by Caelainn Hogan, June 17, 2016.

Despite losing some of her own children during an attack, Dada Nguru is keeping other women and their babies alive.

Outside a zinc-roofed shack on the fringes of Nigeria’s capital,
Abuja, Dada Nguru, a self-taught midwife, hangs a large sugar sack that
has been ripped open out to dry. Earlier that day, she had laid a woman
on it as she delivered her baby boy.

Hours later, a saline bag still hangs from the small open window, the
only source of light in the cramped single room that is heady with the
smell of sweat.

Nguru’s children sleep in this room, the same room that the women
come to give birth in. For more than a year, this ramshackle building in
the suburb of Kabusa has been their home – and the midwife’s delivery
room.

Her one-year-old son, Muhammadu, nursing at her breast beneath the
folds of her flowing red abaya, was still in her belly when she fled her
home in the town of Gwoza, in the northeastern state of Borno, and
arrived here.

“I came pregnant and gave birth to him here,” she says, adding: “We left because of Boko Haram.”

A midwife’s gift

Nguru sits on a low stool beneath a metal sheet awning in her small
dirt yard, just hours after delivering the baby on the sugar sack. The
story she begins to tell is one that many women share. As the insurgency
in the northeast has escalated over the past few years, the number of
Nigeria’s internally displaced persons (IDPs) has skyrocketed, with 2.15
million displaced as of last September, according to the UN high
commissioner for refugees (UNHCR) and the International Organisation for
Migration. These IDPs are either living in camps or are living
scattered across neighbouring states.


Hundreds of thousands of those forced to flee their homes were women,
and Nguru knows first-hand, as a mother and a midwife, the particular
challenges they face.

“It’s a gift,” she says of her skill as a midwife.

The 37-year-old mother of nine, who has a long scar running across
her right cheek, has been a traditional birth attendant for more than a
decade, learning, she explains, from knowledge passed down by others and
her own intuition. “I can tell if the child is positioned right,” she
says, smoothing her hands over her stomach. “If a woman has a baby that
is breach, I can turn it.”


Five other women from Gwoza gather around her as she speaks. Some of
them are her patients. Her elderly mother, Aishatu Audu, whose lined
face is marked with the same furrowed brow as her daughter, sits among
them, playing with her three-year-old granddaughter, Umma.

Mamma Mary, as the women affectionately call a softly-spoken mother
of six with a vibrant wrap of fabric around her head, is nine months
pregnant. Nguru says she is ready to give birth any day now.

“Our life in Gwoza was good before Boko Haram,” Mary sighs. “We had our houses, the kids were in school, we had food.”

The day Boko Haram came


It was late afternoon on a Tuesday in October 2014. Nguru remembers
how fighters in army uniforms drove into their village in armoured
vehicles. They entered their homes, forcing the women and children out.
At first, the women had assumed they were soldiers.


“Then we noticed a lot of them were wearing flip-flops,” says Nguru.
“Some of them, the trousers wouldn’t be their size – they had to fold
the bottoms. They were not looking smart.”

They ransacked houses and dragged men outside before slaughtering
them in front of their wives. “They told us they were instructed not to
kill the women,” she says. “Otherwise, they would have killed us, too.”


In the panic, families were separated. Nguru thought her husband was
dead and kept scanning the ground for his body. When they began to set
fire to the houses, she and the other women fled. Her mother hid with
others in the mountains nearby for five days. Both are in Kabusa now.

‘They took our children’


Many of the women lost children along the way. One sitting among them
now clutches a toddler to her chest and wipes tears from her cheeks.

“They took her kids,” says Nguru. “The one feeding her baby there, they took her boy.”

Two of Nguru’s own children, her 14-year-old daughter and
nine-year-old son, were separated from her in the chaos of the attack.
“We couldn’t find them,” she says simply. “I hope they are still alive.”

The journey for Nguru and the other women from Gwoza to Kabusa took a
month. First they fled on foot, walking for nearly two days to reach
the nearby town of Madagali, where they hoped to rest.

But after
they arrived, Boko Haram attacked there also, so they had to push
onwards. It took them five days to reach Mubi, the next major town. They
spent a week or so there. But once again, Boko Haram followed, as if
hunting down the women. They pressed on, getting lifts from passing
trucks or cars whenever they could.

“The vehicles that picked us [up] would be the ones driven by
traders, used for carrying beets,” says Nguru. “If it were a smaller
car, one woman would go in the car and we would give her the children.” 

Some women gave birth as they walked along the parched, barren roads, with nothing but miles of bush around them.

