect for him and he has played his role but the space is large and we make changes for progress. So there is need for us to also move forward because when someone has been in a position for a long time and gains lots of experience, he should be able to move on.

So for me, it is the difference that is the conviction and my conviction is that I am bringing a huge difference. With all the experience I have gathered at the state, national and the international level, I think Borno State is not where it should be. In fact we have gone almost 50 years backwards in terms of development.

Narrowing down to my constituency which is Southern Borno, we are battling with so much level of lack of development looking at it from education, employment of our young people and infrastructural development. The roads are so bad, you cannot travel for 30 minutes smoothly apart from some of the areas that were just being constructed by the governor.

Most of them are federal projects that have been abandoned. So I feel the southern area of Borno State has not benefited from federal projects and it is out of my passion for my people and the willingness to support them to move them to the next level that I ask for this opportunity. If I am given that opportunity, I will be able to support and address three critical areas: education, girl child education and the health sector.

PT: Most women in politics complain about the warped party structure. They say it’s skewed against them. What is your take on this?

Annas-Kolo: At the primary level, which is the most challenging, money and gender is being used to marginalise women. The representation of women at the party level is very poor.

If you take five delegates from each ward, it’s only one woman you will have. For me, what I am presenting to the men here is that I need them to support me. I am pleading with them to be fair- based on the lessons they have learned in the past. It is not about selling your conscience for money and sacrificing the next four years for poor governance.

They should see me as a progressive individual trying to help her people. God can only help someone that is sincere. It is a man’s world. They decide who goes there at the moment.