Archive for the Nigeria Category

Nigerian Chronicles X- PPFA in Gboko II

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, Recent Projects, womens reproductive healthcare on November 16, 2010 by tuschman

This is the concluding chapter in this series, and will focus on healthcare training and an AIDS clinic at the NKST church headquarters facility.  Some personal impressions will follow the visual presentations.

The NKST reproductive-health project recently upgraded a center for educating midwives and nurses on reproductive-health issues, particularly basic family planning, contraceptive technology, and post-abortion-care services. The NKST education course produces a large pool of skilled family-planning attendants, whose outreach provides basic healthcare services to the wider community. Below is a series of photos taken in the classrooms.

This next series are photos taken in an AIDS clinic at the NKST facilities.

In my last night in Nigeria, I met with Dr. Mairo Mandara, director of the Packard Foundation programs, to go through a debriefing session on my experiences during the previous 10 days. She is a very bright, energetic, determined and outspoken woman, someone whom I greatly admire. I consider her, Thank-God Okosun, and some of the doctors I met to be true heroes. It would be easy for them to move to Europe or the U.S. and have a much easier life, but they are completely devoted to improving the quality of healthcare for so many of their fellow citizens; their hard-work and dedication is truly admirable.

I told Dr. Mandaro that Packard had indeed made progress in bringing family planning and post-abortion-care services to many communities, and that this changing cultural norms represented no small task . Apparently, I had only visited 20% of the projects that Packard had instituted in northern Nigeria, so the work that they had undertaken was even more widespread and extensive than what I was able to document. Yet, I told Dr. Mandara, there is so much work that remains to be done. The birth rate had been reduced to approximately 6 in the communities where they were working (as opposed to 10 or 12 before), which is definitley a big step in the right direction; nevertheless, without further reductions and better educational opportunities for children, it will be difficult for these communities to attain an improvement in their quality of life, and they will continue to struggle with poverty.

I asked Dr. Mandaro how much the Nigerian government contributes to women’s reproductive healthcare programs, and her answer left me quite speechless — it was precisely zero. To make really lasting changes in a country the size of Nigeria, these successful programs must be scaled up; however, without government support, it will be difficult to deliver the necessary education and family-planning programs to the millions of people who need them.

If I ran a large foundation, I would insist that the government match my annual budget by at least 5-10 times. Of course, this is my personal blog and opinion and in no way reflects the policies of the Packard Foundation or the realities that they may contend with. But I find it shameful that the government of Nigeria does not contribute any funds or programs in family planning. Despite the handicap of working without government support, Packard has made a significant contribution to the well-being of many communities in northern Nigeria.

Nigerian Chronicles IX- PPFA in Gboko

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, Recent Projects, womens reproductive healthcare on November 8, 2010 by tuschman

So far I have been documenting family planning in Muslim communities in Northern Nigeria.  This next post brings us back together with Thank-God Okosun and PPFA’s activities in an evangelical Christian community in Gboko, Benue State. The NKST (Nongo u Kristi u k Sudan hen Tiv) Church, whose headquarters we visited, has 127,115 members distributed among 298 well established congregations. As Nigeria provides little to no health care service for its citizens, the church had taken over this responsibility by being a health care provider;  9 hospitals and 123 primary health centers are managed by NKST.

The highly restrictive religious bias against reproductive health issues is a serious cause for concern in Nigeria. Most religious organizations view issues of reproductive health, particularly issues of sexuality and family planning, as immoral. Seven years ago PPFA was able to partner with the NKST church in altering this cultural and religious perception. Family planning, sex education and post abortion care are now accepted throughout the church and the fact that the church has a well established network of hospitals and clinics has made this PPFA project an effective one for reaching a large number of potential clients.

We arrived at the church headquarters as a large thunderstorm was brewing. The church compound is quite large, encompassing schools for both primary and secondary education, as well as those that train nurses and midwives and support several clinics.

As is the custom, we paid an honorary visit to the head pastor of the church upon our arrival. I photographed him by dim window light as there was no electricity in the building.

