Bello is screaming by the time Atti Mohammed reaches him. At three months old, he weighs six and a half pounds and his skin wrinkles into deep folds along his tiny arms and legs. His mother, Modedi, is visibly shaking with exhaustion. She can’t feed him, she explains. Formula milk is too expensive and she doesn’t know why, but her breasts don’t seem to work any more. In desperation, she tried to give her son milk from a cow, but it nearly killed him. “We travelled for nearly a week to get here,” she says, sitting on the edge of a low hospital bed draped in blankets. “We walked across the desert. I’m very scared.”
Gently, Atti lifts Bello from his mother’s arms and assesses the chronically malnourished child. “It’s OK,” she tells Modedi and her husband in a soothing voice. “I know what to do.”
For the next eight hours, Atti walks the cream-coloured corridors of the malnutrition and pediatric clinic in Agadez, her white nurse’s uniform flaring out behind her as she strides purposefully from room to room, weighing, measuring and attaching feeding tubes to the seven children who have been brought in over the past 24 hours. According to a blackboard in the hallway, two have died in the last month. At 3.30pm, she pauses to pray, before continuing the day’s check-ups until the sun begins to set. Only then does Atti begin the 40-minute walk home across the city. Sahelian sand sinks into her sandals and blows into her face, forcing her to cough into her hand. “It would be easier if I had a scooter,” she says. “Sometimes I think that if someone was ever to start paying me for my work, that’s the first thing that I would buy.”
It’s been over a decade since the 37-year-old started working at one of the busiest malnutrition clinics in Niger – a country deemed the world’s “least developed” by the 2018 Human Development Index, and where more than half of all children under five suffer from either chronic or acute malnutrition. But Atti doesn’t have a job title and she doesn’t receive a salary. “After I graduated from the Institute of Public Health in Niamey, I took a six-month internship at the clinic so that I could gain more experience before finding a job,” she says. “Within a few weeks, I realised how desperate the situation was – how many children were dying because there wasn’t enough food, and how few people knew how to treat them. When my internship finished, my manager asked me to stay permanently, but explained that she wouldn’t be able to pay me. In the end, it wasn’t a choice. The children needed me to say yes.”
So many skilled women still have to work for free in the female-dominated Nigerian health sector – when men in similar industries are invariably salaried
The clinic is struggling financially, she adds. UNICEF supplies the majority of the funding for much-needed medical supplies, including the emergency peanut paste, Plumpy’Nut, and provides free training for unqualified members of the community to perform (voluntary) outreach and support, but it’s the government’s responsibility to pay staffers’ salaries. “They say they can only pay three nurses,” Atti says. “So the other 10 of us who work full-time have to go home with nothing.” She dreams of moving out of her parents’ house and living independently, like her sisters. “But unless something changes, that’s not going to happen.”
Hadiza Amadou, 43, is in a similar situation – wholly reliant upon her husband, because the Agadez health centre where she works from 7.30am until five in the afternoon, seven days a week, refuses to pay her – or her 17 colleagues – for their services. “If the manager isn’t here, I am in charge,” she says. “I do everything – the vaccinations, the treatment of acute malnutrition, childbirth… I’ve been here for 15 years. I don’t think there are any procedures that I haven’t performed.” Today alone, she has already singlehandedly vaccinated over 75 children against tuberculosis.
“If it wasn’t for Hadiza, this clinic couldn’t function. There is absolutely no way that we could treat all of these children without her,” her manager, Fatouma Yaye, speaks up from the corner of the room. As one of only eight paid staff members, she earns 200,000 CFA [£275] per month and admits her guilt over the fact that so many skilled women still have to work for free in the female-dominated Nigerian health sector – when men in similar industries are invariably salaried. In fact, in the past 10 years, she says she’s never come across a male volunteer.
“It makes my heart hurt,” she says. “The women who volunteer here do the same work that I do and, at the end of the day, all I can say is thank you. They’re exposing themselves to diseases and putting themselves in dangerous situations where they don’t have any independence or savings and have to lean on other people for food, housing and support. I want the government to see this as a problem.” She pauses. “But also NGOs and international organisations need to stop recruiting women as volunteers and start paying them for the services that they provide.”
Atti agrees. “We all say yes to volunteering because we know how much our work is needed,” she says. “But I do feel sad that nobody thinks we deserve to be paid for it.”