For over 30 years, 56-year-old Ibrahim Ali has made his living as a fisherman on the River Gashua, Yobe State, North East Nigeria. Throughout his life, he relied on herbal treatment from a close friend who is a herbalist to treat his ailments. However, three months ago, the herbs he had been using failed to alleviate the pain from his prostate.

In search of relief, he visited a local chemist and took some medications, which temporarily eased the pain.

“But the pain came back worse than before,” Ibrahim said. “I collapsed while walking, and they had to bring me home. Since that day, the pain has worsened daily.”

“When one consumes harmful substances in the form of herbs, over-the-counter drugs, food preservatives, or adulterants, the primary target is the kidney,” said Dr Celestine Nwosu, Chief Medical Officer of Dambam General Hospital in Bauchi. “This causes the kidney to fail.”

Dr Nwosu stated that several factors contribute to the high prevalence of chronic kidney disease. Socioeconomic conditions, including poverty and limited access to healthcare, high level of illiteracy in the region and poor access to potable water, play a significant role. 

A 2021 Water Quality Analysis of River Gashua and select boreholes and hand pump wells in the community revealed that the water bodies have a higher concentration of dissolved solids and harmful bacteria. 

Ibrahim later sought help at Yobe State Specialist Hospital in Gashua, where he was referred to the Yobe State Teaching Hospital. There, he received the devastating news that both of his kidneys were failing. “They told me to visit the hospital every week, but I can’t afford that. I only go for dialysis when the pain becomes unbearable,” Ibrahim explained, shaking his head sorrowfully. “I’m just waiting for my time.”

The financial burden of treatment

This kidney disease tragedy in Gashua also sank its clutches into Musa Ali, a local trader who faced the unimaginable loss of ten family members within five years.    

“I lost two aunties, an uncle, a sibling, and several cousins—ten relatives in all. But if I were to list everyone I know who has died from this disease, it would be uncountable. You just keep hearing about more and more people dying from kidney failure,” the 42-year-old told HumAngle.

Musa’s stepmother is currently undergoing dialysis for kidney failure, but despite having a willing donor, the family cannot afford the transplant. “Losing so many family members in such a short time is indescribable,” he shared.

According to Dr Nwosu, “Dialysis is just to buy time before one gets a kidney transplant and is not a permanent solution.” 

The financial burden of treatment is overwhelming, with countless families battling similar tragedies. “I had a provision store, but I lost it trying to pay for my stepmother’s treatment. Now, I’m drowning in debt that I can’t repay anytime soon,” Musa added. 

Though dialysis is free in Yobe State, it often remains inaccessible for many Gashua residents due to the transport cost to the Damaturu facility. Many locals cannot afford the ₦3,500 needed for kidney damage tests and rely on over-the-counter drugs and traditional medicine whenever they are sick. Globally, over 2 million people currently rely on dialysis or kidney transplants to survive.

The International Society of Nephrology reports that more than 850 million people worldwide have some form of kidney disease. This is 20 times the prevalence of cancer (42 million) or people living with AIDS/HIV (36.7 million). Between 5.3 and 10.5 million people require dialysis or transplantation, though many do not receive these treatments due to a lack of resources or financial barriers.

Contributing Factors

In Gashua, many other factors influence chronic kidney disease (CKD). 

According to Dr Sulaiman Ibrahim, a nephrologist at the Federal Medical Centre Azare, “Preliminary studies suggest that the use of harmful chemicals for food preservation, banned herbicides in farming, and the heavy presence of iron in the region’s water could be contributing factors.” 

“The incidence of kidney failure in Gashua and surrounding areas is alarmingly high,” Dr Ibrahim said. 

Environmental factors play a crucial role. The weather in Yobe State rises above 40°C for more than half of the year, and locals often do not hydrate adequately.

“A herder will spend the whole day under the sun with less than a litre of water hung on their shoulder, and this goes on for days,” said Dr Nwosu. “The continued dehydration causes the bladder to form stones, which further leads to kidney failure.”

The dominant occupations in Gashua are farming, fishing, food processing, and trading, all of which involve preserving foods with chemicals due to the lack of food-preserving facilities.

“Last year in Gashua, many traders were caught grinding rice husk and wood chaff with dried spices (tomato, bell pepper, pepper); others added rotten kola nuts. Beans and stockfish are stored with preservative chemicals and are often sold once the market price is favourable or the trader needs the goods.

“A single day does not pass without a patient from Gashua dying from chronic kidney disease,” said Yusuf Abubakar Nadabo, a nurse at Gashua Specialist Hospital. “And this is from people who don’t even know about the disease until it becomes chronic.”

Once a local is diagnosed with CKD, it is often considered a death sentence. “These locals can’t even pay for transport from Gashua to Damaturu and back,” said Nadabo. “A patient will need at least one weekly dialysis session to survive. They often return home for traditional medications and usually die within days of stopping the treatment.”

About 10 per cent of the global population is affected by chronic kidney disease, and millions die annually due to a lack of access to treatment.

“He was misdiagnosed”

In 2023, Amina Haruna, 45, lost her husband to CKD. They both worked as librarians at Yobe State University. “It all started with prostate pain in 2020,” she recalled. “Initially, the prostate problem was minor, and he sought treatment at a local pharmacy, where he was misdiagnosed with a liver problem.”

For a year, Amina’s husband took medication for liver failure, but his condition only worsened. Eventually, Amina decided her husband should go to the hospital. “When we went to Aminu Kano Hospital, tests revealed that it was kidney failure, not liver failure. Three dialysis sessions were prescribed, but we ended up undergoing 58,” Amina said, her voice laced with pain.

She spent over ₦21 million on treatment and related issues. Friends and family mostly donated the funds. 

Amina’s husband initially used Neolife supplements, but they were ineffective. He then switched to KEDI Healthcare, a traditional Chinese medicine, which allowed him to stop dialysis for a year and resume normal activities with a catheter. 

Unfortunately, he was hit by a tricycle, causing severe injuries to his kidney. Despite resuming dialysis, he later died from kidney failure, leaving Amina with their four children.

Dr Ibrahim highlighted that sedentary lifestyles also increase the risk of diabetes and hypertension, particularly in those over 45, further raising CKD risk. He stressed the need for greater awareness, regular health screenings, and controlling blood sugar and blood pressure. 

He also advised relatives of CKD patients to undergo regular check-ups.

The #SaveGashua Campaign

Amidst the continued tragedy of kidney failure leading to deaths in the community, a youth-led initiative, #SaveGashua Campaign, has been calling on government intervention and urgent comprehensive research to identify the root causes of the kidney failure epidemic. The community demands detailed research to uncover these causes, which is crucial for developing effective prevention and treatment strategies.

“If you stop a random person on the streets of Gashua and ask if they know someone who has died of chronic kidney disease (CKD) or has been diagnosed with it, the answer is invariably yes,” said Hamza Mohammad Tasiu, a medical student and a member of the #SaveGashua campaign. 

Part of the demands of the #SaveGashua Campaign is the establishment of free screening centres in the local communities that are most affected, as early detection of kidney problems can significantly improve treatment outcomes and reduce mortality rates, providing a much-needed lifeline for the affected population. 

“One in three households in Gashua has been affected by kidney disease, either directly or through loved ones. Many are unaware their kidneys are unhealthy,” Ibrahim Usman, another member of the campaign, told HumAngle.