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
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.
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.
most visitors to the church are poor people in search of help for their pain
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
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
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
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."
* * *
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.
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.
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.
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
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.
* * *
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.)
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.
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.
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
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."
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.
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."
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.'"
* * *
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
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.
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."
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."
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.
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.
* * *
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."
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."
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.
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
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.
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.
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.
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."
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