Timothy Olanrewaju, Maiduguri
For 40 years, the tall building at the heart of Maiduguri, capital of Borno State, which serves as the institution where nurses and other health personnel are trained, has been painted and repainted in different colours. Yet, the contents of the building, in this case the students, have remained like the proverbial old wine in a new bottle.
“Most of us never knew the status of the school. We just got admission to study nursing and midwifery but unsure of our acceptance outside Borno,” Aishatu Bello, who graduated seven years ago from the school, said.
Established in 1971 by the then Northeast State Military Government, the school could only admit and train 100 nurses and midwives yearly. This, many argued, was grossly inadequate for a state grappling with dearth of medical personnel amid growing public health challenges, including high maternal mortality, incessant outbreaks of measles, cholera, diarrhoea, meningitis and, recently, COVID-19 pandemic.
Statistics provided by the school indicated that the institution has produced over 4,000 skilled nurses and midwives in the last 40 years for a state with a population of over four million. The school graduated 242 nurses for the 2013-2017 academic session out of the total 308 students enrolled for the three-year programme.
There are 788 frontline health workers, nurses, midwives and community health workers in the state. This means that there are only 10 nurses and midwives available to about 100,000 patients!
Before 2009, when the Boko Haram insurgency started, the reporter learnt that most of the community health centres in the 27 local governments had very few nurses to provide care for patients, especially women during pregnancy and delivery, which compelled many residents to opt for the services of traditional birth attendants.
The story of 35-year-old Fasuma Saleh was quite pathetic. Fasuma was brought to Dalaram Primary Health Centre in Old Maiduguri in a Keke NAPEP (tricycle) in a pitiful condition sandwiched by two elderly women. She had been in labour for three days at home, assisted by the two elderly women, apparently traditional birth attendants. By the time she was brought to the centre, it was too late. She died at a referral hospital following complications from prolonged labour.
It was the seventh birth for the mother of six.
“She delivered previous children at home and she thought she could do the seventh one the same way but that was not possible. She died eventually,” a family source disclosed.
The reporter observed a gap in the workforce of the health centre despite its efforts to provide proper care for pregnant women, nursing mothers and their babies, as well as minor ailments. There are five community health extension workers (CHEW), six junior CHEW, eight environmental workers and two midwives, without a nurse, for 35,914 patients annually and about 150 deliveries in a month.
Facility manager, Yagana Lawan, said the centre has been attending to patients well despite this challenge. She said government renovated the facility and provided more equipment to facilitate better and quicker services. Some patients said they wished the health centre and other hospitals in the state had more personnel.
Their wish can only be realised through training of more medical and health workers. This is what health institutions like the nursing school and school of health technology were established to provide, but lack of official approval by relevant authorities for programmes offered there has hindered this objective.
The World Health Organisation (WHO) became more visible in the North-East following years of Boko Haram insurgency and the negative impact of the insurgency on public health. Health indices in the North-East, according to WHO, was one of the worst in the country even before insurgency. The situation became evidently precarious with the violence entering its 11th year.
“In 2018 alone, attacks on health care system have become commonplace. A total of 13 attacks on health facilities, leading to 17 deaths and 12 injuries were reported in 2018,” WHO’s health emergency communication officer, Chima Onuekwe, disclosed.
He said eight of the attacks involved health worlers, five affected supplies, five were on health facilities, and one on transport logistics. He said the increasing loss made the organisation to intervene by renovating teaching and learning facilities in the school, including the laboratory, library, classroom and demonstration room, which led to accreditation of the school by the Nursing and Midwifery Council of Nigeria (NMCN).
In 2016, the institution was upgraded to a college status and it recently secured the approval of the nursing council and was licensed to accept higher number of intakes for its nursing and midwifery programmes. It was also granted permission to start new programme/courses including community nursing.
“We can now admit up to 100 students for basic nursing, 100 students for basic midwifery and 100 for community nursing programme; all for three years,” provost of the college, Mrs. Rukayat Shettima, told the reporter. This increment is also expected to produce about 300 nurses, midwives and community nurses every three years.
“There are more programmes to be introduced because we now have a better and well-equipped laboratory and demonstration room to take care of the population of students. Students will no longer wait for another set to finish their practical. They can be doing them simultaneously with equipment available now,” she explained. She also said the intervention included new books for students, chemicals and testing equipment.
Shettima enthused that she felt on top of the world when she bagged a nursing registration number following her graduation from same school in 1991 but her postgraduate education in other nursing institutions in the country and the recent upgrade shown the school was then far behind some of its peers.
So, what impact will these interventions have on health care delivery in the state? Shettima maintained the state would have more health workers, more importantly, at the community level.
“Each local government is expected to sponsor candidates for community nursing and they will return to work at the community health centre upon the completion of their studies,” she explained. The health workers would also receive training in sensitisation of locals on personal and community hygiene, detection, control and management of disease and public health emergencies.
“This will substantially reduce incessant disease outbreaks in Borno, especially among the local population, because there is a link between information and disease outbreak,” she said.
Indeed, Borno people would be looking forward to experiencing the impact of the accreditation and upgrade on the state in the coming years.