The problem with Nigeria

I realize this title is provocative even if I've tweaked the title of an old monograph by Chinua Achebe.  But I've chosen this because I started this blog to focus on my interest in health in developing countries, and most importantly in Nigeria. I wanted to talk about things related to women, children, young people, infrastructure, workforce, etc. A few weeks into this, I realized my posts, both the ones I've written and posted and the ones I've drafted were nothing but doom and gloom. I had nothing positive to say, and I was having trouble finding anything positive to write about from my discussions with people.  So I broadened my topics to whatever I wanted to talk about. It had to be closer to home: friends, women I find inspiring, relationships, hair, and other social issues that are important to us.  It's been fun writing about these topics, and generating great interest from my readers.

So what is my problem with Nigeria?  Why did I stop writing about the place?

Well, let me start by saying that a few people I know have moved back to Nigeria or are in the process of doing so.  For them, this is the best move for their families both in the long and the short term. Otherwise, no one would move themselves, their children, their lives to another country if there were no long-term benefits to doing so.  But when I listen to the reasons some people have said is prompting their move, it gives me great pause (and honestly, concern).

Many are families with young children. We all know that life is difficult in the United States when you are raising small children. If you are doing everything you are supposed to do to maintain your family, as well as holding on to a full time job, then you have little time for leisure, fun, or anything else.  If you are paying for private school, given that we live on what we earn for the most part, then you are also out of money! It's a tough life. That's why most people (particularly middle class, educated couples with jobs) do not have more than two children. It's too much of an unpleasant stretch on available resources (time and money among others) to manage any more. So, given these difficulties, it does not surprise even me that young families would choose to move to Nigeria where they can get maids, drivers for themselves and their children, cooks, nannies, and any sort of available help you can imagine. One person has said she does not want to wipe another nose or change another diaper for as long as her kids are in that phase. Another one wants the kids bathed, dressed, and shipped off to their private school before she even wakes up in the morning.  And they have all returned to Nigeria.  It's tough to wipe every nose and change all diapers of course, particularly with a large family so who could blame them?

I didn't have children to shuffle them to several people to take care of, but a little help with mundane duties is of course a good thing. My problem is not with the easy life, per se.  No one won any award for doing every single thing yourself when it comes to child rearing.  My problem is with the societal conditions that make all the house help one can want cheap and readily available. (Notice I did not say easy; the problems house helpers can pose is a later conversation.) The society that creates--on one hand very few select people who are well connected, well paid, and well respected, and on the other hand, creates the vast  majority of people who have next to nothing-- is not a good society.  A society where the vast majority of people, regardless of their talents, can only hope to serve as another person's driver or maid because that is where their connections might lead them is not a good society.  It is not even on the path to becoming a decent society.  It is a society that creates a permanent underclass.

An example:  A typical driver who makes 10,000 naira a month  (about $66.00) in Nigeria.  He (haven't seen a woman yet but I'm sure there is one) is not planning nor hoping to send his many children to a good school on that monthly salary. He might spend his meager income to send the first boy to school and the other children will go without their education or they rely on the ever dwindling number of family members who are nice enough or have enough to chip in.  But his options do not include returning to school to obtain a degree in anything to get a better job.  He has watched most people who have degrees from the top universities in Nigeria land in nothing but permanent unemployment, and as long their parents are not well known and do not appear in the latest magazines, they will never be gainfully employed. When this driver speaks English, you realize within the first sentence that he is speaking the "queen's English." Refined. It is not by accident. He is probably well educated, but his fortune of being born in Nigeria has left him with no options other than to serve as a driver for a probably much younger man or woman (married), earning a wage that will not serve as a respectable shopping bill for the woman for the week.

By the way, how many generations will it take before a serious rebellion in some form begins to take hold? Think of armed robberies, hijackings, kidnappings, bombings that are commonplace in Nigeria. A permanent underclass if we know nothing else breeds unrest.

So, this is my problem with Nigeria.  It is great for some, and if I only talk to this moneyed group of people, I might believe it is like this for everyone.  In listening to those who love Nigeria and all the help you can get, their children are not destined for such occupations.  Several years ago on a visit to Nigeria, I was being driven by the driver of a relative to the market to buy a few things.  She first offered her maid to go to the market for me. I thanked her but declined; that would defeat the purpose of exploring the market for me. As I rode in the backseat, seatbelt absolutely fastened and praying to arrive at the market in one piece through the high speed insanity of Lagos highways, I thought about the fact that as much as I've driven in New York, DC, even a bit in London, they are all organized, and I could never drive in Lagos.  So if I had to live here, I thought, I would hope for a driver. As we approached the market, I began to see absolute and complete poverty. I realized then, that as comfortable as I was in the backseat of that shiny new air-conditioned car, the car fumes from other people's dying cars still managed to seep into our car and sting my eyes, and I am still surrounded by absolute desperation no matter how much I willed it to go away. I don't have the heart to say that this is okay or good enough just because my own children will not be subject to penury for the majority of their lives.

