Every week, thousands of people attend a megachurch in Lagos. But they aren’t there for the sermons -- they believe the televangelist pastor can cure them of HIV, cancer, and other terrible diseases.
WLAGOS, Nigeria — On any given weekend, one of Africa's largest concentrations of cancer patients, people living with AIDS, sufferers of strokes, diabetes, chronic kidney disease, asthma, epilepsy, abscesses, ulcers, severe burns, infertility, sickle cell anemia, and hypertension can be found in the Prayer Line at the Synagogue, Church of All Nations, in the Ikotun-Egbe section of Lagos, Nigeria. Rising from a warren of cinder-block and sheet-metal houses, the Synagogue is a hulking, faux-Gothic megachurch with blue-tinted windows and a concrete facade sculpted to look like the stonework in a castle. A cluster of police and suits with earpieces guards the entrance, tucked behind an ornate wrought-iron fence nearly 20 feet high and bordered by a long row of royal palms and international flags.
Early in the morning every Thursday and Sunday, thousands of people with chronic, debilitating medical conditions congregate under large white tents across the street. One by one, they present their medical certificates to church ushers as part of a winnowing process that culminates in a group of about 200 worshippers evenly spaced along both sides of a passageway at one end of the church's main hall. Each patient holds a large white placard describing his or her illness. Some placards have been filled in by hand with permanent marker; others, such as those for patients with HIV/AIDS, cancer, or diabetes, are common enough that the church has already had them printed in bold red block letters, easily legible to a TV audience.
This is the headquarters of Temitope Balogun Joshua, a flamboyant 50-year-old televangelist, with a neat goatee and, on filming days, a thick layer of foundation on his face. His prophesies of world events (the death of Michael Jackson, the Costa Concordia disaster) and claims of miraculous medical cures have earned him a following far beyond Nigeria. Since 2004, when Nigeria's National Broadcasting Commission banned "unverified miracles" from public television, T.B. Joshua, as he is known, has broadcast across Africa on his own network, Emmanuel TV. His loyal audience includes soccer players, movie stars, and heads of state past and present, from Ghana, Gabon, Malawi, the Central African Republic, and Congo (Brazzaville). When Air Zimbabwe announced direct flights between Harare and Lagos in January 2013, the headline on New Zimbabwe's website was "Air Zimbabwe targets TB Joshua pilgrims." In October, I sat behind Morgan Tsvangirai, Zimbabwe's former prime minister, at the church as other worshippers in a crowd of some 15,000 waved souvenir flags from South Africa, Botswana, Equatorial Guinea, Senegal, and Cameroon.
But most visitors to the church are poor people in search of help for their pain and suffering.
Indeed, poverty has fueled T.B. Joshua's practice. With limited access to doctors and facing rising costs of care, some suffering from severe illnesses are turning to faith healing as a last resort. For others, however, the promise of miracles that pervades so many African churches has made places like Synagogue their primary or even their first stop for help. A dozen doctors I spoke with in and around Lagos voiced concerns that their patients were interrupting or deferring orthodox treatment altogether in favor of the divine. Recent research from several African countries confirms the problem. One survey of perceptions of cancer found that more than a quarter of Nigerian nurses view going "to a prayer house" as an appropriate response to a breast cancer diagnosis. In Uganda, researchers found that a belief in "divine healing" led some AIDS patients to stop taking antiretroviral drugs. And in Ghana, the practice of "healer shopping" -- seeking spiritual cures alongside medical treatment -- has been tied to increased complications among people with diabetes.
In the Prayer Line at the church, I met a woman who had planned her visit after being diagnosed with breast cancer. "Why would I go to a hospital," she asked me, "when I know there is a supernatural power who will heal me?"
Pentecostal and so-called charismatic churches, where faith healing is most widely practiced, now account for more than 500 million believers worldwide, concentrated in Africa and Latin America. Taken together, they represent the fastest-growing segment of global Christianity. (Spiritual healing is practiced in many U.S. churches, too, but because American health care is far more accessible, faith healing rarely supplants conventional medical treatment.)
In Nigeria, many churches like T.B. Joshua's deliver a message that can be read as a response to the shortcomings of a costly, patchwork health-care system: Seek spiritual healing first, and medical treatment only if all else fails. That logic, as one Lagos oncologist told me, is an important reason that around three-quarters of cancer patients in Nigeria show up at the hospital for the first time only when the diagnosis is terminal, or close to it. "And that's the tip of the iceberg," he said. "Most people won't come to the hospital at all."