PPFA and Packard also made an advocacy visit to the leadership of NKST church to honor Rev. Inyonogie in appreciation for his contribution to the achievements of the family planning project. Here he is pointing to a painting of the founder of the NKST church.

A recess at the primary school in the church compound.

In the church. congregants are singing hymns before the start of the official PPFA program.

Church officer organizing PPFA donated contraceptive commodities. The materials also include MVA kits and Misoprostol. Manual vacuum aspiration (MVA) is a fast and safe way to empty the womb using a large syringe and cannula. It can be used to help a woman who has had a miscarriage or abortion that was not complete. Misoprostol is also used for incomplete abortions or miscarriages.

Prophylactics that will be distributed to the congregants.

Since the community is rather self contained ample opportunities for reproductive health care counseling exist.

The program takes advantage of normal everyday activities to distribute condoms. Go to the seamstress to get a dress made or an alteration and you also get a lecture on birth control and some prophylactics.

Similarly, go to the hairdresser, get counseling and free prophylactics.

A couple obviously anticipating using their new contraceptives.

Patients waiting to see health care worker at family planning clinic.

At the clinic, a couple receives counseling on family planning and they choose a method.

The introduction of family planning into a conservative religious community is no small achievement; changing cultural perceptions is a formidable task and we have to look no further than our own country to see how difficult it is to make lasting change. Packard and PPFA have successfully partnered in having family planning become a totally accepted way of life in the NKST communities.

Nigerian Chronicles VIII- Social Networking

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, womens reproductive healthcare on November 1, 2010 by tuschman

In a small village an hour outside Kano I was asked to photograph a large congregation of people inside a small courtyard. Apparently this was the beginning of a wedding ceremony where Traditional Birth Attendants take the opportunity to dispense birth control materials  and  engage in family planning discussions. My initial impression was that there were more birth attendants than guests, but it was only the very beginning of the  celebration.

Two experienced TBA’s from CEDPA ( Center for Development and Population Activities) were among the first guests.

Gathering of guests in the courtyard.

Traditional Birth Attendants gathered in one of the rooms adjacent to the courtyard. Frankly, I did not see much interaction between them and the guests. Perhaps they were planning their strategy, or more likely  just resting before the guests arrived.

A few scenes from the courtyard:

A retired birth attendant.

A retired birth attendant, her colleague ( also retired) and her granddaughter.

Male Peer Counselors visit the marketplace to counsel males on the importance of  family planning.

Finally, Pathfinder volunteers at a university in Kano dispensing information on AIDS prevention.

I will be completing this series of  with two new posts on PPFA’s work in a Christian community in northern Nigeria.

Nigerian Chronicles VII- Hospitals

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, Uncategorized, womens reproductive healthcare on October 25, 2010 by tuschman

Abortions are illegal in Nigeria; nevertheless, abortions occur and as they happen under non-medical conditions, serious complications are all too frequent. Murtala Mohammed Specialist Hospital (MMSH) is the primary public sector hospital in Kano State and has the largest program for treating women for complications of unsafe abortions. Although the hospital serves mainly woman in Kano, patients from neighboring Nigerian states and countries as far away as Mali and Niger seek treatment here as well. I was informed that due to lack of blood storage facilities, the MMSH is one of only three comprehensive obstetric care facilities in the state able to provide the full range of life saving obstetric services. Trained nurses and midwives treat women suffering from incomplete abortion with manual vacuum aspiration (MVA) in a dedicated procedure room. Care is available 24 hours a day.  Women normally wait only 30 minutes to be treated, and most go home within an hour after treatment, after receiving counseling and choosing a contraceptive method.

MMSH is the only large scale hospital whose work in maternal health care that I documented. There were 3 very large hospitals where I was scheduled to work but was unable to do so for reasons that will become apparent at the end of this post.

Women waiting to be seen at MMSH

Health care worker recording patient information.

Patients and nurses in the ward for post-abortion care.

A patient undergoing Manual Vacuum Aspiration in the procedure room.

