One of the most concealed forms of death is a sentence that cannot be brought about by the justice system but by the health sector in Nigeria. It can be labelled as “death by disability” and lives are being lost one woman at a time and silently too. I recall a woman I knew Bisi, four-months pregnant with her first child, who complained of sore throat at a health facility. She had lived with a hearing and speech impairment since she was born. The medical professional misinterpreted her sign language to mean she was having stomach problem and went ahead to prescribe drugs for treatment. She returned home to take the drugs as she was instructed and few weeks later, Bisi started having severe stomach pains, forcing the pregnancy to be aborted. This situation affected her health condition which led to her death a few months later. This is just one of various tragic stories that people with disability (PWDs) encounter as they seek healthcare in Nigeria. Due to the circumstances surrounding her death we can say that Bisi was sentenced to death by DISABILITY.
Nigeria has one of the highest maternal mortality rates in the world contributing an approximate 10 per cent of the total world estimate of maternal deaths. In this country, the 640 women out of every 100,000 live births die in the process of childbirth. In other words, it can be extrapolated from findings that every 10 minutes a Nigerian woman dies as a result of complications of pregnancy or childbirth. In the UK, it is 12 women out of every 100,000 live births.
Lagos State is critical contributor to these health indices. Apart from being Nigeria’s commercial hub, it is home to over 16 million Nigerians and if Maternal Mortality is high in Lagos, this will reflect significantly on National Maternal Mortality indices. Currently, Lagos’s Maternal Mortality has been pegged at 545 out of 100,000.
Given that PWDs represent 10% of the population, it is likely that maternal death as it affects this social group, will bear heavily on Lagos State indices. A 2013 study on Maternal Mortality undertaken by InnovationMatters Limited on behalf of the The Lagos State Civil Society Partnership (LACSOP) and the Lagos State government’s Ministry of Health, showed that local governments areas (LGAs) and primary health centres (PHCs) are major contributors to maternal deaths. For example, it was noted that very few LGAs have complied with the Special People’s Law almost two years after it was passed into law. No form of support has been put in place to help pregnant women or mothers living with one disability or the other. Specifically, none of the PHCs assessed in that research have met the specification especially designed for wheel chair users.
Epe PHC is a case in study. There is no accessibility for persons in wheelchairs, hearing impaired and even the blind. As was the response from one of the women living with disability, they “will prefer to seek medical help elsewhere.” It is worrisome that if PHCs are unable to prevent the deaths of abled pregnant women, are they equipped to handle cases of the more delicate women with disability?
Pregnant women with hearing impairment seem to be worst victims as medical staff struggle to understand them to determine the right treatment to give them. Imagine the number of unreported deaths that occur due to similar stories like that of Bisi across the State. InnovationMatters’ research also showed that most PHCs do not have sign language interpreters, special care givers, counsellors, disability health specialists and PWD’s specific toilets. It is obvious that a disabled woman would have difficulties delivering at PHCs in Lagos State. For example, the statistics show that only 2 out of 20 PHCs (Ilasamaja and Awoyaya PHCs) assessed have sign language interpreters and these interpreters are not always available at ante-natal/post natal clinics. Only 5 out of 20 PHCs have Special Care Givers and counsellors but it was emphasised that staff these are not specifically specialised in disability affairs. Accessibility to toilets facilities was a fascinating subject because none of these facilities met the disability specification. This means that even if PWDs succeed in gaining health access, they will be unable to use the toilets.
Women with Disability (WWDs) suffer injustices and discrimination in accessing healthcare. They have difficulty accessing the health centre facilities since they cannot climb stairs with wheelchairs; therefore, they are limited in accessing maternal care and too often seek this care in more fatal and dangerous environments.
The LGAs should be the first point of call on healthcare and a great deal has been done by the Lagos State’s Ministry of Health to upgrade the PHCs to meet basic healthcare. However, it is the primary responsibility of the LGA to make sure that it steps up to the needs of the people. To do this, the Local Government Chairmen have critical roles to play. The PHCs are their direct deliverable and if PWDs are unable to access healthcare the maternal mortality indices will continue to grow. With the elections in view, LGA Chairmen have an opportunity to demonstrate their commitment by performing at healthcare and raising standards and access to health care on an equal basis and providing equipment and professional services that will once and for all eliminate the silent, but crawling giant affecting Maternal Mortality in Lagos State today.
Osareme Olotu writes for InnovationMatters Limited, a social research institution located in Lagos State. Send your comments to twitter: InnovationMatt1 and facebook: InnovationMatters