Where oil rich Nigeria has precious little

New MSF project fights malaria
The Niger Delta. Hot, humid and covered with rainforest and mangrove swamps. Underneath all this tropical greenery lies black gold: 90% of Nigeria's oil comes from the Delta region, and there are many multinational oil companies operating here. But despite this great wealth, the local people live in poverty. In the heart of the Delta, in the federal state of Bayelsa, MSF is making preparations for a project to fight malaria, the No. 1 killer in this remote, watery region. Medical care is a luxury here, while high unemployment and conflicts are everyday reality. The sun barely peeks out as we leave Yenagoa, Bayelsa's tiny capital. A thin cloud hangs over the Niger. The desert sand that came blowing in from the Sahara this morning obscures the view. On board the motorboat is the MSF team: two doctors, a nurse, a medical anthropologist and a logistician. We're on our way to the village of Oporoma, where MSF carries out consultations twice a week in the local clinic, as there has been no doctor there for six months now. The trip takes just over an hour. Along the banks we see tall palms and acacia trees. Now and then we give a wide berth to a fishing net, or slow down as a vessel approaches in the opposite direction: a narrow dugout canoe with two women in it. Everything here is done by water. People fish in it, swim in it, relieve themselves in it, and drink it. 'Clean drinking water is scarce,' Doctor Saskia de Vries explains. 'There are wells, but they are often polluted.' We approach Oporoma, with its mud huts on the banks. We step ashore via a rickety landing stage. On the other bank we see the first evidence of oil extraction: a gigantic orange flare against the grey sky. 'We weren't very welcome here as first,' Saskia tells us. 'The people already had bad experiences with Shell. They were very critical, and made all sorts of demands.' Begging for work, roads and a clinic The main grievance of the people in Bayelsa is that the oil, which has earned billions of dollars for the government and oil companies, has brought them precious little. There is no running water here, hardly electricity and no roads. The first oil was found in the east of the Niger Delta in 1956, in Oloibiri. The people had high hopes then: they thought they would get all sorts of facilities. 'For years we've been begging Shell and the government for employment, roads and a clinic,' relates the local ruler, His Royal Highness Maddocks Ogbog of Oloibiri, whom I have met on an earlier occasion. 'But it's all been in vain. The land has been taken away from us for a pittance. They just sucked us dry and threw us away. When the oil wells were no longer profitable, in the 1970s, they simply stopped.' Gaining confidence There are 35 patients at the clinic this morning. Lots of mothers and children with diarrhoea, a boy with an abscess in his groin, and three toddlers with malaria. There is no laboratory in the clinic, and the only microscope doesn't work. 'You have to go on your own observations and the symptoms,' says Dr. Jones Stow, himself an Ijaw from the region (Ijaws are the largest ethnic minority in the region). An oil company helicopter clatters above the clinic. 'We don't have any hard figures, but on the basis of studies and discussions with the authorities we know that malaria is the main cause of death for children under five. A lot of pregnant women succumb to it as well. When people are ill they go to a traditional healer. There are few doctors and hardly any nurses. After all, who wants to live in such an isolated area, without running water or electricity? At the most, such village might get a young, recently-qualified doctor who is obliged to work in are remote community in Nigeria for one year after completing his studies. After a great deal of effort we have finally managed to get a doctor here who will shortly take over the consultations'. Floating malaria clinic His Dutch colleague Saskia de Vries chimes in: 'In this tense region it takes a great deal of time to win the confidence of the people. It's a difficult project - we'll only see the results in the long term.' She explains that the project has two main components. A maximum of 10 healthposts will be selected in places where the medical needs are greatest, and health workers will be trained there in diagnosing and treating malaria, and in providing information about the disease. The healthposts will be given a microscope, and MSF will train laboratory assistants in doing malaria tests. The second component is a boat that will be fitted out as a mobile malaria clinic. This will travel to otherwise inaccessible villages in order to treat malaria patients. In the small village clinic, Dr. Jones Stow sits behind his consulting desk and listens patiently to the stories of pregnant women with abdominal complaints, small children with infections and a surprising number of people with muscular pain. 