We also had the opportunity to visit the FOMWAN (Federation of Muslim Women’s Associations of Nigeria) Maternity Hospital in Kaduna. FOMWAN originally established the clinic in an area very close to an urban slum with the intent of treating women and children from this community. For religious reasons FOMWAN did not provide any family planning services. Pathfinder worked with community leaders to change this policy.  Pathfinder’s programs are focused on reproductive health and family planning–specifically healthy timing and spacing of children for improved maternal and child health outcomes. As mentioned in previous posts, the fertility rate and the maternal mortality rate is extremely high in Northern Nigeria. Increased birth spacing plays a critical role in reducing maternal mortality.

The hospital is a maternal and child health facility and at least half the patients in these small wards were very young children. With the help of Pathfinder, the hospital was able to increase their capacity and treat a larger number of clients.

Maternal Health Care Coordinators in front of hospital.

Organizing patient records

The pharmacist.

Women and childrens wards.

As I mentioned, we visited three very large regional hospitals only to discover that there were no patients, only senior administrators. The wards were completely empty, no nurses, health care workers, just empty beds. The reason for this was shocking; the government refused to pay the employees, including all the doctors and nurses, a reasonable wage for their services. Consequently, all hospital employees were out on strike and the hospitals had shut down. This was quite unbelievable and it doesn’t take much imagination to picture the serious consequences. I have to say I find this situation quite incomprehensible. Here are two photos from a hospital showing the empty wards.

Nigerian Chronicles VI: Bixby Girls Education

Posted in Africa, Documentary | Photography, education, Nigeria, Non Profit, Recent Projects on October 17, 2010 by tuschman

An hour outside of Kaduna, we arrived in a small village to document the Bixby Girls’ Education project. It was raining, and as we waited outside a small mud structure, a few women came to sweep out the water that had accumulated on the floor and then proceeded to lay down a dry carpet. About 15 girls appeared, and they all sat down in a big circle in the room and took turns reading from a single, soft covered book.

The girls are taught once a week in the afternoon from 3 PM to 5 PM. Every group of fifteen girls has one mentor. The books consist of some folklore stories that teach them cultural values; other books teach the girls the basics of child-raising and simple ways of combating deadly diseases through vaccines, including practical details of when to get them and where they are available. Other books discuss health-related issues: oral rehydration therapy, HIV/AIDS, and gender equality.

During the Children’s Day Celebration, the girls are normally taken out for excursions to various places with Program Officers and their mentors. The girls started this program completely illiterate, but now they can read and write without much difficulty.

Some girls were removed from the program by their parents, who had arranged marriages for their daughters.  Nevertheless, some of these girls later came back to continue with their studies.

I was very moved by the intensity of these girls as a single, very worn book was passed around so each girl could take a turn reading a single passage. Their attention was complete and unwavering as they were soaking up each and every word that was read aloud.

When everyone had had a turn reading, the mentor brought out a laptop computer and all the girls surrounded her, jostling with each other to be able to get a view of the computer screen. There was an image on the screen of a building in Europe (or the U.S.), and their hunger to get a glimpse of the outside world was palpable.

I have to admit from my Western eyes, I felt very sad that these girls were unlikely to ever have a chance to achieve their potential, to become doctors, nurses, lawyers, scientists, artists; their choice was limited to getting married and to having frequent pregnancies. I think it is wonderful that they learned how to read and write, but I could sense from photographing them that there was so much more they could achieve.

Nigeria has the wealth to educate these young girls and it is very unfortunate that the government can’t provide a full education that would give them the choice and the opportunity to attend a university. These girls’ situation is not unique; unfortunately, it is all too common. Their tragic loss of potential belongs not only to these young students who have such a desire to learn, but also to the nation of Nigeria and to the wider world.

The Emir of the village. It is customary to always greet an Emir when entering a village and get his permission to visit and photograph.

The girls reading and attentively listening:

The girls were totally captivated by the computer.

