Fieldset
Context

"On arrival, the sturdy iron gates opened to allow the white MSF logoed Land Cruiser to pass, and I am greeted by the security staff. 'Welcome to Jahun Paradise!' they say with a smile."

Here I am in Jahun Nigeria.  I have settled in. And yes, I’m safe.

Jahun is little more than a small northern village in Jigawa state, one of the poorest of the country’s 36 regional subdivisions.  It is an eight hour drive from the central capital of Abuja where I landed now 2 weeks ago.  The road is well maintained and lined with markets, people, a surprising amount of garbage and an excessive amount of petrol stations (seemingly at kilometer intervals or less).  The landscape is mostly flat, scattered with lush trees growing out of the dry sand and red earth.

Tucked just off the main road in Jahun is the Medecins Sans Frontieres (MSF) compound. On arrival, the sturdy iron gates opened to allow the white MSF logoed Land Cruiser to pass, and I am greeted by the security staff. “Welcome to Jahun Paradise!” they say with a smile as they stand up from their white plastic seats in front of an industrial sized fan.

It is hot and dry under the midday sun with temperatures soaring above 40 degrees. The gentle warm breeze is welcome but when the wind picks up it sends fine sand particles into suspension, and I am temporality blinded and left with a granular sensation in my mouth.

Nigeria’s history is complex. Decades of military rule and dictatorship have created a situation of economic, political and social setbacks characterized by endemic corruption, failure of the public service system, and extreme inequality.  National politics are marred by the increase of religious extremists and militant groups such as Boko Haram in the neighbouring northeastern states.

Interestingly, Nigeria was where MSF was ‘conceived’ over 45 years ago. After the Biafra secession conflict in 1969/1970, a group of doctors and journalists concluded that a new aid organization was needed that would ignore political/religious boundaries and prioritize the welfare of victims.

Since then, MSF has opened numerous projects in Nigeria including this one in Jahun which began in 2008 initially focusing on treatment of vesico-vaginal fistulas – a tragic and preventable complication of obstructed labour whereby prolonged pressure of the infant’s skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (or ureter or rectum) and has uncontrolled leakage of urine (or feces).  Women with obstetric fistula suffer devastating social consequences, as they are often rejected by their husbands and excluded from their communities.

The scope of the project has expanded over the years to include prevention of obstetric fistula and other obstetrical complications. MSF now runs the maternity unit at the Ministry of Health General Hospital of Jahun.  The facility is generally running at well over 100% capacity with over 1000 consultations and 750 deliveries per month!  The majority of patient cases are classified as “complicated” presenting with hypertensive disorders, severe anemia or excessive bleeding.

It is certainly an adjustment of practice. Patients present sicker and more critical than I’ve ever seen before.  The work is demanding but rewarding. I feel privileged to be able to work in an area where MSF has a long history and continues to be valued.