All photographs by Kasia Strek for the Guardian Photograph: Kasia Strek/The Guardian
The sound of chanting fills the narrow corridor that serves as a waiting room, as about 30 pregnant women pray for safe deliveries and protection against wizards, witches and other enemies they believe could harm them or their babies.
The women take turns in the small bathroom, where they stand on a rock and use soap, nest-like straw sponges and seeds blessed by a prophet to wash away evil spirits.
Afterwards they are ready to see Ronke Oje, the founder of the medicine clinic. She takes their pulse, asks about headaches, sleep and eating routines, checks the foetuses’ heartbeats, and provides personalised blends of herbs and seeds.
Later, when the women are ready to give birth, she will give them palm oil or fermented seaweed water to speed the delivery process; if a woman is bleeding more than usual she will insert a mixture of powdered snail shells and lime juice into the vagina to stop it.
In extreme cases she will “bewitch the flow” by boiling a sample of the patient’s blood on a stove in the clinic’s kitchen until it dries out.
Oje is a traditional birth attendant (TBA), or midwife, known locally as lya abiye in Yoruba, meaning “mother and child are alive”. She is one of thousands of such attendants in Lagos state and has been helping women in Mushin, one of the poorest districts in Lagos, get pregnant and deliver babies for 26 years.
In Nigeria, the doctor-to-patient ratio is among the lowest in the world, while rates of maternal and infant mortality are among the highest. More than 60% of births in the country happen outside medical centres or hospitals, mainly with the help of people such as Oje.
Lack of medical insurance, fear of surgery and high hospital bills can deter patients from visiting modern medical practitioners.
Women often have more faith in TBAs, who draw on the traditional knowledge of the Yoruba people, using herbs, plants, seeds, snail shells or dried animal parts to treat patients, as well as elements of evangelical Christianity. Many patients attend “charismatic churches”, where witchcraft and animist spirituality plays an important role.
The medical profession may not approve of the treatments used by TBAs, but it recognises the vital role they play in maternal and infant care, and the importance of collaboration between conventional medics and TBAs.
In Lagos, the Traditional Medicine Board was created as part of the state’s health ministry in the 1980s to register, regulate and connect traditional practices to the medical system. Today, more than 10,600 herbal and religious healers and birth attendants are licensed by Lagos state, although there are probably many more who are not registered.
“We all want mothers and infants to be safe and healthy, but for an effective collaboration, trust has to be built first,” says Dr David Enushai, a gynaecologist and founder of the private Absolute Care maternity hospital.
For the past three years Enushai has worked with 60 TBAs, primarily from the Mushin area, giving monthly lectures on different aspects of maternity healthcare. He teaches them how to recognise risks to the mother or baby’s health and when to refer the patient to hospital. As a result, patients treated by the traditional midwives get to Enushai early, often for the first-trimester ultrasound scan.
When TBAs bring their patients to Enushai to find out the baby’s gender and due date he takes the opportunity to check the foetus’s heartbeat again and look for possible abnormalities.
He also provides the midwives with essential equipment including stitches, syringes and gloves, as well as misoprostol and oxytocin in case of post-delivery bleeding.
“When an emergency happens, the idea is that they provide first aid, prepare the patients for transportation before the ambulance arrives, set an IV access and a hydrating drip, so that the blood loss is reduced and priceless minutes are saved,” says Enushai, who also runs the Enushai Foundation, which offers affordable healthcare to pregnant women and mothers.
Dr Kemi DaSilva-Ibru, an obstetrician-gynaecologist and a founder of the Women at Risk International Foundation (Warif), also recognises the wider role that traditional birth attendants play in women’s lives.
Since 2017, her Lagos-based foundation has trained more than 11,000 TBAs as first responders to cases of sexual and gender-based violence in Lagos, Ogun and Oyo states.
“As a medical doctor, it is difficult at times to remain silent [when disagreeing with their methods],” says DaSilva-Ibru. “So I often decide to leave my medical hat at home when I come to work with TBAs because otherwise there are clashes.
“Yet, one thing that cannot be denied is their role in our society,” she says. “They are neighbours, custodians of secrets, and gatekeepers of women in these communities. We need to work with them.”
While TBAs work with doctors and attend training sessions financed by the Lagos state authorities, belief in indigenous spirituality remains central to traditional medicine practices. Alayode Olaogun, the leader of a local association of healers, runs the biggest traditional medicine centre in the neighbourhood.
Every day, the clinic’s waiting room is full. Aishat Husseini, pregnant with her sixth child, is among the women seeking treatment. Her previous deliveries were attended by her mother in the north of Nigeria, where she used to live.
This time, after moving to Lagos, she wanted to have her baby in a hospital. But during her first visit, she learned that her baby was breech and that she would probably need a caesarean section. The possibility of a surgical procedure scared her, and instead of returning to hospital she turned to Olaogun.
“For about two weeks, I came to chant prayers, received herbs, and drank different soups,” Husseini says. “Once, there was a dried rat in it, but I did not know until I saw its tail. I didn’t mind; the soup was delicious, and I trusted it worked. The baby turned around, and I’ll now stay to deliver here in the clinic.”
She knows she can come at any time, day or night, as Olaogun lives at the clinic. “My father had this clinic, and his father was here before. I’m the third one in the family. Women know where we are,” he says.
Looking after his patients’ mental wellbeing is just as important as checking that they are physically healthy. “During clinic days, we sing, pray, try to make them happy and calm them down, and they confide in us,” Olaogun says. “We also inform them what to eat; we warn them against chocolate, soda drinks or sugar during pregnancy. Each time they come, we give them soup made with snails, fish, herbs and other things.
“If I see a problem, for example, if the baby is breech, I consult an oracle I work with and trust. I know she is talking to spirits, and I do whatever she tells me the woman needs to be well again.”
Olaoluwa Olowu contributed to reporting
This reporting was supported by the International Women’s Media Foundation’s Howard G Buffett Fund for Women Journalists
