International staff: 15
National staff: 38
Although Nigeria is slowly coming to political life after the death in 1998 of military leader Sani Abacha and the election in 1999 of a new democratic government, many Nigerians continue to live in poverty, untouched by the country's vast wealth.
They are distrustful of giant multinational oil companies that continue to exploit the country's abundant oil resources. Tension among various ethnic and religious groups continues to erupt in violence. MSF, whose roots reach back to the country's 1967-1970 civil war, has had ongoing programs in the country since 1996. There is an emergency response program in Kano, in the north, and a new malaria program in the Niger Delta.
In the low, watery Niger Delta, malaria is endemic. Access to screening and care is minimal, and people must often travel several days by canoe to reach a health post. Malaria is the main cause of illness and death in Bayelsa State, an area of the Delta with about 1.5 million inhabitants. The disease is estimated to be the number one killer of children under five.
After assessing nearly 30 health posts in Bayelsa in spring 2000, MSF, members of the local communities, local health workers and the State Ministry of Health met to select the villages where the malaria program would be launched. Work in eight village clusters began in June.
The MSF team spends up to two and a half weeks in each cluster. Part of the team works in the health center of the central village; the others take a malaria boat, fitted with lab equipment and medicine, to villages that are more than a half day's paddling away from the health center. They do malaria smears and treat patients. Health workers in the villages are trained in diagnosing and treating malaria, and in educating local people about the disease.
As part of the malaria project, a medical anthropologist, working with three local field investigators, carried out an in-depth survey of the population. Who do people turn to when they are sick? What medicines do they use? How far do they have to travel to reach care? The answers have been illuminating.
It seems that many people who suffer from malaria go first to a masseur to have their painful muscles treated. If that doesn't help, people may seek out a traditional healer, who works with herbs, or a spiritual healer. The results of the survey are being used to understand how the Ijaw people - the main ethnic group in the region - seek health care.
MSF is also working with the Federal Medical Center in the state capital Yenagoa on protocols for laboratory work related to the malaria project. An MSF lab technician trained a group of village lab workers earlier this year. These technicians, in turn, are putting in place advanced screening techniques in the village health posts which are part of the MSF project.
MSF runs an emergency preparedness program based in the northern city of Kano, which has a population of around 1.6 million. Concentrating on 19 health centers and hospitals, the organization supports surveillance of four epidemic diseases - cholera, measles, meningitis and yellow fever - in the city's main hospitals and clinics.
In the event of an epidemic, MSF intervenes in cooperation with the Ministry of Health in case management, epidemiology and disease control. In 1999, MSF treated 9,000 cases of cholera and 550 cases of post-measles complication. Over 2,000 community health workers were trained in cholera prevention and hygiene.
As part of the program, MSF has sponsored training sessions for local health workers. Initially, participants met to share information on traditional beliefs, personal and environmental hygiene, nutrition and health-seeking behavior. Based on this, MSF worked with the State Ministry of Health/HECTIC (Health Education Communication Training Information Center) to develop ten different health education kits covering topics such a measles, malaria, female genital cutting and nutrition. The kits are used during the organizational training sessions.
MSF also aids victims of violence in emergency situations, a growing problem in Nigeria. In late 1999, MSF treated over 500 villagers in Bayelsa State after their village had been blockaded and set on fire.
An urban health care program in Lagos was handed over to the local government and UNICEF in early 2000.