Nigeria might pose the biggest challenge for the Gates Foundation

Thursday, March 22, 2001

By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER

	Gen. Yakubu Gowon, a former Nigerian head of state, visits villagers in Lafia. Gowon now works to improve water quality. Mike Urban / Seattle Post-Intelligencer Click for larger photo

LAGOS, Nigeria -- Flying into the biggest city in Africa's most-populous country, the first indications that all is not well are the wrecked, moss-covered airplane hulks strewn like elephant carcasses across the fields of the nation's main airport.

Leaving Murtala Mohammed International Airport -- named for the head of state assassinated in 1976 -- further signs of chaos and urban decay come flying at visitors like paper scraps in a windstorm.

Countless shanties built of junk, mountains of filth and dilapidated buildings provide the backdrop for throngs of people pushing, shoving, shouting or honking in a frenzy of street corner enterprise that will still leave many in poverty at day's end.

Welcome to Nigeria, perhaps the biggest and best example of the challenge the Bill & Melinda Gates Foundation faces in its global quest to reduce disease and poverty.

Here in one of the world's top oil-producing countries -- fifth-largest supplier to the United States -- the wealth is in the hands of a few. On many counts, the average Nigerian is worse off now than when the nation gained independence from Britain 41 years ago.

It is no secret that Nigeria is a mess. Ask any Nigerian. Ask, for example, how they're doing when it comes to the basic public-health need to vaccinate their children against diseases such as measles, polio, diphtheria or tetanus.

Increasing number of deep wells, or "boreholes", is one key to guinea worm eradication in Nigeria. Mike Urban / Seattle Post-Intelligencer Click for larger photo

"We have no immunization system," said Dr. Benedict Mairiga, the earnest medical director of one of the country's major care centers, Plateau State Hospital in the northern city of Jos.

"We don't even have a surveillance system that can tell us how many are not being vaccinated."

In 1990, Nigeria claimed that 90 percent of its children were immunized with the basic vaccines. The latest figures from the World Health Organization suggest an average 20 percent coverage, but Mairiga finds even those figures highly optimistic.

"What we're seeing here is the breakdown of our primary health care system," he said.

Nigerians don't mince words. Most will tell you that their country is judged the most corrupt nation on Earth. Just getting through the airport in Lagos is considered a trial. The locals, if they aren't seeking to separate travelers from their money, will at least want to know what they're doing here.

Nigeria is not known for its tourism.

With just a nudge, Nigerians can launch into such a litany of grievances, abuses, annoyances, allegations of government fraud and criminal wrongdoing after decades of military rule that one wonders why anyone stays here.

But that's the real secret about this place.

Beyond its strategic and economic importance, there's something about this country and its people that make it the gravitational center of Africa. One of every six Africans is Nigerian.

	Jonah Gutai, 17, bathes in a stream near Mungkohot. The water that many in Nigeria use is conaminated by parasites. Mike Urban / Seattle Post-Intelligencer Click for larger photo

Before Nelson Mandela gave South Africa a leadership role on the continent, Nigeria led the fight for human rights and African independence.

And it still is often called upon to play the role of peacekeeper when fighting breaks out in neighboring countries like Sierra Leone and Liberia.

One of Bill Gates' top health strategists, Dr. William Foege, thinks Nigeria "provides an important model for the rest of the developing world" and some key lessons the Gates Foundation must take to heart if it wishes to accomplish any lasting change.

Those lessons come from the resilience and resourcefulness of Nigeria's people, not its government. And they can be found in the work of Nigerians like Dr. Emmanuel Miri, who was educated in the United States and has devoted his life to improving the health of his homeland.

Miri directs Global 2000 in Nigeria, a project sponsored by the Carter Center in Atlanta. His name, in the Igbo tribal language of southeastern Nigeria, means both "water" and "life."

Dressed in a cream-white cap and caftan, a long robe favored by Muslims, Miri smiles and laughs often as he speaks. His large friendly face, set off by his clean-shaven head, exudes both kindness and an iron will. He has needed both in his fight against waterborne diseases in Nigeria.

Yawa Tanchi, 50, suffers from onchocerciasis, or river blindness. The waterborne disease is caused by a worm transmitted to humans through biting black flies that live near rivers. There is no vaccine. Mike Urban / Seattle Post-Intelligencer Click for larger photo

The first waterborne disease Miri targeted was river blindness (onchocerciasis). It's caused by a worm transmitted to humans through biting black flies that live near fast-moving rivers. The worms often migrate to the eyes, damaging tissue and making this disease the leading cause of blindness in West Africa.

Another, even more common disease, is snail fever (schistosomiasis). It's caused by a blood fluke transmitted from snails to people when they swim or bathe. It's a debilitating, chronic and occasionally lethal infection characterized by bloody urine that afflicts about 200 million people worldwide.

Elephantiasis (lymphatic filariasis) is an infection that causes massive swelling of the leg or, in men, the scrotum. The parasite, a worm that infects and blocks the lymph system, is transmitted by mosquito bites and, occasionally, person-to-person.

None of these diseases can be prevented by vaccines -- the Gates Foundation's weapon of choice. The common link for all is water, whether directly through drinking or bathing, or indirectly as a breeding ground for the parasites.

"Many people don't think of water as a public health issue," Miri said. But he said it is the biggest public health challenge for Nigeria and for many poor nations.

Most rural Nigerians get their drinking water directly from rivers, streams or ponds. But even in urban areas, water safety is an issue. In Lagos, only about 30 percent of the city's 8 million residents have direct access to potable water.

	At Plateau State Hospital in Jos, water is drawn from a well for patient needs, from drinking and washing to minor surgery. Mike Urban / Seattle Post-Intelligencer Click for larger photo

And in Jos, one of Nigeria's main cities in the north, the regional hospital draws its water from an open well outside the children's ward.

"If you have good water, many of the diseases of Africa would disappear," said Gen. Yakubu Gowon, a former Nigerian head of state who now works with Miri promoting water safety programs throughout the country.

"Clean water is the key to health in Africa. It is paramount."

Global 2000, a non-governmental organization, has made clean water its top priority. But even with the donations it has received from the Gates Foundation and from drug companies, it lacks the resources for the major, capital-intensive projects that are needed to fix the problem.

Those agencies that have the budgets -- UNICEF, the World Health Organization, the United Nations Development Program -- acknowledge the need for clean water.

But it doesn't really fit their public health agenda. As a result, Miri said, "very little has been done about it."

Part of the problem is a lack of coordination among the various international bureaucracies.

But another reason is that the big aid agencies, unlike non-governmental organizations, must work in partnership with government.

"In Nigeria, it's always a problem if you work through the government," Miri said.