Fieldset
Nigeria: Mortars and pestles, lead and gold

Our staff are used to fighting epidemics. But not every outbreak is biological. Abdalla Karim shares the story of a community hit by a different kind of crisis, and the MSF team who worked with them to bring it under control.

This is my fourth assignment with Médecins Sans Frontières / Doctors Without Borders (MSF), the usual unfamiliar surroundings signaling the beginning of a new posting. With it a rush of anticipation emanates through me, feelings that feel almost impossible to desensitize to. It’s Nigeria this time, which in many ways feels like going back home: I wonder how different it is compared to 1970 when a group of doctors and volunteers witnessed the atrocities in Biafra and decided to speak out, telling the world what they saw. That was MSF’s inception and birthplace.

Almost all new international assignments with MSF start in the coordination office, usually located in the capital city. I’m greeted by warm and dancing smiles, interest and reciprocal fascinations followed by my first lesson of the local Yoruba and Hausa languages. “Wahala” means trouble.

I hadn’t envisaged starting this way, my heart skips a beat, then I understand and let out an audible sigh of relief. “No wahala” is something you tell someone thanking you for answering a question, I had asked about the location of the water cooler earlier. I gulp down the water and pray for no major wahalas in my assignment ahead.

MSF’s country director and her deputy brief me. Challenges, risks, plans, wishes, a chocolate chip cookie, descriptions, limitations, advice and a sincere good luck. They speak to me for more than an hour.

I’m going to Sokoto in northern Nigeria. They tell me that it’s relatively safe, we have a good relationship with the Sultan in that region. Words of comfort that make me rejoice, also it was good to know that it’s relatively safe.

Later that night I couldn’t help but reflect on the briefing, in particular the part about one of our other projects in Zamfara region and its lead poisoning component. I want to learn more so I read:

“In 2010 an annual immunization program in Northern Nigeria led to the discovery of a high number of child deaths in the area … It was thought by the villagers that all the children had contracted malaria but Médecins Sans Frontières (MSF) found unusually high levels of lead in the blood during tests.”

MSF can be a locus for strange paradoxes sometimes. Zamfara region is rich in gold, which has led to innumerable misfortunes and the largest known outbreak of lead poisoning in history, affecting an estimated 3,500 children alone.

In order to extract gold, rocks from Zamfara’s rich soil were being crushed and then ground to a fine powder, before being sluiced with water. The dust from this process contains highly toxic lead, which settles on surfaces and contaminates water sources.

Without safety measures in place, when mine workers returned home, exhausted and battered by the day’s work, the dust went with them. The dust was being accidentally ingested not only by the workers themselves, but also by their children, both through breathing it in, and through contaminated food and water.

I try to imagine what it would have been like for the mine workers, laboring hard on the land, believing it was worth it, taking solace in the chance of having a better life, seeing their children happy.    

But many of their children died.   

I go back to thinking about the briefing. The country director explained that, 11 years after setting it up, MSF is now planning to hand over the lead poisoning program to the local health authorities.

I ask why. I know that detaching our programs can sometimes end up badly for patients; it means a loss of resources and expertise. However, at times we have to do this in order to focus our actions where they can have the most impact.

She explains that it’s because the low number of patients doesn’t justify having such a specialized MSF-run program, and that the local authorities are in a good position to be able to take the project on.

There’s a perceptible tension and momentary silence. She notices my discomfort and tries to impede the gloominess in the air. Reaching to her desk drawer, the deputy and I are offered some cookies.

My mind is fixated on poisonous lead, rendering all refreshments foul. There’s a taste of battery acid in my mouth as I ask for the reason behind the low numbers of patients. Curious to know as to what has changed.
I learn that ever since MSF discovered the crisis, there has been a multi-pronged  approach to mitigate the disastrous impact unsafe mining has had on local people, especially children.

One very tangible aspect of the intervention has been case management, including medical treatment, follow-up and support, lab diagnostics and community outreach. However, advocacy, awareness and health promotion campaigns have also been key.

Our teams have been working with communities to do everything from risk assessments to sharing information about lead poisoning, including how it can be recognized and prevented.

MSF has worked with environmental management experts to take away the contaminated soil, and a safer mining program has been developed. This program gives mine workers training in how to prevent contamination, as well as bringing in new protocols and equipment at the processing sites.

All this has proved to be immensely impactful in the long run. MSF’s raison d'etre is to reduce morbidity and mortality rates; to a large extent, we did.

Still I clinch my arms as I remember the plight of the mothers of Zamfara. I hate it but I purposefully look back at it, I hear the lacerating words of the country director again:

“The most tragic factor in all of this has to be the mothers who worked in the field. They used to use their kitchen tools, mainly the mortar and pestle, to crush the rocks into dust. Then they would cook for the family and children using the same tools. Hundreds of children died.”

I cannot sleep. I grab a pen and push it with anger against the blank spaces on the scattered pages of my briefing documents. The pen tears through the papers, while a fire burns me within. I breathe deliberately in hopes of conjuring up enough gentleness to write. I write: it’s unfair.

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Read more: Stories from Nigeria

Blood and community: How health promotion is saving lives in Nigeria

“I could see the joy on their faces”: Life-saving care in northern Nigeria