July 24

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Unbreakable

Greetings to all! Having been in Nigeria for over a month now, I can look back and reflect on my experiences so far with a slightly new perspective. To be honest, I was worried when I found out that I’d been placed in Nigeria for my PULSE assignment, and especially in a large city. Wasn’t a PULSE assignment going to be about living and working in rural areas, becoming ingrained in a local village culture and directly helping those in need? How was I going to do that living in the capital city? And Nigeria? Aren’t there real safety and corruption concerns there? Well, as is so often the case, the perception and reality were quite different.

That is not to say that there aren’t challenges here; there most definitely are. Nigeria has the resources to support significant development itself, but there are so many structural and political challenges which prevent those resources from going where they’re needed. Nigeria exports over 2 million barrels of oil per day, but has only very limited refining capacity, so most oil is exported- accounting for 99% of Nigeria’s total exports- and then refined petroleum products are imported. The lack of refining capacity means that the country loses much of the economic multiplier effect of oil production, and also means that there is significant pressure to maintain the status quo from those who benefit by the current environment (foreign refineries). The infrastructure of the country is in need of significant improvement, with frequent power and water supply outages. But again, there are forces which seek to maintain the status quo (generator manufacturing and sales, perhaps?). And there are definitely corruption issues; just the other day, we were stopped in our cab by the local police. There were no violations cited, but it became clear that the officer was going to keep us there for no reason other than to see if the driver would offer him some money to let us on our way. After about 20 minutes of negotiating with the cab driver, the policeman let us go, but not before the driver offered him a small tribute. It’s a terrible state of affairs, and is a source of huge frustration among the ordinary population, but something that people feel powerless to change.

But the most surprising thing I’ve found since being here is the people. I expected to find talented, passionate people here supporting malaria consortium, and that’s exactly what I’ve found. But the ordinary Nigerians I’ve encountered have all been extremely warm and welcoming. People here love to laugh and do so easily. Everyone is genuinely happy to see each other and, despite all of the challenges of life here, demonstrate a level of resilience that is inspiring. One of my Nigerian colleagues said “Nigerians have no breaking point” and I think that’s a good lesson for all of us.

The project work at Malaria Consortium is very interesting and will have significant positive effects on the population. Malaria is endemic throughout Nigeria and the burden of disease is borne mostly by children and pregnant women, with over 30% of childhood deaths (<5 yrs) attributable to malaria. I feel fortunate to help support an effort aimed at Seasonal Malaria Chemoprevention (SMC) where these at-risk children are treated with anti-malarial agents as part of a mass drug administration (MDA) campaign during the high transmission (rainy) season in areas where the season is 3-4 months long. In doing so, children may be protected during the worst of the season. This approach is supported by WHO and has been shown to be highly effective in other countries. However, each country has its own structural challenges (healthcare delivery systems, perceptions of MDA campaigns, education and religious beliefs, etc) which mean that a local contextual solution is needed for each country. The potential benefits are significant, and if shown to be effective in the Nigerian context, our results will be used to help drive adoption of this approach across the appropriate regions of Nigeria. While I may not be in a village setting offering direct care to patients in need, the magnitude of positive effect this project can have is quite humbling, and I feel lucky to be here supporting it.