Nigerian Chronicles V: SWODEN in Kano

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, Recent Projects, womens reproductive healthcare on October 11, 2010 by tuschman

SWODEN is a foundation supported by the Packard Foundation that operates in Kano, the second most populous Nigerian city after Lagos, which has an estimated population of 2.1 million inhabitants (from the 2006 Nigerian census).  SWODEN is a multi-faceted NGO, whose work encompasses women’s reproductive health care, girl’s education, vocational-skills training, and microfinance – all with the express purpose of empowering women.

The SWODEN Community School project is designed to break the cycle of hopelessness that children experience from their impoverished environment. The school has operated since 2001 and is designed to give the students a positive, hopeful dimension to their lives.  So far, the school has graduated 127 pupils, with many of them going on to secondary school.  A total of 87 students are currently attending classes.   The school offers scholarships, and provides the basic educational materials needed to attend, including uniforms, bags, sandals, books and writing materials.  Of course, guidance and counseling are always available to each and every student.

We were rather late arriving to the school; our plane was delayed by 3 hours and I only had about 20 minutes to photograph there. Below are some select photos from my very shortened visit.

SWODEN’s program has a skills-acquisition training program, where women are instructed in simple trade and handicraft skills, including sewing, dying and quilting. A total of 203 women have graduated from this program since its inception in 2005. Microfinance loans are available, which give graduates an opportunity to increase their earning potential.

Our last leg of the SWODEN tour led us to a clinic in the village of Sarauniya, about an hour outside of Kano. Well aware of our arrival, a reception had been planned for the Packard Foundation in a show of appreciation for their funding of this community clinic. SWODEN has trained Community Health Extension Workers to educate their clients on reproductive-health measures, HIV management and prenatal care. When we arrived, the small country clinic was overflowing with community dignitaries and clients, waiting to greet us (they too had been waiting an extra 3-4 hours).

Arriving at the clinic:

A gift was presented by the Emir of the community (on the left)  to Fatima Usman, Program Officer for Packard. The gentleman in the middle is one of the Emir’s aides.

The main exam room at the facility; the Community Health Extension Worker is taking the patient’s history.

Four women, in the same exam room, waiting to confer with the health worker.

Inside the larger waiting area, clear visual evidence of the number of people attending the community meeting, which also served as a reception for Packard.

Elders of the community were there in support of the family planning programs.

This elder was continually praying- I hope for the success of the program!

Close-up of an elder

Women and their very young children-

A mother telling her appreciation of the family planning program to the Emir and Fatima Usman from Packard.  In the second photo she is shown with her 3 year old and one can see that she is clearly pregnant now.  The increased spacing between births is a main focus of the family planning program.

I believe the next three photos (especially the second one) will give a sense of the number of children in this small meeting place. Of all the places in the world I have traveled, this was the densest concentration of children in one small meeting room that I have ever experienced. It is commendable that the Emir and elders of the community are behind the family-planning programs, but birth rates are still high.  Without decent education for these children, the cycle of poverty will no doubt continue.

Nigerian Chronicles IV- PPFA in Maiduguri

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, Recent Projects, womens reproductive healthcare on October 3, 2010 by tuschman

In Maiduguri, PPFA ( again supported by Packard Foundation grants) had set up a Reproductive Health Information and Services Center run by youth peer educators. PPFA considers peer to peer interaction very critical for successful youth and adolescent reproductive health programming. The philosophy behind these programs, according to Thank-God Okosun, the PPFA Program Officer here , “like poles attract and unlike poles repel”.  PPFA has invested heavily in training young peer counselors to implement their educational activities, especially  in contraception and safe sexual practices. They are also trained to refer clients for post abortion care and unintended pregnancies for possible counseling and services. Emergency Contraceptives have also been introduced and considering the conservative religious climate, this is seen as a major point of progress in family planning programming.

PPFA’s Youth Friendly Center is very much like a boys and girls club for teenagers. There is a pool table and other recreational activities and every opportunity is used engage teenagers and educate them on sexual reproductive health issues.

A peer counselor educating a young women on various birth control options. Here she explains the “female” condom option.

Condoms are distributed here in the pool playing room.

These two young women are being counseled in birth control options. They are very young and recently had abortions.

Another counseling session where every available birth control method was discussed.

The resource has an abundance of educational materials.

