Niger is located in West Africa, north of Nigeria. It also borders Chad, Libya, Algeria, Mali, Burkina Faso, and Benin. The Sahara desert makes up 4/5ths of the land area, with 1/5th along the southern border being semi-arid grasslands. It is one of the hottest countries in the world, and rainfall is minimal even in rainy season. The population is predominantly Muslim, and the percentage varies from 80% - 95%. The remainder follows African Traditional Religions, and 0.5% of the population is Christian.
The Hausa are the predominant people group in Niger, at 55%, and they were also the largest group in the area that I was working (south of Maradi, near the Nigerian border). In Niger, there are also Djerma (21%), especially in the east, around the capital of Niamey. The Fulani (8.5%) and Tuareg (9%) are nomadic and semi-nomadic peoples who are present in smaller groups throughout the country.
Politically, there is evidence of a highly civilized people 4000 years ago, with several subsequent empires. More recently, Niger was a French colony from 1895 to 1958, with independence coming in 1960. However, the first multi-party democratic election was not until 1993, and there were military coups in 1996 and 1999, with a democratic civilian rule starting later in 1999. It is now relatively stable politically although there is some rebel activity among the Tuareg in the north.
The population of Niger is nearly 13 million, most of whom are subsistence farmers or involved in animal husbandry. The climate of the country is such that farms are not very productive. The country is extremely poor, and the government relies heavily on international aid for its operating budget. 63% of the population lives below the poverty line. Most people live in mud huts with no electricity or running water, and many do not have enough money to send their children to school. The literacy rate is 43% for males and only 15% for females.
The life expectancy at birth is 44 years, and the infant mortality rate is 117/1000 live births. AIDS is not a big problem in Niger, with estimated figures of adult prevalence ranging from 1.2 – 3%. However, leprosy and polio are not yet eradicated, especially in remote villages. Malaria is a problem, despite the dry climate, as most people lack the money to purchase mosquito nets. Malnutrition is common.
The health system is basically non-existent for many people in villages, and what does exist in larger centres is limited. There is no health coverage, so patients must pay for everything, and many people simply cannot afford to pay for basic health care. Patients are expected to have family take care of them while they are in the hospital, including all personal care and meals. There are mission hospitals in the country, and Medecins Sans Frontiers is quite active.
Generally people in Niger are accepting of people with disabilities; it is common enough that it is simply a fact of life. Extended families take care of each other, including family members with disabilities. However, for most people, rehabilitation is not within their grasp (either due to availability or finances). Wheelchairs are very rudimentary and very little of the country has pavement. Many people with disabilities, especially polio, end up begging.
There are very few rehabilitation professionals in Niger. Foreign physiotherapists are held in relatively high regard, although there are some difficulties with the status of women, and so it is difficult for women (especially young women) to make suggestions to men. Within the country, I don’t believe there is any school of rehabilitation, and so people have to go to surrounding countries for training.
I was in Niger for six weeks in the summer of 2003, with SIM (Serving in Mission). See their webpage (www.sim.ca) for opportunities for rehabilitation professionals to work abroad for both short-term and long-term projects, subject to availability and need. SIM is an international Christian mission organization, with its Canadian head office in Scarborough, Ontario.
I was working at the Centre de Santé et Léprologie, which is a small general hospital with a focus on patients with leprosy. It is run in conjunction with The Leprosy Mission (TLM). The hospital works with the government in the effort to eradicate leprosy through education and medications, but other types of patients are also treated there. There are a number of western and African missionaries working at the hospital, who raise their own support to work there, and numerous Nigeriens are employed in various capacities by the hospital. There was a Nigerien doctor, a British nurse doing some physiotherapy, a Nigerien physio assistant (both trained to do physiotherapy specifically for people with leprosy), and numerous Nigerien nurses when I was there.
I acted as a consultant to the nurses, especially the British nurse, and spent some time teaching her basic physiotherapy concepts. I also treated primarily outpatients, most of whom did not have leprosy. Burns, spinal cord injury, CVAs, peripheral neuropathies, and LBP were among the diagnoses.
In the morning, I would go on rounds with the nursing staff and greet the inpatients. Then, I would go to the PT department to see if there were any outpatients to be treated (for the most part, people did not book appointments). I would spend my day between outpatients as they came, and the inpatients as I had time. I also spent usually spent about an hour a day being taught Hausa informally by the physio assistant. We worked until 2pm, then had lunch and siesta and came back and worked from 4-6pm.
I was able to make a lot of progress with a number of children with peripheral neuropathies, which were apparently due to injections/immunizations. A lot of them ended up with learned non-use, and just teaching them to start using their limb again was helpful. In general, any little bit of knowledge that I could share was greatly appreciated, and in a lot of ways, I ended up being the PT, OT, and SLP for patients (especially CVA patients).
I went out to some surrounding villages with a doctor to consult on a few patients. These patients were extremely debilitated (had rapidly progressive, undiagnosed neurological conditions) and there was very little I could do for them at that point. There was also a difficulty with patients wanting instant improvement, and getting frustrated when I told them they needed to continue to work on things on their own. Lack of education was a huge factor in all of this. For example, leprosy is not eradicated in Niger because people do not know that there is a cure for leprosy and that the drugs are free.
In many ways, the needs of the people of Niger are so basic (food, clean water, drugs) that rehabilitation almost seems like a luxury. There is little infrastructure to support rehabilitation, especially outside of the main cities, so anyone going to Niger to do rehab needs to be willing to start from scratch.
