Absence Of Effective Community And Environmental Health Care Services At The Local Level: A Reason For The Mysterious Deaths In Kano, By Nasiru A. Ahmad, PhD

The world is challenged by COVID-19, which changed its order dramatically. The virus, as a self-replicating pathogen, has the potential for mass destruction. It releases its venom by infecting a host, which becomes a factory for producing more virus that spreads like wildfire among people due to its contagious nature. The disease was labelled as a global pandemic, and as such, necessitates a global response. COVID-19’s negative attributes remind us of some forgotten epidemics that were equally destructive in the history of humankind.

The 6 th -century Justinian Plague killed as many as 30–50 million people, about half of the world’s population. In the same vein, the Black Death of the 14th century also unleashed severe agony onto the world, with recorded fatalities
of about 75 to 200 million. The world also lost about 50 to 100 million people to the 1918 influenza (more than the number lost in the First World War), which infected about a third of the world’s population. These pandemics showed that plagues are not just an incidental aspect of human life but contributed to the reshaping of human history. For instance, European diseases wiped out thousands of Native Americans as the Europeans marched into Native territories, paving the way for the creation of the United States of America. Similarly, even after the discovery of Africa, it was difficult to be accessed due to the prevalence of tropical diseases. As the Europeans did not have a natural resistance to those tropical diseases and vaccines were not developed as artificial remedies.

Coming to our society in Nigeria, the lockdown in Abuja and Lagos started while I was in Kano and observing social distancing in line with Nigeria Centre for Disease Control (NCDC) directive. This gave me the chance to visit some
places within the metropolis before the state was also lockdown. I also paid condolence visits to loved ones before the situation became horrific. This necessitated little breach of my strict compliance with social distancing while critically observing our environment. Despite the sad moments, Nigerians never abandon their topical discourse about the government and its responsibilities. The surrounding belief about the invading virus in the state was also a subject of their discussion.

I stopped and had a critical reassessment of the people’s condition in the area. First of all, I observed the poor sanitation conditions in the locality. One would need to hold his breath intermittently while passing heaps of garbage and stagnated exposed gutters filled with sachets of table water and other assorted junks. Many people, particularly little children and the aged population, wore tattered clothes, which indicated total disparity with highbrow settlements.
However, from the look of things, the adult population appeared to be more active, agile, and energetic. This proved that many of them were engaged, doing something to earn a living, but whatever they did was insufficient to take
care of themselves, let alone their immediate families.

I also saw ruined houses that appeared to be built in ancient times. I observed that some of the houses had utterly collapsed, and some were haphazardly supported to guard against the likely eventualities. This demonstrated that
people’s net income was not adequate to rehabilitate these ruined houses. The inadequate drainage systems, scattered ambulating goats, and their dumps exacerbated my remorseful feelings for the local inhabitants. The location just described is the central area of the most populous local government in Nigeria, with a population of 418,777 according to the 2006 census, and a landmass of 19 km 2.

The local government in question received N239,067,181.90 in February 2020 alone, despite the dwindling nature of our revenue, while the state government received N7,398,160,643.44 for the entire 44 local governments in the state. I did not conduct an empirical assessment of the local government’s economic empowerment plan and the sanitary and disease control measures. Being an eyewitness, I examined some facts and conducted a brief undocumented interview with the local officials. The result of my preliminary investigation collaborated the reality on the ground—the local authorities are faced with a paucity of funds; as such, a sanitation and empowerment plan could not be in their list. Meanwhile, the state had little regard for these programs, as they are too local and cannot be of public interest if compared with its top-priority edifice currently under construction.

The recent COVID-19 outbreak showed the importance of disease control at the local level, as the federal government could have leveraged on this structure to extend its preventive measures and sensitization campaign at a grassroots level. Also, the vast amount budgeted and expended by the federal government as a palliative to relieve the citizens from economic pain could have been applied more optimally with a robust local government structure. The increasing number of COVID-19 cases in Kano demonstrates the government’s lack of readiness and disposition to curtail the spread of the disease.

Many people were reported to have died in Kano from an unknown mysterious disease that is characterized by high fever. The reported number was argued by the state to be exaggerated and unrelated to the illness at hand (COVID-19). I was happy to hear the glad-tidings story from the state governor — accepting the death — but the question remains unanswered. Until a scientific approach to collecting data of patients is employed, there will remain a divergent view on the matter. Though, the state officials could be overwhelmed with the increasing number of COVID-19 cases as such they might be reluctant to accept any health challenges during this trying time.

The people in the ancient city do not seem to be worried about the cause of the increasing number of deaths. This lack of fear is due to their belief that the trend is normal and happened previously during similar seasons. Moreover, no
scientific proof was provided except for the ideas of the elites who ascribed it to malaria and environmental change, which allegedly brought about unbearable heat that delicate bodies could not withstand. Just as with the case of COVID-19, the recorded death rate is prevalent among the aged population and those patients with complications. But the inadequacy of the test facilities could not have enabled adequate coverage for the sample size of the deceased
and living patients to provide any meaningful statistics.

The condition of Kano may be very precarious for the entire north compared with its southern counterpart (Lagos). As they are taking extreme measures and are wholly supported by their indigenes, we are busy trying to educate our
people to believe that there is a global pandemic already at their doorstep. Kano’s experience when it lost about 50,000 of its 3 million population to the 1918 Spanish flu was too far back to be remembered. Therefore, the need to take the stringent measures that were imposed in San Francisco that same year to avoid the kind of Philadelphian catastrophe is vital at this juncture.

In the meantime, more draconian measures are needed to ensure compliance with the lockdown and NCDC measures. Nonetheless, adequate palliative services should be made available to the people—to give listening ears to the
NCDC’s call. While conducting the COVID-19 test exercises, the state should rethink on improving the sanitary conditions of overpopulated areas. To lower the rates of these seasonal deaths, community and environmental health care measures should be taken seriously by the state. Now that the state government overturned its earlier denial of the sudden increase in deaths—attributing it to meningitis, hypertension and acute malaria—it is up to them to conduct an independent investigation on the recurrence of the disease for a more permanent remedy. It is also high time to rethink the need to empower local governments to handle community and environmental health care services at their level. Or else people will continue dying with the state living in denial as they pay more attention to building bridges and
monuments, where more lucrative deals happen.