When 51-year-old Sa’adatu Abdullahi was rushed to Misau General Hospital earlier this month, her sister Jamila Abdullahi accompanied her to the cholera ward with a sample of their well water in a 4-litre gallon. Sa’adatu looked pale and could not speak coherently.
Experts say persistent outbreak of cholera in Bauchi State is caused by poor urban planning and regulatory failures. WikkiTimes’ Rauf Oyewole reports that due to indiscriminate refuse dumps, stinky abattoirs and unclean sources of water, the state government has endangered the lives of residents by failing on its basic responsibilities.
When 51-year-old Sa’adatu Abdullahi was rushed to Misau General Hospital earlier this month, her sister Jamila Abdullahi accompanied her to the cholera ward with a sample of their well water in a 4-litre gallon. Sa’adatu looked pale and could not speak coherently.
A commercial vehicle from Gwaram village in Misau, about 89km away, had brought her to the hospital where three of her neighbours had also been sickened by cholera. “I feel so empty. I can’t stand on my feet and my stomach is hurting, ” she told WikiTimes.
“Her stool has changed to something like water from boiled rice,” a doctor who has been treating her said under the condition of anonymity because he was not authorised to speak to the press.
Sa’adatu was lying down in a makeshift hospital bed, clutching her abdomen in a gesture to stop her severe vomiting and diarrhoea. The hospital had removed the mattresses from the beds to give way to her stool and that of other patients, placing a bucket under each bed.
The doctor explained to WikiTimes that the measures would prevent the mattresses from harbouring the bacteria that sickened Sa’adatu and others.
The hospital is grappling with the latest wave of cholera outbreak in the state that have sickened thousands of people and killed several people, a disease whose occurrence is associated with contaminated and infected water supplies. The frequent outbreak of cholera in the state has drawn attention to the failure of the state government to safeguard the lives of the residents, negligence that has been costing lives over the years.
At Trauma Section of the Abubakar Tafawa Balewa University Teaching Hospital in Bauchi, the state capital, Khadija Umar, a nursing mother had suffered diarrhoea for more than a week before her husband brought her to the hospital.
“While I was at the Primary Health Centre, Federal Low Cost, the nurses were just administering drips on me without knowing or bothered to ask about my underlying condition,” Umar said. “This exacerbated my condition. I thought I would die because my BP was so high that the doctors were giving me much attention. I was not part of those taken to the cholera camp. I think it was because of my condition.”
The cholera outbreak has not also spared young people in the state. Eighteen-year-old Sale said he had spent one week in isolation while receiving treatment at Bauchi Specialist Hospital. “It was a terrible experience,” he said. “I was about vomiting everything in me.”
Outbreak overwhelms health facilities
Several health facilities visited by WikkiTimes in Bauchi State had been overwhelmed by the cholera outbreak. In Dass Local Government, for instance, cholera patients were being treated under the trees located in the hospital premises.
“We cannot accommodate the influx of patients as a result of the outbreak”, said Amina Umar, a health worker.
The situation was the same in Bayara General Hospital where the female ward was filled with patients, forcing Maimuna Ibrahim to lie on a wooden bench outside. “I had to lie here because there is no space inside,” Ibrahim said. “The situation had turned into a pandemic of some sort.”
In Misau, the chief medical director at Misau General Hospital, Dr Mohammed Sani, said this year’s outbreak has overstretched the services of the hospital. “Many of our doctors and other personnel were made to work overtime to treat the increasing number of patients. Some of them could not go home to celebrate Eid-il Kabir.”
Bauchi, like many other states in Nigeria, especially in the North, has been experiencing seasonal outbreaks of cholera. Many residents of the state have died of this preventable disease while thousands of them have had a near-death experience.
Cholera remains a global threat to public health and an indicator of inequity and lack of social development, according to World Health Organisation. The UN health agency estimates that about 4 million cases are reported every year while 21,000 to about 143,000 deaths are recorded annually globally.
WikkiTimes’ findings in Bauchi has shown that poverty and poor access to water, as well as negligence by the government, has worsened the outbreak over the years.