“We had to cut the umbilical cord with anything sharp we could find,”
Nguru remembers. “We would pack the babies and keep on walking, and
most of those babies survived.”

Miscarrying: ‘I sat on the road – there was blood’


Rakaya, a fresh-faced 22-year-old in a black T-shirt and white head
wrap, sits quietly as Nguru speaks. She was five months pregnant when
they fled. She miscarried on the road.

“We were scared, we were running, the stress of everything happening
around us,” she explains. “I was walking on the road when I felt I was
losing my pregnancy, so I just sat on the road and there was blood.”


She is pregnant again now and nearly at the same stage of her
pregnancy as she was when she lost her last baby. She already has three
children. Nguru worries that this pregnancy will be difficult since she
did not get the medical attention needed to evacuate the womb after she
miscarried on the road.


“Medicine and healthcare are our main challenges here,” says Nguru,
adding: “Some of the women [from Gwoza] cannot afford food to eat.”

Helping the unreachable


Her own supplies are rudimentary – a bottle of Dettol and methylated
spirits for sanitising, a knife for cutting the umbilical cord and
washing detergent to clean the sheet and towels. But, often, even these
run low. Plastic gloves are a luxury. Nguru says she needs everything
from cotton wool to IVs and clamps for the umbilical cord.


Most of the women here, she explains, have no access to a hospital:
The private clinics near by are unaffordable and the public ones are
hard to reach.

The UN children’s fund, UNICEF, has been training outreach teams of
health workers to support more than 100,000 displaced people living
across 17 camps in Borno state, as well as others in nearby Adamawa and
Yobe states. But it is the traditional birth attendants, like Nguru, who
are often there for the women when no one else is.


“In some of the camps, we cannot say it’s 100 percent secure. At
night, the health teams don’t stay there,” says Kennedy Ongwae, a health
specialist with UNICEF in Nigeria. “Women who go into labour in the
night, the traditional birth attendants have been trained in those camps
to assist with those deliveries.”

Here in Kabusa, Nguru estimates that there are more than 1,000
internally displaced people from Gwoza. As of this month, she has helped
more than 64 displaced women to give birth safely.


“We know there are pockets [of IDPs] here in Abuja and in other
states,” says Ongwae. “The main issue coming up, both in the capital of
Abuja and in restive Borno, is that the hospitals operate on a
fee-for-services system.” 

Those who are displaced are technically entitled through an emergency
measure to receive free healthcare, with hospitals reimbursed for
treating them by the government, but Ongwae says that without an
effective system in place, the IDPs often have to pay out of their own
pockets upfront before seeing a doctor. This, Ongwae believes, is one of
the biggest challenges facing displaced women.


Those who have taken shelter among local communities, like the women
from Gwoza, can be difficult to identify and reach, Ongwae explains, and
traditional birth attendants such as Nguru have played an important
role in providing support where health systems and even emergency aid
have failed.


“Traditional birth attendants are part of the social support mechanism,” says Ongwae. “Not just for deliveries.”

An advocate for displaced women


Nguru has become an advocate for the women within the local
community, with her talents as a midwife making them welcome. Local
scavengers, known as baban bola, bring them scrap pieces of wood for
their cooking fires. Night and day, her yard is abuzz with women coming
and going.

On a busy day in Kabusa, Nguru says she can deliver as many as five
babies, sometimes more. Her reputation has travelled by word of mouth in
a country where maternal mortality rates remain stubbornly high.
Despite efforts to improve maternal health over the past few decades, a
woman’s chance of dying from pregnancy and childbirth in Nigeria is one
in 13, according to UNICEF, making it the second-largest contributor to
the world’s maternal mortality rate.


The fact that Nguru rarely loses a mother or a child has kept her
services in demand. A week ago, one of the women from Gwoza had a
stillborn, she says. But other than that, the women cannot remember the
last time she had a bad outcome.


A consultant obstetrician and gynaecologist who volunteers with
Foundation for Refugee Economic Empowerment, a grassroots NGO which has
been assisting the displaced in Kabusa, visited Nguru last year. She
came away impressed by Nguru’s skills and knowledge and promised to
provide her with further training so that she can better help the women
from Gwoza, as well as the local community. Another organisation,
Mothers Alive, supplied her with a non-pneumatic, anti-shock garment
(NASG), a special device to stop haemorrhaging during or after
pregnancy.


The woman who had given birth earlier that morning on a sugar sack
had experienced some difficulty with her labour. “She was shaking as if
she had a fever, so I called the pharmacist, and we gave her an IV,”
Nguru explains. “If I notice they have eclampsia, I have to send them to
the hospital.” She makes a rolling sound with her tongue, describing
the seizures some pregnant women can experience if they suffer from the
condition.