So I have asked some friends to tell me what I might be missing in talking about good things that are happening in Nigeria.  I haven't come up with much on my own. I'm not cool enough to blog about the music, art or club scenes. Someone else can take that up.  There's nothing but bad news on the academic scene; we see enough horror stories from supposed graduates of Nigerian universities here in the United States so no need to delve into that.  When and if I can find out more about these great things people bring to my attention, I will write about them.  If I can't find any information, I won't blog about them being good things.  If it is anything like "we have electricity because we have generators and we are rich enough to buy the quiet ones" then I'll blog about how many people died due to generator fumes entering their homes as they slept wiping out entire families.  Just to keep things in perspective.

Toughest places to be

I started off my blog with the desire to write about anything but health issues.  I wanted to write about fun things like film, fashion, books, recipes, high quality dark chocolates.  One month in, and I am struggling with that plan.  See, I like fashion, but I am not interested enough to blog about it.  I love chocolate but I am bored by the discussion of it. I don't see enough movies to have a constant stream of thoughts on them. I would probably never, ever, blog about recipes.

I am interested in health, and the social determinants of health.  What do I mean by this?  I am drawn to the intersection of education, housing, income, assets, neighborhood and community, air/water, race, sex, and policy and how they all impact our health.  So here's my plan: I will use this blog mostly to explore and highlight these issues in a non-academic, accessible, and meaningful way. This will be more or less the focus of the blog.

Of course, I still reserve the right to write about  non-health issues like Tina Fey's recent essay on juggling motherhood and career in the New Yorker (subscription needed).

Now, on to another post.

A show on the BBC called Toughest Place to Be sent an experienced midwife named Suzanne to Liberia to see how they practice midwifery in that part of the world. Suzanne was quite open to learn more about "natural birth" methods and how to improve her practice.  What she learned in Monrovia shocked her.  Women frequently suffered unbearably during the childbirth process--many babies and their mothers die of preventable causes.  One young woman, after a failed abortion using the "leaf of death," became septic, and died right before our very eyes.  She was 21 years old.  No family members were around.

Women, inpatients with various conditions shared the same ward with nothing but a curtain (in some cases) to shield them. Births occurred right next to a woman whose child may have just died minutes before, with what appeared to be a lack of sensitivity. But this--few resources, death--is a matter of fact here. Most heartbreaking of all, one Liberian woman with five living children (she had delivered a stillborn just hours before) begged Suzanne to take any of her children off her hands...she was struggling to feed them as things stood.



There are many video segments on Youtube.

Another segment of this show is of a London bus driver named Josh who was sent to Manila, Philippines to interact with his fellow bus driver, a Jeepney driver named Rogelio.  Manila is a city of about 20 million including its outskirts.  An unbelievable scene, when Josh went to visit a family in a house that measured 6 ft by 6 ft, revealed that the young woman had 13 children and a husband all living in the house. No one could quite stand up straight in this house. She described her repeated pregnancies (she's normally pregnant during the first birthday of the last child), and the difficulty it now posed as life had become impossible. As Catholics, she had long believed it was a sin to control her fertility. That decision had led her to a terrible bind-no food, no space, education for the children was not an option.  This is juxtaposed with Rogelio's wife who insisted early on birth control, and subsequent prayer for forgiveness.

In Liberia, you see standing water in most of the outdoor shots, filthy conditions outside the hospital, no medicines (no antibiotics for a septic patient) in the hospital, self medication in the most outrageous circumstances, stigma, poor training for some of the health care providers, poor transportation and no fans. In the Philippines, even in a 6 by 6 ft house, there's electricity, but lack of education, terrible infrastructure, extreme poverty. While I marveled at the shared ward in Monrovia, Liberia, there were shared beds--four women and their newborn infants--to a bed in Manila.

The common denominator: In both places, poorly educated women, arresting poverty, poor healthcare infrastructure and poor health, and family planing--in more ways than one--gone completely awry.