'Paddling on the river in the wrong position,' laughs Jones. After Oporoma, we travel farther to the next village. We leave the wide Niger and sail up a narrow creek. A dugout holding a mother and her child paddles past. The mother gives us a friendly smile. Suddenly we see plenty of young men on the bank, sporting red headbands and holding dangerous-looking machetes. They wave to us, but they look threatening and so we keep our distance. Kenneth, our local logistician who is travelling along with us, tries to reassure us. According to him, it's a ritual in honour of the war god Egbesu, the protector of the village. But since we can't be sure of the situation we press on. Later we hear that the machete-wielders were expecting an attack from a neighbouring clan. Courtesy visit Just under an hour later we reach the village of Opuoma, with its mud huts and row of dugouts hauled up on the bank. There are probably some six or seven thousand people living here. Saskia asks for the village leader. A crowd of villagers escorts us to the village hall, a small stone building beside a dirt road. We are invited to sit at a long table, and the council members take their places opposite us, in almost their full number. There follows a complex round of introductions. Dr. Jones Stow explains who we are and what MSF does. He tells them that we represent an independent organisation that is not financed by an oil company or a government, that we help everybody, irrespective of their ethnic origin, religion or politics. The doctor asks if we may see the local healthpost. We are allowed to, but first we have to make a courtesy visit to the local ruler, King Oumatebe Opu VI, who is waiting for us in a dimly-lit room. He is wearing his full royal raiment: a colourful embroidered tunic and trousers, and a tasselled cap. The villagers peer curiously through the open window as Dr. Jones once more explains the reason for our visit, speaking in English and Izon, the Ijaw language. Once he has finished, the king offers us a drink: Cola or local beer. We then go in procession to the clinic, which is undergoing alterations. The dust is swept off the treatment table and the shutters are opened. Saskia discusses the situation with the local health workers, while the nurse, Marjan, chats with the villagers about their health problems. A man complains about his painful eyes, which he ascribes to the smoke from an oil well where gas is flared off. Others tell how oil spills affect their lively hood: killing their fish and farm crops. As our visit comes to an end, the team is called to a seriously ill man who lies groaning on a mat in his hut. Saskia examines him, and hears that he has previously been treated for tuberculosis. She proposes taking him with us in our boat to the hospital in Yenagoa, but his daughter and son prefer him to stay at home. Saskia leaves medicines with the health worker, who promises to visit him every day. Chloroquine as sweeties Esmee de Jong is a medical anthropologist who has joined the team to study the health behaviour of the local people. Who do they go to when they are ill? What medicines do they use? How far away is the nearest healthpost? It seems that when they have malaria, many people go first to a masseur, to have their painful muscles treated. If that doesn't work, they go to a medicine seller who sells them chloroquine. 'The people here eat chloroquine like sweeties,' says Esmee. 'We suspect that the malaria mosquitoes in the Niger Delta have become resistant as a result of this uncontrolled pill-popping. It's important to take the proper dose, otherwise resistance can occur.' If the chloroquine doesn't help, then they go to a traditional healer, who often works with herbs or to a spiritual healer. According to the prevalent belief in Bayelsa, cerebral malaria is caused by evil spirits who can only be treated with prayer or exorcism. Security risk Only in the last resort do patients come to a healthpost, which sometimes takes them days to reach. By this time it is often too late, certainly in the case of the deadly cerebral malaria. People don't trust what they don't know. Few Nigerians know MSF, and so MSF deliberately seeks publicity in that country. Months before the project started, MSF sought contact with the authorities and with the media in Nigeria. Through interviews with newspapers, radio and television the team announced its presence and informed the public about its humanitarian mission and what it intended to do in the Niger Delta. There were also security reasons behind the campaign: some 250 people were kidnapped in the Niger Delta last year, most of them oil company employees who were eventually released in return for a hefty ransom. However, the security risk is still high for MSF workers, despite the publicity campaign, as I experienced for myself. Although having to go everywhere by water is troublesome, I was very glad to be sitting safely out of reach in a boat when the young guys with red headbands and machetes appeared on the river bank.