Routine Immunization (RI) coverage is poor in Nigeria with 50% unimmunized children of under-one population[1]. Most of these children are in poor and hard-to-reach communities where access to healthcare service is difficult. Research carried out by the Paediatric Association of Nigeria (PAN) in 2020 suggests that the COVID-19 pandemic has reduced RI coverage and increased the dropout rate in Nigeria[2]. To this end, interventions are being implemented by Direct Consulting and Logistics (DCL) and other stakeholders in the immunization space to improve immunization demand and reduce dropout rate in the country.

These interventions regularly require visits to communities, usually in rural areas. While our primary agenda in these communities is immunization, we frequently encounter other issues that require our attention and we provide assistance where possible. During one of these visits in October 2020, when Merck Sharp Dophme (MSD) supported, through DCL, the Modified Integrated Medical Outreach Programme (MI-MOP) in the Federal Capital Territory, Abuja, Nigeria, I encountered a child named Yusuf who elicited negative behaviours from his community.

I was privileged to supervise the Ruga Nomadic settlement during the MI-MOP and as I observed the immunization session being conducted by the health workers, I heard people calling a child kajere in Hausa language which translates to shorty. I turned around to get a good look at the child but I could not see him clearly from my vantage point. Curiously, I asked why everyone was calling the child “kajere”. His mother responded that it is because he is a little person.

A little person is someone who has a genetic condition that results in a short stature. The exact number of little persons is unknow but studies show that the genetic disorder occurs in 1 child per 10,000 births[3]. Thus, they belong to a minority group in society. Little persons are considered deformed in Nigeria and are often avoided, ridiculed, denied leadership and political opportunities[4].

The health worker called him closer and asked me to take a look at him. I enquired about his name and age from the health worker and was informed that his name is Yusuf and over 6 years old, though looked as tall as a 2-year old. Yusuf is a handsome and sweet child but it was obvious that his large head was disproportionate to his small body as were his short arms and limbs.

He had two younger siblings with him and they played with other children from the community. The most refreshing thing I noticed about Yusuf was his smile and the way he interacted cheerfully and joyously with his community. I introduced myself to Yusuf’s mother and asked if they would be willing to take some pictures, she agreed. Yusuf was very excited to appear in the pictures.

I was uncomfortable with the way he was nicknamed Kajere, I advised his mother, the health workers as well as other community members around to address him by his name — Yusuf instead of addressing him by his looks or height; fearing that he would grow up with a derogatory name. But neither the community nor his mother took me seriously.

My experience in this community with Yusuf and his mother once again brought to light the casual stigmatization and insensitivity of communities to the plight of little persons especially in developing countries. As I reflect on the behaviour of Yusuf’s community to his stature, I wonder if their use of such terms as Kajere reflect their lack of understanding of the psychological implications of verbal abuse (intended or not) on the child, or if they were just not sensitive to the harm that they may cause to his wellbeing as he develops physically, mentally and psychologically. Whatever the reason, their interactions with him highlight the need to sensitize the public on the plight of little persons and increase their understanding of the crucial roles communities play in child development.

Field visits often provide me with opportunities to learn and assist communities in whatever way I can. During MI-MOP, I supported in delivering vaccines and medicines to little children in hard-to-reach communities in FCT. In doing so, I met Yusuf who was ridiculed by his community, I challenged the community to rethink how they treat the little people amongst them, and I hope this challenge encourages them to change their attitude toward little people.

Reference

[1] National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF

[2] Tagbo, B.N., Alikor, E.A.D., Ogunrinde, G.O., Tabansi, P. and Nwaneri, D.U., 2020. Impact of COVID-19 pandemic on immunization services in Nigeria; A preliminary report by Paediatric Association of Nigeria (PAN). Nigerian Journal of Paediatrics.

[3] Olaniyan, A.O., 2019. The curse of a size: socio-cultural conception of dwarfism and effects on political participation in south-western Nigeria. IJDS: INDONESIAN JOURNAL OF DISABILITY STUDIES, 6(2), pp.250–258.

[4] The ridicule we face even as decorated athletes in Nigeria — Dwarfs in sports. Available at: https://punchng.com/the-ridicule-we-face-even-as-decorated-athletes-in-nigeria-dwarfs-in-sports/ (accessed November 4, 2020)