On a hot, quiet Monday morning in a Nigerian fishing village on the banks of the Otodo River 18-month-old Blessing Asokri developed an unusually high temperature.
Rumours of a strange illness, accompanied by a fever and body rash, had been doing the rounds in Otodo-Gbame village in Lagos State. In their native language, Egun, the village's impoverished residents were voicing their suspicions. "Was the illness caused by evil spirits sent from a nearby community?"
Blessing's parents were terrified. They tried traditional healing methods. They even went to hospital to bring down Blessing's fever. Nothing worked.
Her body was covered in a rash and, days later, the little girl died.
A few weeks later, towards the end of January, Sunday and Demola Asokri are still struggling to control their emotions as they squat under one of several canopies set up by health officials in a square in the middle of the boggy island community.
Asokri, a dark and lanky man who ekes out a living selling fish, recalls that Blessing was an active child. "She kept her mother so busy, chasing her all over the place, but [that day] Blessing couldn't lift her arms or even open her eyes."
'The illness was sent to them through an evil spirit'Like most people here, the Asokris have more faith in traditional than Western healing methods. That's why she gave her daughter a local herbal remedy first.
"A few days later, we woke up and discovered she had rashes all over her body," Asokri says.
The worried couple went to consult the villages's woman leader, Rosaline Esisu. But when they arrived at her home, they found that they were not alone – two other women had already arrived to complain of the same sickness and other villagers had begun to gather there with their sick children in tow.
Esisu told the Asokris to take Blessing to the nearby Aderain Clinic.
"When we got there, they told us to take her to a bigger hospital because her situation had worsened. But before we were ready to take her there, she died," Asokri explains.
Blessing was just one of many children who died when the mystery illness swept through Otodo-Gbame early this year.
Godsave Tabiti, the doctor at the Aderain Clinic where Blessing died, says that when the children started getting sick in early January, he tried to encourage residents to come to the clinic for treatment. They refused and opted to use traditional herbs instead.
"The community people believe in using local herbs. They say it is what they have been using all their lives to cure any illness," Tabiti says.
Many people were convinced the illness had a supernatural cause."They believe that the illness was sent to them through an evil spirit … by the [neighbouring] Ikate community whom they earlier had a land dispute with," Tabiti explains.
Otodo-Gbame's estimated 100 000 residents are mostly illiterate. People here speak only their native dialect. Men make a living fishing while the women roast and sell the fish.
Living conditions are dire. There is no clean water except for that in shallow wells, which provide water suitable only for bathing and cooking.
Tabiti says residents generally do not believe in going to hospitals. Even if they did, there is no state clinic nearby.
The privately-owned Aderain Clinic offers immunisation against measles, polio and cholera on Fridays, but Tabiti never sees more than seven children on these days.
Cost may also be a factor: the clinic charges between 200 and 250 naira per vaccination (between $1 and $1.25). With villagers saying the daily income here is between $2 and $5, the vaccinations are too expensive for most.
Aderain Clinic in Otodo-Gbame. (Gabriel Fatoye)
Tests confirmed the 'mystery' as a straightforward illnessAs more children died from the strange illness and panic swept through the village, the chief, Hunpe Dansu, notified the local government in Eti-osa. The Lagos State ministry of health was alerted and healthworkers were sent to Otodo-Gbame.
Tabiti says they conducted house-to-house searches and listed 34 sick children.
In February, the health commissioner of Lagos State, Jide Idris, identified "febrile rash illness" as the possible cause of the deaths. Idris announced in a press release that 20 children had died since the start of the outbreak on January 6, but some reports list as many as 70.
There are several diseases that present with a fever and a rash, according to the American Academy of Family Physicians. These include measles, German measles and chicken pox.
Blood samples and swabs were taken from sick children. Within days, the "mystery" was resolved and tests confirmed the source of death as a rather straightforward illness: measles, caused by a highly infectious virus.
World Health Organisation (WHO) data shows that the disease continues to be one of the leading causes of death among young children. In 2014, there were 114 900 measles deaths globally – about 13 deaths every hour – despite the availability of an effective measles vaccine.
Between 2000 and 2014 measles vaccinations have resulted in a 79% decrease in measles deaths worldwide and prevented an estimated 17.1-million deaths.
Severe measles is more likely among malnourished young children, the WHO says. In populations with high levels of malnutrition and a lack of adequate health care, up to 10% of measles cases result in death.
Dr Akinpelu Tola, a member of the nongovernmental organisation Project Foresight who helped treat the sick children after the outbreak in Otodo-Gbame, says many were lethargic and malnourished, had parasitic worms and had never been vaccinated.
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The state intervenesThe Lagos State government, together with the NGOs Project Foresight and Mount Zion, staged a major intervention in Otodo-Gbame. Children have been vaccinated, dewormed and given nutritional supplements. Sick ones have been monitored and got vitamin A shots which, according to the United State's National Institute of Health, supports the immune system and promotes growth.
Officials and health workers have pitched canopies in the middle of the village and on Saturday mornings they hand out food, water and advice on health issues.
In mid-March Demola and Sunday Asokri are among the roughly 200 men and women huddling under the canopies. The couple, who never believed in hospitals or vaccines, struggle to make sense of all the officials' promises – much of which had to be translated.
Mount Zion's Lemuel George, for one, pledges truckloads of drinking water and help with building more toilets.
Then there will be additional vaccinations in the ongoing programme and traditional birth attendants, who are well trusted by the community, will help the local government with disease reporting. Eventually the villagers will get their own health centre.
To one side, Christain Nwabo translates for those nearby.
Nwabo lost two children to the disease in February – his three-year-old son Elvis and 18-month-old daughter Glory. But, says Nwabo, he's happy that the government has stationed doctors in the village and is bringing in water.
"Since they started coming, we have not lost even a child. We are happy about that," says Nwabo. "The doctors said that they will be stationed here until they are sure we have learnt that it is important to seek medical help and take our kids for immunisation. It is sad but now there is hope that this evil illness will not befall us again. Though I lost two of my kids, I don't want any child to die again." - Additional reporting by Adri Kotze and Mia Malan.
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