Fighting TB and stigma in the slums of Lagos
Zainab Danjaki, a community health frontliner who specialises in turberculosis, tells Chioma Umeha her story.
- 14 June 2024
- 7 min read
- by Chioma Umeha
"It gives me joy to spread the news that [it is not] TB that kills, but that stigma and self-denial are the biggest killers," says Zainab Danjaki, a community health worker who specialises in contact tracing for tuberculosis (TB) in Lagos"s informal settlements.
"Contact tracing and community volunteer work, for me, is a life-saver. A young woman in my communityalmost died from tuberculosis because of stigma, before help came her way," Danjaki explains. "Her family, neighbours and everyone ran away and neglected her. They thought that TB was a death sentence for her and anyone who stayed around her. I taught her to stick to her drugs and hygiene regimen and she got well."
Our work as TB contact tracers comes with big challenges. I will never forget one encounter where a man threatened us with a cutlass and questioned the importance of our visit. The situation escalated to the point where we had to flee to avoid harm, as they also attempted to loose a dog to attack us."
– Zainab Danjaki, a community health worker
It"s the passion to see people free from tuberculosis that has helped Danjaki conquer any of her own fears about the risk of transmission. TB, an ancient bacterial infection, is spread through the air when people cough or sneeze or spit. Most commonly, it affects the lungs. And 1.5 million people worldwide still die of the illness each year. In Nigeria, the disease"s death-toll hovers at an alarming 268 people each day. But Danjaki understands that it"s both treatable and preventable.
Finding her way to TB
She can count more than 70 patients on the list of people she has helped to recover from TB in the last three years. All from Mushin, Lagos, many of them are drawn from the high-risk population of persons with disabilities, people living with HIV or people struggling with drug addiction.
She joined the Damien Foundation, an organisation that specialisedsin the control of two related mycobacterial infections, tuberculosis and leprosy, in 2021, and says she is "living her dream".
But Danjaki has lived other lives before. A university graduate, she was once a thriving household trader. Later, she became a polio vaccinator.
"I noticed many TB patients suffering in silence," she recalls. "This inspired me to become a TB contact tracer to raise awareness and reduce stigma. So, I educate people in my community on TB symptoms, [conduct] sputum testing and screening, stressing that early treatment can prevent TB-related deaths."
She also administers tuberculosis preventive treatment (TPT), which consists of a course of one or more anti-TB drugs, given to head off the development of clinical disease.
"It is not the money that matters to me, but my service that makes my community happy,” Danjaki reflected. “I am happy to see people in my community recover from TB and begin to live normal lives by going back to their businesses."
– Zainab Danjaki, a community health worker
"We do house-to-house visits and join community outreaches organised by the Damien Foundation and Lagos State to identify potential TB cases. Through contact tracing, we engage with household members of TB patients. We encourage them to provide sputum samples for lab testing. If TB is confirmed, we connect them to nearby care facilities for free six-month treatment."
"I will not give up"
As fulfilling as Danjaki finds her job, it"s often difficult, and sometimes painful. "Our work as TB contact tracers comes with big challenges. and even threats to our lives. This was the case in Akala, one of the Mushin TB high-burden populated areas of drug addicts where I worked with three others.
"During our contact-tracing efforts, we faced both welcoming and hostile reactions from families. But I will never forget one encounter where a man threatened us with a cutlass and questioned the importance of our visit. The situation escalated to the point where we had to flee to avoid harm, as they also attempted to loose a dog to attack us," she said.
It"s sometimes difficult to convince suspected TB patients to go in for screening, with some people saying they don"t have the money for transport to the lab. "In many cases, I pay for their transport to the hospitals," she added.
There are, of course, instances where patients don"t stick to their treatment protocols, are "lost to follow-up," or where her team struggles with language barriers. "This happened in Idiaraba where there are many residents from the Northerners with disabilities, hearing, and speech impairment, so we had a language barrier," she explained. "It was difficult to understand what they were saying. Despite, the language and threat to our lives, I thank God that we had over 70 people placed in treatment in three years.
"It is not the money that matters to me, but my service that makes my community happy," Danjaki reflected. "I am happy to see people in my community recover from TB and begin to live normal lives by going back to their businesses," she added.
"Nurse" Zainab
During a visit to some of the communities Danjaki serves in Mushin, VaccinesWork discovered that she is not just a household name among residents, but that she is celebrated as a "nurse," because of her valued role as a caregiver.
Olarabiu Umar, a community leader, commended her dedication to identifying and supporting TB patients, leading to significant recovery rates. Danjaki"s collaboration with local hospitals provides free treatment.
"We thank God for using Zainab. Zainab is trying as a caregiver. There were over 28 people who were sick and had tuberculosis in this area. Twenty-five of them have recovered, and only three are remaining."
– Olarabiu Umar, community leader
"We thank God for using Zainab. Zainab is trying as a caregiver. There were over 28 people who were sick and had tuberculosis in this area. Twenty-five of them have recovered, and only three are remaining. She links them with the hospitals where they are given free drugs," he noted.
Credit: Chioma Umeha
She's found friends and collaborators here. Hajia Memuna Abdulrahman, a popular petty trader, told us, speaking Pidgin English, "I dey help Zainab. Myself and Zainab dey carry people wey cough to hospital. We dey collect their sputum. If dem get TB, the doctor go give dem medicine, na me dey help them keep their medicine. I no wan make dem miss to take medicine one day."
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Solomon Adedoyin Gbajobi, a 58-year-old TB patient, said that he met Danjaki during a health campaign in his community. Gbajobi said that Danjaki linked him up with Oloyede General Hospital for treatment. He now receives free TB drugs and regular check-ups, leading to significant improvement in his health. The ecstatic Gbajobi said, "I am happy that I met Zainab, because she made things easier for me on the current treatment that I am receiving for TB. Zainab always visits me to know how I am doing too," he said.
Credit: Chioma Umeha
Dr Ogwa Omonigho Destiny, a Medical Advisor at the Damien Foundation in Lagos State, stressed the challenges of addressing TB in Mushin"s slum communities, citing misconceptions, poor awareness, stigma, and silence as major barriers. "Thirty percent of Nigerians have the right information concerning TB. And we cannot overcome TB with that level of knowledge."
He called for more awareness, lamenting that many individuals go into denial upon diagnosis. Still, Destiny praised the efforts of TB contact-tracers and community workers like Danjaki for their significant impact in reducing the disease burden. Under their strategy, officially registered TB cases in Lagos State increased from 9,000 to over 18,000 – meaning many more previously hidden cases are accessing treatment, and proving the effectiveness of the community health model.
"Thirty percent of Nigerians have the right information concerning TB. And we cannot overcome TB with that level of knowledge."
– Dr Ogwa Omonigho Destiny, medical advisor, the Damien Foundation
Dr Olusola Daniel Sokoya, Deputy Director and Programme Manager, State TB, Leprosy and Buruli Ulcer Control Programme (STBLCP), Lagos State, also commended the state TB detection and control, especially in slums like Mushin.
According to him, the state found and treated 23,422 TB cases from 2018 to 2024. Specifically, the STBLCP statistics showed that 1,154 cases were found and treated in Mushin Local Government in 2022, he said.
He commended the progress in TB work in Lagos State, especially in the area of case findings, saying "We need to implement more strategies to ensure that more cases are notified through the system to the next level, National TB Control Programme."
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