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I met Ikechukwu Nwana, a driver from Nigeria's Anambra state who has diabetes, on the front porch of one of several dozen makeshift motels that dot the neighborhood of mud streets and tiny shops behind the Synagogue, a spoke industry spawned by the weekly influx of pilgrims. Nwana was in his early 40s, with the set jaw and downcast stare of a person in severe pain. He was so thin that he appeared much taller than his 6-foot-2-inch frame.
Nwana's troubles started four years ago, when he began getting up to urinate in the middle of the night -- first twice, then three, four, and five times before dawn over the course of a few months. He took ground-up leaves and roots prescribed by a local traditional healer, but his condition did not improve. At a hospital in January 2010, a doctor said he was at risk for diabetes, prescribed insulin injections he couldn't afford, and told him to give up a diet of starchy cassava and yam in favor of beans and ripe plantains. When Nwana began to experience blurred vision and faulty balance as he walked, he returned to the hospital a second time and scrounged up enough money to pay for insulin. The treatment practically bankrupted him: A month's worth of insulin injections ate up more than half his $250 salary. As a father of four, he often had to forgo medication in order to pay for groceries and school fees.
With frequent interruptions in treatment, Nwana's blood sugar levels tripled over time, and he began to lose weight. There were days when he couldn't get out of bed. His own pastor, an Anglican, came to say prayers at his bedside. Later, members of his wife's congregation, the Deeper Life Bible Church, prayed over him as well. Nothing worked.
Spurred on by his brother Ejike, Nwana began to watch DVDs of T.B. Joshua on Emmanuel TV. Ejike carried a T.B. Joshua sticker in his back pocket at all times for good luck, and he was certain the anointing water he'd gotten on his last trip to the Synagogue had been instrumental in helping him sell his house at a good price. On TV, the acolytes who narrated T.B. Joshua's exorcism and faith cures during the Prayer Line told viewers to reach out and touch their television screens, that "space and time are no boundary for the healing power of Jesus Christ." But when his brother's diabetes persisted, Ejike thought it would be best for Nwana to come to the church itself. So they took a 10-hour bus ride to Lagos.
Nwana squinted in the sun and told me they had been there a week so far, without being able to take part in the Prayer Line -- there were simply too many people. Ejike was convinced that this, like his brother's diabetes, was the result of inherited sins. Before the family became Christian, he said, "our father worshipped idols." Nwana himself was circumspect but hopeful about his prospects at the church. "I believe I will be healed," he said.
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In 1991, Aderemi Ajekigbe, an oncologist at Lagos University Teaching Hospital (LUTH), home to West Africa's oldest cancer treatment facility, published a survey of the reasons breast cancer patients gave for coming to the hospital long after they first felt breast lumps. One in eight, the survey found, cited a "preference for prayer houses or spiritual healing homes." Nearly a quarter reported that they had been to "native doctors or herbalists," who were generally seen as treating the spiritual causes underlying physical illness -- and often at a price cheaper than that for hospital-based care. (Many women in Ajekigbe's study also acknowledged "economic reasons" for delaying their first hospital visit.)
Today, Ajekigbe said in an interview, "It's just as bad as it was 23 years ago. It's even getting worse." He now directs cancer treatment at LUTH and sees 15 to 20 new patients a day pass through his department. The vast majority of them come too late for him to be of much help. When I visited Ajekigbe at LUTH's radiotherapy department in the fall of 2013, he directed the receptionist to show me photographs of cancer patients at the time of their first visit to the hospital. The receptionist handed me a thick brown paper envelope with pictures that told stories of enormous suffering. In one, a young woman stared at the camera with a gaping, pus-filled cavity between her eyes. The next showed a man in his 40s whose jaw and teeth had been halfway consumed by a large tumor. And on: a man, naked on a hospital bed, his back, buttocks, and genitals covered with blistering lesions; a woman's upper body, her swollen left breast only partly concealing a festering wound the size of a baseball in her rib cage. Among patients whose illness is diagnosed only at autopsy at LUTH -- people who die in the ambulance or the emergency room -- cancer killed nearly one in 10.
