Update from the Field
June 14, 2006
by Ayodeji (Deji) Shedu MD, MPH
Makoko is a teeming shantytown in Lagos State. It has an estimated population of 50,000 people, the majority of who live in wooden huts built on stilts sunk into the dark waters of the Lagos lagoon. Makoko waterside inhabitants are mainly fishermen, who go out to fish in the night and stay indoors during the day, while the women take the fish to sell in the market or to dry. The maximum family income is about $50 dollars a month. The vast majority lives on less than $1 a day. They are mainly of the Ijaw and Egun ethnic stock. The adjoining mainland is inhabited by people from other ethnic groups with similar socioeconomic status.
The social infrastructure in Makoko is very poor. The mainland does not have good roads, the area lacks potable water and the waterside is devoid of a sewage disposal system. This results in high morbidity from malaria, diarrhea and other infectious diseases. To reduce the high morbidity and mortality, medical volunteers in conjunction with the Nigerian Red Cross organized a free clinic for children under the age of five years in 2001. This clinic also provided care for the children in the motherless babies’ home being run by the Nigerian Red Cross in the area. The clinic was shut down the following year because of lack of support from other stakeholders.
Provision of adequate health care to the inhabitants of this deprived section of the Lagos metropolis will be three stages.
1st Stage: Restoration of free pediatric services to children under 5years and provision of same to children aged 5 – 11. Duration: 2 years.
2nd Stage: Enlargement of health services to include older children (up to 18 years) and also provision of maternal health services. Duration: 2 years.
3rd Stage: Provision of expanded primary health services to include acute and chronic medical services to adults.
The services of the maternal aspect of the second stage and the third stage will be paid for. The goal is that by reaching the third stage, the health facility will be self sustaining. This proposal is focused on the first stage of the plan.
To restore free pediatric care services to the estimated 15,000 children under the age of 12 years (primary school age) in this Lagos slum.
- To improve the access to health care for the pediatric population.
- Provide a standard package of primary health care for the target group, incorporating health education to mothers, disease prevention and health promotion.
- To involve the local community in the health care delivery system, thereby ensuring acceptance of the clinic at the grassroots.
- To train health workers who are interested in working with the underserved urban population, especially in the areas of health education and promotion.
- To collect demographic and health related data of this population and their analysis to improve understanding of their health needs.
A) Restoring the free clinic for children
Provision of a health center in the area: This health center will replace the two room facility that was used in the previous attempt to provide services. A building with the best location, adequate number of rooms and standard facilities will be leased for the first phase of the project. Ideally it should accommodate an Out Patient Department, nursing station, doctor’s office, call room, nursing room, treatment room, dispensary, storage and ward of four beds.
- Staffing: The following staff will be hired to accomplish the stated objectives of this project.
- A full-time medical doctor who has at least 5 years of independent practice in pediatrics or general medicine with pediatric care experience
- Two full-time nurses experienced in pediatric care
- Four full-time, experienced nursing assistants
- One experienced, part time laboratory technician
- One part-time public health practitioner
- One part–time cleaner
- One full-time watchman
B) Disease Prevention:
The public health practitioner will lead and coordinate the activities of the nurses, nursing assistants and trainees to assess the vaccination status of children especially those in the waterside (according to the National Program on Immunization schedule) through a hut to hut survey. Not yet immunized children will be vaccinated and data will be collected to determine why these children had not been vaccinated. Data will also be collected on the ailments and medical problems that commonly affect this population.
C) Implementation Strategy:
The Real Medicine Foundation, through Comprehensive Health Support Service, will have direct administrative control over the clinic and other public health programs. These programs will be run in accordance with national and state health programs. Community involvement and participation will be a cardinal tenet in the execution of this project to ensure acceptance and sustainability.
- Up to two part time doctors may be employed as the need arises.
- The project will start with 2 nurses and this number will be increased to a maximum of four if there is need.
- Two additional nursing assistants may be employed if the need arises. Up to four nursing assistant trainees will also be hired. Rigorous attempts will be made to hire qualified and motivated personnel from the community, especially those from the waterside.
- Public health practitioner will coordinate outreach health promotion and health education services to inhabitants of waterside and the adjacent mainland. He / She will also be responsible for data collection and collation.