Poverty, poor hygiene and Lassa fever…Bayo Olupohunda

A few days ago, I had visited an area of Lagos known for its population density, chaos and filth– a fertile ground for breeding rodents which health experts have said are the carriers of the Lassa fever virus. I had gone on a condolence visit to an acquaintance and junior colleague whom I had known from my previous job. Emmanuel, who had been bereaved, was a driver in my former office lives in Ikota, a slum settlement in the Ajah area of Lagos. Residents of Ikota are the remnants of Maroko slum dwellers who were forcibly evicted from Maroko in the infamous demolition by the Lagos State Government in the 1990s. Emmanuel had lost his son to a preventable disease-typhoid fever. The boy’s death was a direct result of ignorance and poverty. They had kept him at home treating malaria until his condition became worse. By which time it was too late to seek medical help.

Emmanuel’s father had been a victim of that forced eviction. With his demise, Emmanuel had inherited the knocked up two-roomed shack made of old corrugated iron sheets and wood planks. He was the first of 10 siblings. All of them are crammed in the small room. During my visit, one of Emmanuel’s sisters, a heavily pregnant woman, had also brought her two sons to live with him. She had complained of the cost of renting a house in Lagos. Emmanuel had no choice but to take her in. The house itself was like a junkyard. Old furniture, “Ghana-must-go” bags, and other odd things competed for space with sweaty children crammed in the small space. As one can imagine in an environment like that, there was neither electricity nor conveniences. Everybody urinated in the open and the stench was choking. Ikota should qualify as one of the most inhabitable places in the world. Yet, human beings are living there.

Welcome to the harsh reality of living conditions of Lagos slum dwellers.

According to the World Population Review, about 60 per cent of Lagos population lives in slums in different parts of the city with no access to roads, clean water, decent housing, electricity or waste disposal. At Ikota, I could see how the dreaded Lassa fever would spread quickly if it ever breaks out there. The entire community was filth personified. Drainage was stagnant and overflowing. Mountain of refuse was everywhere. Rats were everywhere. But Emmanuel hardly noticed. The presence of rats seemed normal to him and his neighbours. I called his attention to the presence of the rodents. I asked if he knew they could cause Lassa fever epidemic. He said he was hearing it from me for the first time. When I tried to educate him about hygiene, he just answered casually and dismissively, “Bros, na God dey save person.”

As the Lassa fever spreads to epidemic proportions in the country, health officials in cities across Nigeria will have to worry about how poor hygiene in communities such as the Lagos slum I visited and many others can contribute to the spread of the disease. Poor sanitary conditions in many Lagos communities and settlements will no doubt aid the spread of not just the Lassa fever disease but other communicable diseases. Unlike the Ebola disease that was quickly put in check through the heroics of Stella Adadevoh and the prompt intervention of health officials before it could spread, Lassa fever is caused by unsafe health practices which breed rodents, which cause Lassa fever. The threat of Lassa fever therefore presents a different health challenge. As Lagos records its first case of Lassa fever, the emphasis should be on controlling the spread of the fever. The population of Lagos also presents a challenge. With about a third of the population living in slum areas, the spread of any communicable disease is a disaster waiting to happen. Poor sanitary conditions, open sewage and houses built on stilt without conveniences can aid the spread of any disease.

Lagos slums are breeding places for rodents. But it is not just the slums of Lagos that harbour rodents. Generally, Lagos residents seem not to take the hygiene of their environment seriously. That is why many residents are prone to other illnesses like malaria, cholera and the silent killer typhoid fever. There is hardly a house in Lagos today where there are no rodents. Lagos residents seem to have come to accept the presence of rodents as neighbours.

In a release by the WHO after the first case of Lassa fever was reported, the organisation identified rodents as carriers of the Lassa fever virus. “Lassa fever is an acute viral haemorrhagic illness caused by Lassa virus, a member of the arenavirus family of viruses. It is transmitted to humans from contacts with food or household items contaminated with rodent excreta. The disease is endemic in the rodent population in parts of West Africa. Person-to-person infections and laboratory transmission can also occur, particularly in the hospital environment in the absence of adequate infection control measures. Diagnosis and prompt treatment are essential.”

Having identified the cause of the fever, there is the need to create awareness among residents about the danger of unsafe health practices that lead to the breeding of rodents. The Lagos State Ministry of Health has to be alive to its responsibilities. But it seems to me health officials in Lagos often prefer to wait for diseases to break out before they perform their statutory duties. Rather than the usual panic measures of sealing health institutions and quarantining victims of diseases, it will be more worthwhile to anticipate and prevent these diseases from breaking out. Sometimes, I cannot help but consider Lagos as a place where an epidemic is just waiting to happen.

As a solution to the poor hygiene situation in many Lagos neighbourhoods, there is the need to bring back the once dreaded health inspectors. In the past, health inspectors visited houses unannounced. Health inspectors were feared by residents because they had the power to recommend the sealing of a house if the landlord and tenants did not comply with health standards. Since they were domiciled in the local government areas, they conducted health inspections in the grassroots and enforced compliance to health standards. But over the years, since the states have usurped the functions of local governments, they have been effectively rendered redundant to perform their statutory functions including that of health inspection.

In Lagos and many other places, you will often find homeowners who do not comply with health standards. How many of those houses have been sealed? How many landlords in Lagos have had their houses sealed for not providing toilet facilities for their tenants? In Eti-Osa Local Government Area, for example, many of the houses have no toilets. You will often see residents defecating in the open. If you visit any hospital today in Lagos, you will be alarmed at the death rate resulting from typhoid fever and malaria. I want to advise the state health ministry to strengthen its compliance and enforcement units. A situation where people are allowed to build houses without providing facilities should is unacceptable. The local council development areas should also strengthen their public awareness and inspection outreaches. Stakeholders and the civil society also have a role to play educate Nigerians.

Follow me on twitter: @bayoolupohunda

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