"When people have cancer or any suspicion of cancer," Ajekigbe told me, "the No. 1 belief is that it's [caused by] witchcraft. Patients think orthodox doctors deal with the physical aspects of illness, and native doctors and the others [pastors] deal with the spiritual aspects. So when you think you're bewitched..." He trailed off with a sigh.
Nearly every physician I spoke to in Nigeria tied spiritual remedies for chronic illnesses to the uphill battle patients fight to access and pay for orthodox medical treatment. As it did for Nwana, the cost of medication can easily overwhelm a household budget, so people look for help elsewhere. "People believe in the alternative medicine; they believe in the churches," Ajekigbe said. "But this belief may also have to do with how much you have in your pocket. I'm telling you this, even doctors cannot afford cancer care in this country."
Since Nigerian hospitals introduced fees for service in the 1980s, the costs of medical treatment have multiplied. In a paper on family health budgets, sociologist I.O. Orubuloye and his co-authors describe a clinic where he has done research since the mid-1970s that "had, in 1974, every bed filled and long queues of outpatients. Sixteen years later it was almost deserted and doctors and nurses reported that their potential patients had 'run away' because of the expense.... They believed that the patients were attempting home cures or had turned to the traditional medical system or to the faith-healing churches."
Complicating matters is the abysmal state of Nigeria's health-care infrastructure. At the time of my visit, resident doctors at public hospitals went on strike for three weeks to protest unpaid salaries. Only a few of the country's seven radiotherapy centers were up and running, due to equipment failures at the others.
Managing diabetes consumed more than half of Nwana's wages; cancer treatment can cost 10 times as much. "There is no insurance company that covers it," Ajekigbe said. "What you do here is cost-sharing: Members of the family, nuclear and extended, friends, maybe your social club, or the church you belong to help in contributing the money to buy the drugs."
But often, they contribute money to buy something other than drugs. With the help of his brother and his wife, Nwana marshaled $350 -- equivalent to more than two months of insulin treatment -- for his trip to T.B. Joshua's church. Another man I met waiting to enter the Prayer Line at the church worked as a security guard at a provincial hospital. He lifted his shirt to show me an infected wound that had never quite healed in the years since a car accident in 2006. He had already had two unsuccessful operations to remove the infection, and when he approached relatives to pay for a third, his brother-in-law was happy to help: "He said, 'The best thing for you to do is to come to Lagos and see my pastor.'"
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T.B. Joshua's work is not without controversy -- even among fellow faith leaders. He is considered an outcast by many of his peers, not for promulgating false promises, but rather for coloring outside the lines of bona fide Christianity. He has been barred from the Pentecostal Fellowship of Nigeria and the Christian Association of Nigeria, and he has been publicly rebuffed by Pastor Enoch Adeboye, leader of the Redeemed Christian Church of God, Nigeria's largest Pentecostal movement.
Yet the difference between T.B. Joshua and more mainstream Pentecostal and charismatic pastors is mainly one of degree. Miracles and televised testimonials of faith healing are staples of Adeboye's own church, as they are at places with names like Deeper Life, Christ Embassy, Celestial Church of God, Mountain of Fire and Miracles, and dozens of others. Although only a few would go so far as to publicly claim curing of AIDS, the core message to believers is the same: There is nothing God will not do.
T.B. Joshua has also courted criticism outside Nigeria. In 2011, the BBC named T.B. Joshua in an investigation into the deaths of three HIV-positive African women living in London, alleging that he and several other pastors discouraged them from taking antiretrovirals. But the response from the pulpit was swift, confident, and smug. "I know many of you ... might have heard a lot about T.B. Joshua [in] the United Kingdom, some newspaper," he mused on Emmanuel TV the week after the investigation aired. "[It is a] campaign of calumny. Slanderous remarks. Name-callers.... As for me, my household, and Synagogue family, we are using medicine."
Indeed, T.B. Joshua has been careful, particularly in his public appearances, not to present the use of faith healing as an alternative to orthodox medicine. At the church, though, it was hard to avoid the conclusion that T.B. Joshua's preaching gives his followers exactly such a choice. As a Cameroonian man told me in a nearby lodge, "The Synagogue is a big spiritual hospital."