In 2014, about 16,923 people had cholera in the state while 143 died across the 20 local government areas in the state, according to WaterAid Nigeria. Over 87 per cent of the cases were recorded in the state capital. In the following three years after 2014, the state did not record an outbreak of cholera.
But in 2018, Bauchi had 9,725 cases of cholera with 28 deaths. Children under the age of five years made up about half of the victims, according to WaterAid Nigeria.
A coalition of civil society organisations in the state blamed current outbreaks of cholera for “indiscriminate disposal of waste (solid and liquid), inadequate clean water supply within Bauchi metropolis and its environs, and poor hygiene practices.”
So far in the latest outbreak, about 2,874 residents have been hospitalised while 42 persons had died of cholera between May and August, according to Rilwanu Mohammed, the executive chairman of Bauchi State Primary Health Care Development Agency.
About 80 percent of the cases had occurred at Bauchi Local Government Area which covers the state capital. Toro Local Government Area is another hotspot with 212 cases while Dass and Tafawa Balewa local government areas recorded about 100 cases each in June 2021.
Repeated efforts by WikkiTimes to get officials of either the Bauchi State Ministry of Health or the State’s Primary Health Care Development Agency to comment on its findings was unsuccessful.
The permanent secretary of the Ministry, Dr Dayyabu Mohammed said it was only members of the committee responsible for the disease that was allowed to comment on the issue. “There is a committee that is doing that every day,” he said. “I know that our director Disease Control, Madam Lois is there and Gandi is the State Epidemiologist. Go and meet them, they will give you what they have been doing. I’m not part of them.”
Then the state’s epidemiologist said only the director of Disease Control could permit him to speak. But the director instead directed the reporter to the executive chairman of the State Primary Health Care Development Agency, Dr Rilwanu Mohammed. Again, Dr Mohammed declined to comment, saying he was directed not to speak on the issue.
Bauchi’s stinky abattoir and unprotected meat is cholera breeding ground
WikkiTimes’ findings show that there are many cholera breeding grounds in Bauchi State, particularly in the metropolitan where the largest chunk of the cases had been recorded. The meat vendors at Bauchi stinky abattoirs do not cover the meat against flies, for example.
“I have been selling meat in this Wunti market for about 12 years; this is how we do it,” said Sai’d Auwal, a meat vendor who was chasing flies away from his meat. “We don’t want the meat covered because of our customers; it is for them to see that we have meat.”
Cows are slaughtered under a big shade with a corrugated roof. The facility is surrounded by stinky cow-dungs deposited there for weeks. Although there was a clean source of water from an overhead tank, the polluted environment exposes buyers to disease-causing bacteria.
The process of treatment and transporting to other vendors within the metropolis is an eyesore. Meats are conveyed to the two main markets – Muda Lawal and Wunti in open vans, tricycles, and bicycles. These unhygienic practices, according to public health and environmental experts, are some of the causes of cholera outbreaks.
Heaps dump and poor urban planning threaten residents
Littered waste across strategic locations and disjointed residential areas that defy proper urban planning amid population outburst in the ancient city and its environs have made it easy for cholera to hit hard, according to Dr Abubakar Suleiman, an environmental expert.
WikkiTimes’ checks around the metropolis showed heaps of refuse at different junctions and compounds. School-age children were seen scavenging at a dumpsite beside Doya Primary Health Care Centre, along Gombe road. Also, many houses in the capital are built against state urban development plans.
At Yakubu Wanka area, along Gombe road, most of the slums on the hilltop have no proper waste management system. Over 90 per cent of the houses in the neighbourhood release their wastewater to flow down the hill, causing further contamination and health risks linked to the cholera outbreaks.
“We that are down here under the hill suffer the waste from those on the top,” said Ibrahim Umar, a resident of the area. “Their smelly water and toilet waste sometimes flow down here. We don’t have well water and there is no government-provided water source on our side here. I think it is because of the topography of our houses. The water pressure is not strong enough to push the water to climb up.”
