Makoko has the dubious honour of being dubbed the world’s largest floating slum: up to 300 000 people are said to live here – in full view of every person stuck in the notorious Lagos traffic on Third Mainland Bridge. Some view the settlement as an eyesore, and there have been repeated attempts to move parts of the community, sometimes by force.
The air is prickly with tension when we arrive. We learn that a community dispute erupted in violence earlier that day, and the Baale (traditional leader) was forced to intervene. Baale Jeje Albert’s wife Sosiana Aide (50) welcomes us to a covered courtyard outside their house and cheerfully admonishes us not to pay any attention to signs of recent bloodshed. Young men in the community blame outsiders photographing their way of life for the sporadic attempts to evict the community, and we encounter several men who are visibly angry at our presence until the Baale’s son, Benjamin, intervenes.
Most of the people living in Makoko make their living from fishing and sand-dredging – by hand. Benjamin explains that this dredging is done the hard way: the men dive under water and bring up buckets of sand, one lung-bursting bucket at a time.
“We built this by hand” he says, stamping his foot on the sandy ground for emphasis. “We took this land back from the sea, bucket by bucket.”
Makoko consists of 6 villages, with 4 of them on the water and the rest on reclaimed land. It’s a precarious existence, wedged between the sea and the ever burgeoning megalopolis of Lagos.
This is a place where survival is a struggle, space is limited and services almost non-existent. Some of Lagos’ more affluent residents would prefer to keep it that way, suggesting that services such as a hospital will act as a magnet and encourage more settlement. Others are more pragmatic, pointing out that the many thousands of people already living there deserve basic services such as health.
For Sosiana Aide, the facts are simple: women will continue to die in childbirth unless they can get to hospital quickly. “In my day we didn’t go to hospital to have babies. I delivered all 7 children at home with the help of my husband and herbs from the traditional birth attendant.” But Sosiana has changed her mind about hospital births after seeing numerous women die in complicated deliveries. “I can think of 6 or 7 women that I know personally who have died in the last 10 years, because they needed an emergency Caesarean section and couldn’t get to the hospital in time.”
As the wife of the Baale, women in the community seek Sosiana’s advice particularly when they or their children fall ill. “The biggest health problems here are malaria in pregnant women and measles in children. Many people still don’t understand about vaccination. I am not educated,” says Sosiana humbly, “so I tell women it is better to go to hospital for treatment.”
Despite delivering all seven children at home, Sosiana says she thinks professional ante-natal treatment is vital. “Nowadays they can scan the baby and follow its progress, and if you have an emergency or something is wrong, the doctors will know what to do. The herbalists can’t see inside to check if the baby is alright.”
Dr Francis Ohanyido, senior policy advisor for the ONE campaign agrees: “Herbal concoctions can be very dangerous, particularly in the first trimester and can cause malformations of the foetus. We don’t know what these mixtures contain and there is no quality control as they are not regulated.”
In theory, an ambulance could be called in an emergency and should be here within 30 minutes, but Sosiana says “they take very long to come and don’t know their way around here,” indicating with her chin the tangle of cluttered alleys and passageways. Women trying to reach the hospital on their own often find themselves stranded and in labour: “I have even seen women end up delivering on the side of the road because the hospital is too far away and they couldn’t get there in time,” adds Sosiana.
“The most common causes of maternal deaths in Nigeria include bleeding, hypertensive diseases in pregnancy, obstructed labour, eclampsia, maternal infections and unsafe abortions,” explains Dr Ohandiyo. “Emergency C-sections are an important intervention factor but more women are dying because C-sections are not commonly a primary care intervention. These women need to be referred to secondary health care services.”
The nearest hospital is far away and most women can’t afford transport or prescriptions that they are given. “Sometimes they will give drugs for free but if the hospital doesn’t have them, the woman has to buy. Those drugs they prescribe cost N4000 (US$14/GBP10) and they just don’t have the money.” With bus fare to Badagry hospital costing another N4000 (and a bus trip of several hours in the unrelenting traffic) many women have no choice but to take their chances with traditional potions and birth attendants.
“Makoko typifies how the poorest of the poor and those living in hard- to- reach areas are often underserved because of geographic access,” says Ohanyido. “Women bear the brunt of this inequitable state of affairs, becoming even more impoverished by the additional burden of paying for transported to distant facilities. In cases where there are primary health care facilities in hard-to-reach areas, the providers themselves often do not feel incentivized enough to stay and work there. This is a sad state of affairs that cost the lives of our women and children daily.”