One ironclad requirement of the Prayer Line is that patients present medical certificates attesting to their illnesses. On the one hand, having a doctor's imprimatur enhances the drama of T.B. Joshua's healing touch. But the certificates also offer hard proof of the limitations of orthodox medicine: What the hospital cannot cure, the certificates suggest to viewers of Emmanuel TV, God certainly will.
During the long wait for the Prayer Line, I met a woman named Ese Okoro who had come to the church from Nigeria's Delta state. She bore a letter from her doctor: "To Whom It May Concern, Medical Report Re: Okoro, Ese. A known case of seizure disorder who has been on treatment on several occasions here in General Hospital, Ekpan, Delta State.... She has visited hospital, tradomedical homes and religious homes no improvement noticed. We are reffering [sic] to you for treatment support." Another man told me he'd tested positive for HIV twice, four years apart, each time in anticipation of a visit to the church. In between, he'd treated the illness with T.B. Joshua's anointing water, a "complimentary" gift the church includes with $40 packages of T.B. Joshua's books and DVDs, which are sold at every service.
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"Wherever there be darkness in your bones, tendons, fluids, muscles," T.B. Joshua told his congregation, "let there be light." It was closing in on 3 p.m., and the Sunday service had been going on for nearly eight hours. But T.B. Joshua looked like he was just getting started. Wearing trim black slacks and a checkered button-down shirt, he paced rapidly to and fro behind a sky blue podium as he led the room in prayer. "Satan is the author of sickness, disease, cancer!" he cried. "I say the dark disease be cured."
With that, he moved abruptly to begin the Prayer Line, in a long gallery at the end of the building. Pandemonium followed closely behind, as five cameramen and five grips carrying tangled coils of cords jostled for position, struggling to keep T.B. Joshua in the frame during the transition. Beneath dozens of ceiling fans and wall-mounted flat-screen TVs, believers with their placards stood against the walls waiting to receive their healing. Their placards listed a strange mix of ailments, ranging from diseases that could be found in the index of any medical textbook, to approximations like "foot cancer" and "hip cancer," to plainly religious conditions like "evil attacks."
T.B. Joshua began at one end of the hallway, raising his hand toward a frail woman from the Ivory Coast whose sign said she had difficulty walking. "You are already delivered!" he bellowed. "Confess your freedom now." The woman slumped in her chair and dropped the microphone she'd been given. Then, after a few seconds, she stood and shouted, "Thank you, Jesus!" as ushers led her away.
T.B. Joshua had already moved on to the next patient. He pinballed around the room over the next two hours, pivoting to offer the best camera angle and fixing people in the Prayer Line with fierce, stony stares until they collapsed in heaps on the ground. A group of foreign staffers for Emmanuel TV -- Brits, Americans, French, Spaniards, Cameroonians -- passed a microphone around and took turns providing buoyant play-by-play of the service in their native tongues, beamed live onto the televisions overhead and inside the church's main hall.
"Man of God, please help me," a young woman shouted from the sidelines. T.B. Joshua spun around and thrust a hand toward her chest. "In Jesus's name!" he yelled, and the woman fainted.
An American commentator grabbed the mic and took up the thread: "Behold the awesome power of our Lord. That name, Jesus Christ, has been invested with all the power in the universe. When the man of God utters those words, healing takes place instantly." Through all of this, handlers cycled new patients continually into the Prayer Line and took old ones out more rapidly than some people, hobbling or clutching open wounds, could manage. "Keep moving, keep moving," they urged. A few of those who'd received healing stopped just outside to give televised testimonials; others were herded back inside.
Angela, a Californian who'd been assigned as my minder for the day, anxiously kept me near the center of the action, tugging at my sleeve to bring me closer to T.B. Joshua or shielding me with one arm to avoid the scrum of cameramen and cord wranglers who reorganized themselves constantly around him. Eventually, it became overwhelming, and I walked out into the street.
A young woman high off her encounter with T.B. Joshua sat on a bench devouring a plate of rice. Her father had brought her all the way from rural Ghana to participate in the Prayer Line. The pair was jubilant: The daughter appeared to have been cured of an addiction to eating soil and "cancer of the blood."
A few minutes later, I called Ejike to see how his brother was feeling. Ejike and Nwana had been planning to come to the Prayer Line, but in the end they'd stayed in the lodge. "I don't even have the strength to walk from here to there," Nwana said.
This story was made possible by a grant from the International Reporting Project.
Photo: Rowan Moore Gerety