A young women contemplating her situation.

The center has a room where one can be tested for AIDS.

Nigerian Chronicles III- PPFA in Gwoza

Posted in Africa, Documentary | Photography, Nigeria, Non Profit, womens reproductive healthcare on September 27, 2010 by tuschman

Gwoza is a community in northern Nigeria that is over 90% Muslim. As recently as six years ago it was inconceivable to imagine any birth control or family planning options. They were regarded as taboo. The accepted norm was that  “God gives children and God will provide for the children”. It was therefore not unusual to see women giving birth to 10 or more children. The cultural belief system encouraged the high rate as the more children a women had, the more respect she received  from her husband and the greater her status within the  community.

Six years ago, PPFA (Planned Parenthood Federation of America) started to bring a new perspective to these cultural beliefs. Traditional rulers and district heads are  recognized as gate keepers in the community; they are the custodians of the native laws and customs and as such, are revered and respected. PPFA spent considerable time convincing these rulers that family planning would benefit their communities.

The following photos and commentaries will hopefully give a fuller sense of the program activities of PPFA in Gwoza. Again, all these programs are funded by the Packard Foundation. And to add a disclaimer, any opinions here are mine and do not reflect the policies or opinions of the Packard Foundation.

The main street in Gwoza is, in fact, the main thoroughfare in this area. Many young men loiter around here-  the unemployment rate is upwards of 40% and educations doesn’t seem to be a serious option in this part of the country. PPFA health care workers attract the attention of these young men with bullhorns and informational posters and the promise of free condoms.

This poster reads: “Your wives/women are like your farmlands. If they are given a break from childbearing/adequate spacing of child births, their health and well being is at its BEST”. There was a great deal of interest expressed by these young men in what the health care workers had to say.

Thank-God Okosun, here dressed in blue, is the main PPFA officer in charge of programs here in Gwoza. Here he is shown handing out condoms. The few times I saw this activity, it always resulted in a “condom riot”,  as these young men pushing and shoving, tried to grab as many as possible. The chaos that ensued ended very quickly when someone in the crowd ran off with the majority of the condoms. The second of these photos shows a tall young man fighting off  his cohorts. He ran off with the condoms immediately afterwards.

Health care workers with poster that reads “To cut down large family size reduces burden”.

Another health care worker with poster reading “ One of them ( boyfriend/girlfriend) may be carrying the disease HIV but your eyes cannot tell. Stop having sex without protection. Stay faithful to your partner”.

These male motorcyclists are in a procession to visit the Emir of Gwoza.  By distributing condoms and birth control pills to their peers, these commercial motorcyclists aid PPFA. PPFA also use them to mobilize community members during reproductive health public campaigns, seminars and ‘special days’ such as World AIDS day.

The Emir of Gwoza

Thank-God Okosun and members of the community involved in PPFA’s efforts address the Emir in a show of appreciation for his wisdom in encouraging family planning programs in his community. There is significant  difference in acceptance of modern family planning in Gwoza and adjoining communities as compared with six years ago. At that time it was taboo to mention family planning because of the dogmatic religious and cultural norms. I believe it is important to note that at this point in time family planning refers to spacing out the time between births; it is still the women’s role in the culture to have many children.

The Emir’s musician ( the Pied-Piper of Gwoza) leads a group to the main market. The musicians not only draw the attention of the men and boys; their presence lends an air of acceptability to the message of the health care workers.

Health care workers in the marketplace using bullhorns and posters to convey their family planning messages.

A  pool table in the market. I can’t help but wonder how this surreal scene came to be.

A clinic in Gwoza. These young women were pregnant for the first time and were waiting patiently to see a health care worker.

A health care worker lectures on the the process of having a health baby.

These young women appeared to be none too pleased about the prospects of their pregnancies.  They were very sad and introspective and I can only imagine that they were concerned about their futures.

This was the only women I saw with a full burka. I didn’t know the relation between the woman and her baby with the woman in black. They were waiting outside the clinic.

A health care worker demonstrating the proper use of condoms to male and female peer counselors.

