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Stories of Water Access

Martina Ohaegbulem

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56-year-old Martina Ohaegbulem, has worked for the Zuba Primary Health Centre in Abuja, Nigeria since 2011. The hospital has no access to clean, running water; it has only one toilet for its patients and a thin hospital staff. Despite these deficiencies, Ohaegbulem loves what she does. “I love it, I love being a nurse,” she said. “I don’t want to choose another profession…”

Curator’s note: The following is an excerpt of Martina Ohaegbulem’s story as told to WaterAid staff in September 2016

I am a nurse midwife, married with three children. I don’t know the exact year the facility started its operations but it has been running for up to 20 years. I began working here in 2011. We run an antenatal clinic, postnatal clinic, and provide immunizations, deliveries, laboratory and PMTCT (Prevention of Mother To Child Transmission of HIV/AIDS) services.

We don’t have any borehole here, we normally buy water. No tap, no well, we don’t have any source of water supply. We buy from Meruwas (water porters) outside. Yes, the centre has not had access to water in its twenty years of operation. Today, we bought about two kora for six hundred naira (N600). That is the highest we spend in a day. The water is not safe to drink, it is only for washing. When we buy the water, we use it to wash the linen materials like bed sheets. After delivery, we use it to clean the environment and then wash the instruments. We also use it to flush the toilets and bathrooms. We buy two kora, which are two water trucks every day. One has ten to twelve jerry cans. Except on public holidays when the rate of patient inflow is a bit reduced or something of that nature.

We have toilets — the squatting water system. It is washed by the attendants and we buy Jik, Omo and Hypo to keep it neat (various cleaning brands). We have two toilets — one for patients and one for the staff, which is not enough. We admit patients for observation, but after 24 hours we discharge them. As much as 12 to 15 people visit here every day. On immunization days, which are Tuesdays and Fridays, the population will be much more. We get as many as 40 or 50, and even more sometimes on those days. We give antenatal care on Mondays and Wednesdays, but we accept people who come in on other days.

The patients all use the outpatients’ toilet. But the one toilet is not enough. Both males and females use the one for the patients. We need another toilet. On antenatal days, we don’t find it easy. When we come to work on those mornings, we have to first organize the pregnant mothers, we pray then give them health education depending on the topic of the day. After this, we counsel those who should go for the HIV tests. We don’t force them to do the HIV test. We do both pre-test counseling and post-test counseling. We also prescribe drugs, hand these out and decide who needs admission or observation. We put those who need observation to rest for 4-6 hours and then we discharge them.

Apart from sanitation and hygiene, we have other challenges. In respect of hygiene or sanitation, the toilets are not enough and we need water supply to keep them neat. Yes, someone has to teach them about handwashing. We bring water and we bring soap then show them how to practice personal hygiene both at home and outside the home. We give them the opportunity to practice hygiene here. The only thing is that there is no running water. During the practice, someone has to still help them to help pour the water to the hands as there is no working tap. Someone has to assist them.

We need a borehole or a well if one can be dug in the compound. We need more toilets for both the staff and patients. We need running taps and the other things too. We need improvement in handling those things — wash-hand basins and similar things. We buy the soap we use from the little money we are paid for deliveries (births). It’s the money for deliveries we use in paying some of our workers, the volunteers, but we also buy the soap from that same money. We need improvement as we are not functioning efficiently. But we are trying our best with what we have.

We need more manpower as we are lacking nurses and midwives. Most of the staff here are community health workers. In delivery and labour, we only have nurses and midwives on morning shifts. The afternoon and night shifts are entirely composed of community health workers. We need more hands, more midwives or nurses.

There is no toilet in the delivery room. We made the delivery couch ourselves from delivery fees or antenatal purchases. After each delivery, we keep items, like Jik, that remains. We also buy bed sheets for ourselves. We have only one bed; we used to have two but the other one has gotten bad. If we have a situation in which there are two women, one in the first stage of labour, the other about to deliver, managing the both of them in the labour room is a problem for us. The same in the observation room where we have only one bed, the second is no more useful. We need more beds, delivery couches and delivery instruments too. Most of the delivery instruments are rusted.

We buy Izal and Dettol and after each delivery the person who conducted the delivery will wash the instruments in soap and water and soak it in water bought from the meruwas. We have containers with covers for the instruments, to keep them hygienic.

I am happy doing my job. When I finished secondary school, I wanted to be a nurse. I love it, I love being a nurse. The way nurses do things, their smartness, neatness and caring. I don’t want to choose another profession especially as I am almost at retirement age.

As long as there is water, I regularly hand wash even at home. I tell the patients that after waking up, the first thing to do after morning prayers is to wash their faces, brush their teeth, sweep their houses, keep their environment neat, keep their kitchens neat, tidy the rooms in their houses, wash their toilets and bathrooms. I stress a lot on hand washing. I tell them that after leaving the toilet they should wash their hands before touching anything. I tell them to wash the food to be eaten well with water and salts, especially for fruits and vegetables. I tell them what to do.

With the help of this clinic, the community has benefited enough. The rate of home deliveries has been reduced. We have been encouraging them, since we introduced this ‘babies are equal’ program, to come and deliver in the hospital. That after each delivery, the mothers are given ten thousand naira (N10,000). Since then, the number of deliveries has increased, as it has encouraged them to deliver here. Secondly, the HIV testing we administer is free and the women have been responding; the only challenge is that the husbands do not respond with equal ease. Some of the mothers also find it difficult to disclose their status to their husbands. The community benefits from the clinic both in the mother and child health areas. When community members are sick or there is an emergency, they come to the clinic. We operate for 24 hours, so they always get help and the charges for health care received is less compared to private clinics. We differentiate instruments of HIV mothers from seronegative ones, whereas in the private centres they may not run tests and use the same instruments for everyone.

The ‘babies are equal’ program is a newly introduced one, it started maybe a month ago. An NGO initiated it to encourage the women, the mothers to deliver in the hospital. After each delivery, the women receive 10,000 naira (N10,000). That will encourage them to deliver in the hospital rather than at home or in a private facility. The NGO gives the money. They have in place a register, as well as making available their contact information, for each pregnant mother to submit their names, address and phone numbers on antenatal days. Immediately the woman comes to the centre at the commencement of labour, we take a picture of them with the pregnancy — their faces and abdomens to show they are pregnant and their clinic cards. When the woman delivers, the midwife conducting the delivery will still take the woman’s picture — the face, the new baby, and the card. We send all this to them and they will pay the woman. They use a First Bank of Nigeria account, domiciled in Zuba. The NGO is called “All babies are equal”.

We have IECs and posters on hand washing outside in the consulting hall. There is a family planning unit here; the immunization unit is on the other side of the hall. I have to look at the register to be sure, but we should have up to 12 staff members, between 10-12.

We need more midwives in the maternity section so we can have midwives handling labour and delivery. We don’t have enough of that. Then toilets and water issues. Handwashing facilities as well. The laboratory is private, not owned by the government. If we are asked in an official form if there is a laboratory in this facility, we say no.

Photo credit: WaterAid/Simi Vijay

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