Family planning: ‘Tell our husbands’


On Saturdays, pregnant women come to Nguru’s house for appointments so that she can assess them.

Babies that are breach will grow up to be wise, she says, her knotted
brow loosened by a wide smile, amused by her own proverb. If the labour
is long, she sometimes uses a gloved finger to break the woman’s water.
If a woman becomes feverish or the pregnancy is too complicated, she
will make sure she gets to the hospital.

While she tries to help as many displaced women in the area as she
can free of charge, Nguru charges local customers 3,000 naira ($15) for
her services, a meagre sum to cover the cost of materials and keep a
roof over her family’s heads. Her trade also helps her to support the
other women from Gwoza.


She has ambitions to expand her small business. By Christmas, with
some help from a local NGO, she had converted the open space in her yard
under the awning into a four-walled room for deliveries. Her dream is
to get a bed for the women with a heavy metal frame, so that they can
have something to grip on to when in pain.

Nguru is not only concerned for the women’s health during pregnancy,
but their overall wellbeing. With their unstable living conditions, she
has tried to counsel the women on options to avoid getting pregnant.


“I told Mama Mary she should stop,” Nguru says. Mama Mary nods. She
does not want more children, but there are few family planning options
available to her. Nguru tells the women to try to go to the pharmacy to
get a morning-after tonic, but it is beyond the women’s budgets. “Tell
our husbands,” the women laugh.

Celebrating a new baby, remembering a lost one


A week later, another of the women from Gwoza, Aisha Musa, gave
birth. She lives along the roadside, next to the New Life Baptist
Church, one of the countless single-room churches in the area where
sermons and singing blast from open doors on the weekends.

Behind a patchwork of sewn-together cement bags that serve as a gate
to the small compound, she stands, waiting for Nguru to come and conduct
a check-up.

“I am happy she is here,” she says of Nguru.

When Nguru arrives, the sleeves of her dark blue abaya pushed up to
her elbows, Musa untacks a tattered sheet hanging in front of the
entrance to the shed-like building where she lives. Five other families
from Gwoza live in the small compound. At night, more displaced families
who have nowhere else to sleep also shelter here.

Musa emerges from the darkness with her newborn daughter in her arms.
The baby’s eyebrows are smudged with black kohl, a tradition in Gwoza,
her little mouth pursed as she sleeps. She would remain nameless for
three days, a common practice, and a salve against the common loss of
newborns.


This is Musa’s fifth child, Nguru explains, but only four are with
her now. “I had a small boy, Mahmoud,” Musa says. “He was one year and
nine months. I buried him in Mubi.” He had died on the road as they
tried to find safety. Nguru stands beside her as Musa, flushed and
smiling, cradles her new daughter, unwilling to let the past spoil her
current joy.

From the women of Gwoza to the women of Kabusa


As dusk approaches, green husks of corn scatter the dirt roads and
the smoke from cooking fires fills the air. Nguru accompanies a local
woman, whose baby she has just delivered, home.

Within the small walled compound, 22-year-old Safara’u Haruna sat on a
wooden bench, cradling her fourth child. Born only 20 minutes before,
the infant still has a waxy, white residue on her hands and head. She is
wrapped in a colourful piece of patterned fabric, just her chubby face
poking out.

She had given birth to her previous children alone, in her own
bedroom and without any help, even from a local birth attendant. The
labours had been difficult. But, this time she had just walked the five
or so minutes to Nguru’s small room to deliver.


Her husband, Abdullahi, a broad man in his early 40s, is pleased with
the service Nguru provided and is happy that the women from Gwoza have
come to Kabusa. “We’re feeling their impact positively,” he says.
Compared with the nearby medical centres, Nguru’s skills come cheap.
“It’s practically free,” he says.

Boko Haram ‘burned everything’


In the dusk, having checked up on the babies she delivered that day,
Nguru begins to make her way back home to feed her own children and to
prepare the room in case another woman arrives in the night.

When asked if she ever thinks of returning to Gwoza, she shudders,
shaking her head slowly. More displaced people are still coming to
Kabusa every week.

In December, President Muhammadu Buhari declared that Nigeria had
“technically” defeated Boko Haram and assured Nigerians that the return
of millions of displaced people would begin “in earnest” this year. But
the attacks have continued, and many, like Nguru, fear returning home.

“They
burned everything there,” she says, pausing for a moment before
slapping her hands together and pushing up the slipping sleeves of her
abaya. “My work is here now.”

Source: Al Jazeera