Dear health workers of Nigeria,
You will not know me, but I am that infant that is no more. I did not live long enough to have a name. I was dependent on you to live, but I didn’t.
I appreciate that you took the long time and sacrifice to study the science and the practice of healing. But with great power comes great responsibility, which needs to be handled delicately – making sure you are available to mothers and newborn children around the clock so we can access assistance and support when we need it most. Often, it is our only chance of seeing through our early and fragile days.
You went on strike for more than four months in 2014 and for more than five months in 2015, leading to haphazard delivery of essential health services. The story has been the same in 2016, with strikes in one state after another from Nasarawa to Lagos, Ogun to Jos and Ekiti to Kano.
I was told the strikes were necessary because you were fighting for your welfare and for leadership in the Nigerian health system.
The ratio of maternal deaths in Nigeria is 576 deaths for every 100,000 live births. Neonatal and infant mortality rates are very high at 37 and 69 deaths per 1,000 live births respectively. Let me share some stories with you.
The first story is that of baby Gako from a wealthy and educated family. His mum was a teacher, 8-months pregnant, who came to you for help because she was feeling pains in her abdomen. She was educated enough to know that something was wrong, but you turned her away saying you were on strike.
So, with her resources she decided to go to the private hospital for help. By the time she got there and was examined, baby Gako had already died in the womb. The doctors tried to get him out but unfortunately both baby Gako and his mum died in the process.
The second story is mine. Unlike baby Gako, my parents were poor and uneducated. I was meant to be their first child born in a health facility, but just like Gako, you turned away my mother who was in labour. I was delivered by unskilled hands on my mother’s way back home. This is how I came to my death.
The idea that health-worker strikes could have negative consequences on the health and survival of mothers and newborns seeking services has been popular with the media. We cannot deny the association between access to health care and the subsequent improvement in health outcomes.
But those women who have been turned away from health facilities because of strike action have suffered the consequences of which we all know too well.
Using demographic health surveys to create a retrospective panel of births and linking that with records of strikes from Social Conflict in Africa Database (SCAD), Willa Friedman and Anthony Keats show what happens when children are born during health worker strikes in sub-Saharan Africa.
They found that babies born during strikes are less likely to have survived than those born at other times, with more dying within the first month of their birth.
In my opinion, the worst day to die is the day you are born. That day is supposed to be a happy one for families which have been expecting you for so long with excitement, welcoming you with open arms.
Instead they are informed that their precious child has gone. In many cases, the mother passes away too. I was really looking forward to meeting my mother, opening my eyes for the first time to see the face of the person who carried and cared for me. But now I will never see or hear from her ever again. I will never get the chance to talk about my potential, which I will now never reach. Who knows if I might have been the one that would have brought the change that this country so desperately needs?
I understand that you are protesting for your rights – after all, we live in a democratic society. But I believe there are other ways to fight for your rights and still attend to emergency cases like a pregnant woman in labour or with serious danger signs – just like my mother.
I beg of you to think about the consequences of these strikes. Women and children are too important and valuable to be collateral damage. It is your right to protest, but not at the expense of mothers and newborn children
Dr Nasir Umar is a Research Fellow at the London School of Hygiene and Tropical Medicine and is the Nigeria Country Coordinator for the IDEAS project.
The views expressed here are those of the author and not necessarily those of IDEAS or the London School of Hygiene and Tropical Medicine.