An environmental expert at the Abubakar Tatari Ali Polytechnic, Dr Abubakar Sulaiman said that the government’s failure to enforce the laws has worsened the indiscriminate disposal of waste in the state. “How can a government employ staff to regulate abattoir for instance and those who are responsible to do checks at the facility have left the job undone and you keep paying them,” he said.
“In a standard abattoir, there should be health experts, veterinary doctors, environmental officials who must certify the health of the animals and that of the butchers. This is not obtainable in our abattoir. And sadly, someone is being paid for this job.”
He continued: “Another major issue is that the people who are paying taxes have not been holding these government officials accountable for their responsibilities. It is the responsibility of the government to ensure that waste is properly managed.”
He added that it is “so sad that are still dying of these preventable diseases. People build wells very close to their sewage. This is against the standard of six meters of space. They dump refuse indiscriminately. This is where all the contributing factors grow. Many of the residents do not know how to prevent the disease.”
Well water not safe for consumption
In a 2018 report by WaterAid, 65 percent of Bauchi State residents do not have access to clean water. WikkiTimes’ findings across the state capital showed that the majority of residents in Bauchi metropolis rely on wells as sources of water. Experts said well water is not considered a good source of water. Comrade Umar Sabo, assistant director of Water, Sanitation and Hygiene at the Rural Water Supply and Sanitation Agency (RUWASSA) said that “generally we don’t consider well water as a good source of water.”
He added that “We don’t go for testing of such a source unless it is on-demand (by the private owners). No matter how the construction is made and the cover. We only conduct testing on hand pumps and other sources of water.”
Experts believe that drinking well water which they said houses microorganisms, can cause diarrhoea, dysentery, salmonellosis, hepatitis, and guardians. Infants, children, elderly people, and people with weakened immune systems are more likely to get sick or die from disease-causing microorganisms in drinking water.
Although the state’s multi-million-dollar World Bank-assisted urban water project is providing clean water to some areas within the metropolitan areas, challenges of occasional water treatment and breakdown issues leave residents days without water.
According to Mr Kolawole Banwo, head of advocacy, policy, and communications at WaterAid Nigeria, poor sanitation and hygiene practices contribute to cholera spread. “It usually breaks out in the onset through the peak of the rainy season when water sources get contaminated,” he said.
“Where there is open defecation and poor management of faecal waste from poor toilet facilities and poor hygiene such as handwashing with soap and water, poor treatment of drinking water and food processing, cholera spreads easily. So whatever communities do consciously or unconsciously in these directions, fuel the outbreak of cholera,” he added.
“Many depend on water from wells and water vendors which are exposed to contamination. Despite this, only 15 percent of households treat their water before drinking while 84.7 percent do not carry out any form of treatment. 41 percent of people in Bauchi state have access to sanitation services with about 77 percent of the population making use of pit toilets and only 1 percent have access to basic hygiene services.”
BASEPA does so little at prevention
The Bauchi State Environmental Protection Agency (BASEPA) has said that 12 firms have been certified to ensure cleanliness in all the 20 local government areas.
The agency’s director, Dr Ibrahim Kabir said that he met with the head of the Primary Health Care Development Agency to strategise on curbing the outbreak of the disease. “But one of the factors that contribute to the outbreak is when people create a habitable environment for all kinds of diseases to escalate. We also have the responsibility of house-to-house inspection. There are over 125 community inspectors at the agency.”
Dr Kabir said the management of abattoir is the responsibility of about four agencies of which BASEPA is one. “We were there about two weeks ago along with the veterinary council, Bauchi council officials to inspect the facility. As a professional agency, we were able to identify some of the things that should be done in the Inkil abattoir.
“When you go to that place, you will see an unwholesome environment,” he said. “A lot of odours. Of course, they have water, but they don’t know how to use it. The slabs they use are highly unhygienic, especially when you look at the vehicles that convey the meat to the markets. They look unwholesome.”
WikkiTimes’ findings show that despite accrediting 12 firms to keep Bauchi clean as claimed by BASEPA, the city is still littered with waste.
This story was supported by Civic Media Lab