The point of my piece was to take a detailed look from the ground up at the introduction of a theoretically straightforward health protocol – a national program to apply chlorhexidine gel to the umbilical cord stumps of every baby born in Nigeria – and look at exactly why such a strategy is in fact so difficult to achieve. What I discovered was that a myriad of factors were implicated, many of which appeared at first to have little to do with public health – from cultural issues to road transportation; local political structures to a chronic lack of money.
The strategy is crucial from a public health perspective because bacteria entering newly-cut umbilical cords kills tens of thousands of infants every year, and is a significant contributor to Nigeria’s high neonatal mortality rate. Applying chlorhexidine gel to the umbilical cord stumps of newborns has been proven to cut mortality rates by as much as one-third.
To report my story, I talked to the major actors in the Nigerian public and private sector and the NGO world who were charged with making the strategy work. And I went into the field to report on what the policy looked like from the perspective of local health care workers, state health care officials and front-line nurses. By taking an in-depth look at one small piece of the Nigerian health care system, I wanted to show readers just how complex even the most basic health interventions can be in Africa’s most populous country.
But just as importantly, I wanted to write about Nigeria – a chronically undercovered country – with the same depth and attention to detail that reporters use to cover our own health care system. What I discovered was that health care is central to development for more than its own sake; that to improve health care in a country like Nigeria you must improve transportation, education, telecommunications, and political structures, as well. I also found that, perhaps more so than in a country with a more established institutional infrastructure, the sheer force of individual personalities can make an enormous difference on a program’s success or failure. All these points I hope come through in my piece.
Judges comments: The article captures the reader from the first sentence and holds the reader until the last word – it is seamless, well-constructed story-telling. The way it was written conveyed a sense of urgency, yet weaved clinical, economic, and political concerns into a single narrative. The story of neonatal treatment of the umbilical cord becomes a metaphor for the larger issues that plague Nigeria and the world.