Women who had come to testify in appreciation of the PPFA programs. I asked  the women how many children they each had and was a bit taken aback when it averaged 7.5. Thank-God explained to me that most of these women already had the majority of their children before access to family planning was available and now they can safely spread out their births.  It was not unusual to find mothers with up to 15 children each before birth control programs became available.

We then visited the home of a traditional birth attendant. There were at least 30  young mothers with their children sitting outside in the courtyard waiting to see her.

Birth attendant preparing to see a patient

Bed where mothers give birth

The traditional birth attendant counseling mother about to give birth.

The experience of documenting the activites of PPFA in Gwoza left me with conflicting impressions. On one hand, the fact that each women was still having between 6-8 children was a bit overwhelming. Seeing all the young men on the streets and envisioning each of them having at least 6-8 children without any opportunities for education or meaningful productive work would only foment the some of the chaos that I experienced.  Yet, in six years of programming, Thank-God and PPFA had made significant progress. Changing a culture is a formidable task and in a relatively short period of time, they had made a difference. It is in places like Nigeria where I meet people like Thank-God who I hold in such great respect. He is doing heroic work trying to improve the lives and health of this community, especially the women who still have no other choices but to be mothers with many children. The progress PPFA has made is  impressive, especially when one delves into the religious and political climate in this area of Nigeria. I have recently read The Tenth Parallel by Eliza Griswold, a book I highly recommend. It is, as the subtitle suggests, the fault line between Islam and Christianity and it goes all through Africa and Asia and it passes through the region of Nigeria where I did my work.  Here religion comes in only one flavor- fundamentalist- and there are frequent conflicts and massacres between Christians and Muslims.

In Nigeria,  government corruption is a fact of life and people can expect no services from the government. ( I’ll elaborate on this in a later post). According to Human Rights Watch,  politicians have reportedly embezzelled between $4 billion and $8 billion annually.

To quote from Griswold:

“Despite the country’s vast oil wealth, more than half of Nigerians live on less than $1 a day and four out of ten are unemployed. Being a citizen of Nigeria means next to nothing; in many regions, the state offers no electricity, water or education. Instead, for access to everything from schooling to power lines, many Nigerians turn to religion. Being a Christian or a Muslim and belonging to the local church or mosque…. has become the way to safeguard seemingly secular rights.”

“Nigeria’s population is growing at a rate of 2 per cent a year- dramatically faster than the global average…..When it comes to religious competition, population is an undeniable asset.”

In this climate, the fact that Thank-God, with the support of PPFA and the Packard Foundation, has brought family planning programs to Gwoza that have been accepted by the community, is indeed remarkable.

Nigerian Chronicles II- Yola Nomadic Schools

Posted in Africa, Documentary | Photography, education, Nigeria, Non Profit, Recent Projects, womens reproductive healthcare on September 22, 2010 by tuschman

These schools were funded by the Packard Foundation.  According to the foundation, the education of girls is the best indicator of reproductive health outcomes as they mature into women of child bearing age. The plan is to make sure these children will receive an education that will carry them through secondary school.

While these young girls  (and boys) are in the classroom, their parents also are instructed on reproductive health care issues. I was under the impression that the education was limited to the seasonal time that their families spent in this region grazing their cattle, but I was mistaken. Migratory patterns have become more erratic. This area, along the 10th parallel in Africa, is a region greatly affected by climate change. The deserts to the north are moving south by the rate of a quarter to a half mile per year and the frequent droughts make it all the more difficult for these tribes to follow their traditional migratory routes.

Now the mothers and children stay here while the fathers assume the nomadic life, following the rains with their herds.  One of the hidden blessings is that these children now have an opportunity to receive an education.

The schools I visited had, at most, one book per classroom. All learning was by rote. It never ceases to amaze me how children that live in cultures where education is not an integral part of their lives, where there are no books or any other of the resources we take for granted, have such a strong  motivation to learn. I am especially impressed by their attention span, as they continually listen and recite every word their teacher enunciates.

Below is a gallery of the images from two of the nomadic schools we visited.

The three instructors:

End of school day: