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Losing a life to give life: The cost of maternal healthcare

Any woman, who has undergone pregnancy, knows too well that the longest period of waiting is the nine months. It is a time of trials and temptations. Things that you once loved to do or eat are no longer options for you. Life is on a roller coaster, changing from time to time like the chameleon. I still hold on to dear memories of childhood that feel almost sacred to me now. As I was growing up it was fascinating to me how pregnant women looked. In my childish mind I wondered how they felt; was baby Jesus heavy (that’s how adults described the unborn to me), did he cry for milk. And as the woman’s tummy grew, bigger and bigger! What a wonder!

Such great respect was placed on the womb that even in public places such as buses, I saw big, fat, short and tall women and men springing from their seat to allow a pregnant woman rest. ‘Mama Keti hapa”. (Have a sit mum).Now that am done with childish thoughts, it is clear to me how women have faced the successes and challenges of pregnancy since creation and wish the same treatment would transcend during labor.

There I was in the labor ward of a public hospital with a 200 bed capacity with all the adequate equipment to save mother and baby. But that night I did not save the only child of a young mother in labor. I was working into my second week of night duty as a nurse supervisor which entailed taking reports and doing periodic rounds to check that nurses, doctors and paramedics were attending to all patients as needed. It was already promising to be a busy night with calls every ten minutes. ‘’I need an anesthetist fast, sister!” As I put down the phone, another one would rrrring! “Matron there is a child in respiratory distress; we need an ambulance!” Being a public hospital the number of patients would sometimes surpass the capacity. Into my third hour of the duty on this busy night, I already started feeling the effects of a buildup of pressure! And the night was still young!

Towards 11pm my energy was draining. A mother had been referred to our maternity from the Level I Facility health center within the city She presented complications of reduced fetal activity with a breech presentation (baby presenting with the buttocks first in the birth canal), that would require an emergency caesarean section. I called the doctor on duty to immediately attend to the mother. There was need to move with speed.

Later, I went to check the mother who by this time was in acute labor pains, wailing, kicking her hands high up! Calling upon God! Oh Lord! Save me, save my baby! Other women looked from afar with fear in their eyes. Before long another scream came from the furthest corner of the room, Sister! Sister, oh! Oh! Aaagh! The nurse ran to attend. It was just becoming chaotic; we had about seven women in their early labor, three in active labor, one waiting in theater for the same doctor. There were only two midwives in the labor ward. As we were waiting for the doctor to arrive, the mother was getting tired and it was futile to just wait and watch. I summoned my courage to do a vaginal examination and found the infant’s foot, confirming the breech position. The position of the baby meant going skillfully around the foot to loosen it with an incoming uterine contraction.

According to Fraser’s Text Book of Midwives (2008) the causes of breech presentations vary from multiple pregnancies to other uterine abnormalities. A vaginal examination every four hours is necessary during labor to ascertain the progress of a normally descending head and ripening of the cervix. In this case a cervix needs to open as a result of hormonal effects that are active as soon as labor starts up to allow for the descending presenting part (head, breech) to be delivered spontaneously The fetal heart beat was present but weak. I was able to deliver the legs out of the vagina, and to free the forehead of the baby out of the birth canal. Finally the hardest part of delivering was over.

Sadly the baby never cried! I felt butterflies in my tummy and a thin streak of sweat on my forehead confirmed my worst fears. The mother raised her head and with a weak voice asked, ‘Is my baby dead’, with tears flowing in her eyes. I did not have an answer. Cutting the umbilical cord, the pediatric doctor started the resuscitation of the newborn. The dreaded incident happened and within an hour we lost the baby. All due to delay access to reach the facility.

A second death that night dealt a hard blow. A fellow nurse succumbed to unconsciousness after delivery through a caesarean section which was too much for her to handle. She was taken to the intensive care unit and never woke up from the deep sleep. It was the last time to see a colleague, a nurse and a diligent young mother who had much dreams for the new life ahead. The baby survived. The health care system provided life and death for a new born and a mother.

The Health Care System in Kenya

Looking at the trials of these two women brings closer to home the disparities of maternal health care services in Kenya. For the last 50 years the government has been trying its best to address the issue of maternal health policies. Positive changes as well as pitfalls have occurred in health care starting from the 1960s when the government introduced free health care for all. As the population grew in the 1980s there was need in primary health care to focus on family planning, health education and promotion. In the 1990s the rural facilities increased, to cater for the growing population. With the expansion came the introduction of a user fee (paid by individual clients when accessing services) in public hospitals. User fees paralyzed primary health care meaning poor people had to wait to die in the event they didn’t have money to access health care.

A brilliant idea was borne to address women’s’ health. The Minister for Health in 2003 declared that at the Level 1 and 2 deliveries would be as low as Ksh 30 (I $-Ksh 80). This was meant to encourage women seek labor care in hospitals rather than with traditional birth attendants. However a community health worker I met in a village cautioned women on the limitations of the system. “It is good to deliver in hospitals because there are experts, however sometimes the care is not good there. If you don’t have money, it is hard. Remember those women who were locked out after nonpayment? Personally I tell the mothers to go to the hospital’’.

Ideally the health structure within the Ministry of Health functions in a pyramidal sequence starting from the Community then Dispensary as a 1 and 2 Level headed by a nurse licensed to practice-there is no deployment of a doctor. Citizens have these levels as the first contact to health care services .It has limited equipment. At the Health Center, 3rd levels there are basic emergency obstetric care. Personnel include nurses, clinical officers (doctor’s assistant), and laboratory for simple diagnostic investigations. Moving towards level 4-6 the services range from the curative to preventive and the health personnel team is specialized.

However, these levels are largely urbanized and the majority of Kenyans and pregnant women have limited access to these services. The first mother had to endure long waiting hours to reach level 4 of care due to delayed decision making and access that led to the death of her baby. During a focused discussion one business lady, a mother of two, replied,
“Compared to the public hospitals, the NGOs that have been in our area allow that a mother’s visit to their clinic during pregnancy permits a woman to deliver at no cost”.

This disparity in delivery of healthcare poses challenges in meeting the needs of the newborns and mothers. Health professionals are attracted to move to the urban facilities. The government has employed other positive measures to provide more nurses and midwives, and clinical officers to non-urban areas through an economic stimulus package. However the task has been huge to maintain the migration of nurses/midwives to Europe, America and Australia.
A schoolmate of mine in the nursing school and now working in the USA, explained during a Skype chat that, “as long as there are greener pastures out there to explore I will go. After all it is about the dollars and good living, I don’t want to die in poverty”.

However in terms of the National Health Policy Framework 2011-2030 within the Ministry of Health Kenya has made greater efforts in remunerations and promotion of health workers as compared to other East African Countries. The restructuring of the salary and remunerations scheme has awarded the health workers a fair deal even though it is not exhaustive. This is in accordance to the current reforms in the New Constitution that requires equal health care and a fair remuneration for health workers.

The New Constitution and Maternal Health.

I am a member of a professional body for nurses and midwives which during the constitutional referendum were greatly involved in the civic education at the grassroots. We urged Kenyans to vote wisely and to remember the Bill of Rights that promised basic rights to clean water, quality environment and highest attainable standard of health care. Health care was paramount. Without a healthy nation no better agenda could be moved forward.

The reforms of the Constitution of Kenya were the height of achievement in democracy in the Horn of Africa. It was a courageous move and other African nations waited to see the outcome. The people of Kenya displayed to the world an understanding of growing our nation to a better world in which to live. Even though the major hurdle in the Constitution was the Bill of Rights, majority of them (citizens) felt it was a good document that gave checks and balances. It addressed all aspects of life. At its best the government has been a signatory and ratified many International treaties that address women’s health.

Two years later the Constitution remains a popular theme in the country. The health care system has accommodated the articles that touch on health. The woman’s womb has seen controversial talks like never before in this New Constitution.

A childhood friend and an astute lawyer caution that “the Constitution is a good document, when I was conducting civic education some politicians spread rumors. This is not true! But people believed that! We voted for YES or NO.I say that am passionate about the Article 43 that touches on socioeconomic and this where the citizens should take the government to account. Do we have enough schools, hospitals? Are the youth employed?’’

Light at the End of the Tunnel

There are currently major strides to address the gaps in maternal health care. Both the civil society and the government are providing significant inputs towards it. Currently a consortium of non –governmental organizations are reaching out to the women in the hard to reach areas by providing basic training to the community in assisting women to deliver safely in hospitals.

Walking across the slums, I meet amazing women who are part of a community strategy, using tools such as phones and simple charts to explain the danger signs in pregnancy and I find this a positive journey towards reduction of maternal mortality.

The life of a mother and the unborn lie on the mandate of the New Constitution. They can die or live if the social amenities and political will are favorable to support them.

When I was young I thought being pregnant was sacred. I saw people having humility to assist a pregnant woman live in a stress free environment. There was special attention accorded to these citizens because we believed they were bringing forth life and that was precious.

The governments the world over must treat maternal health with utmost diligence and conscience, as they do with defense force in readiness for war or a nuclear plant launch. No woman should die while giving life!

This article is part of a writing assignment for Voices of Our Future, a program of World Pulse that provides rigorous new media and citizen journalism training for grassroots women leaders. World Pulse lifts and unites the voices of women from some of the most unheard regions of the world.

Comments

Chinemu's picture

Great article,

Lucia this a great piece, For a moment I stopped and prayed that I should not have a complicated labour, am expecting. My first labour was something else, i almost lost my baby because my midwife was stubborn even after the doctor had recommended a C section she insisted that i would deliver, it was a bad experience I thank God, I had my son,
I wish i can have a midwife wife who is passionate about her job like you.
Keep it up sister

Okeny-Lucia's picture

Great Article

This is such a tribulation in maternal health.It is ironic that women know what birth is all about,but it turns out otherwise when you become professional.I know out there are midwives who are doing a very good job,but again we have those with bad attitude.This is a research that now being undertaken in my country to address that issue.I hope change will come one day.Thank you for sharing with me.

Lucia Buyanza
Reproductive Health

Stella Paul's picture

A challenge that needs to be won

Dear Lucia
Safe motherhood & Maternal health is one of the Millennium Development Goals that continues to be a challenge in allthe developing countries. In India the government has introduced special schemes like 'Janani Suraksha Yojana' or Maternal security scheme that provides medical care and monetary support to mothers. The problem is, in remote villages, where women need them most, the health centers remain closed due to political turbulence. Finally, its the needy not getting the benefits. I totally agree that the issue needs to be harped upon again and again, until every pregnant woman has availed a secure delivery.

Stella Paul
Twitter: @stellasglobe

Okeny-Lucia's picture

A challenge that needs to be won

I am glad to to hear that a great initiative is taking place in India.I hear you and thank you for sharing.

Lucia Buyanza
Reproductive Health

Celine's picture

Hi Lucia, The way you put it

Hi Lucia,

The way you put it "The health care system provided life and death for a new born and a mother" calls for concern. It is so sad how government in some countries tend to neglect the very crucial system which is very sensitive and strong determinant to survival of mother and child.

Through this frontline, you actually expose me to some rudiments nurses, doctors and midwifes go through in their every day activity in this life saving profession. When I was growing up, I was made to understand that nurses and doctors have special reward from God for providing their efforts in saving lifes even at the detriment of their own health. I could read your feeling when any life is lost in the process.

Keep up the good work!

Celine.

Okeny-Lucia's picture

The way you put it!

Thank you Celine,
I find am always caught in the web of things.A health care system that gives and take away your dignity.Such is the situation in developing countries.

Lucia Buyanza
Reproductive Health

noreens's picture

Hi Lucia, You wrote a good,

Hi Lucia,

You wrote a good, informative article. "No woman should die while giving life!".......... so true!

Noreen

Okeny-Lucia's picture

You wrote a good

My sister! Thank you for having supported me in your reading my most crucial experiences as service provider.

Lucia Buyanza
Reproductive Health

malba66's picture

Dear Lucia, Thank you. Your

Dear Lucia,

Thank you. Your piece is touching for so many reasons. My grandmother was a midwife and nurse, who actually adopted a baby whose mother died in labor in her hospital. I myself had an emergency C-section after 18 hours of natural labor, and had a brief moment of panic after he was born, when I thought that I was going to die (due to an allergic reaction to the anethesia). I myself am a doula, and though I cannot do this work full-time, try to help as many women as I can during pregnancy and post-partum.

Maternal healthcare is a universal human rights issue that touches are lives even here. In Harlem, NYC where I lived for 10 years, the infant mortality rate was as high as many developing nations in Africa and Latin America. (Young) women of color and poor women in the United States encounter many of the same challenges that you describe due to lack of healthcare, the failure of public health systems, and a general lack of support for maternal health.

Thank you for sharing your story and may you always be blessed with the strength, clarity and purpose to continue your work.

Peace,
Mari

Okeny-Lucia's picture

Thank you.

Dear Mari,
It is unbelievable to think of New York having such health disparity.It is very good to know from your side that maternal and neonatal health is similar global.I believe there are going to be interventions.

Lucia Buyanza
Reproductive Health

Lucia,
Your story in Kenya is not any far form Uganda. I have just returned from visiting a sub county in Arua (West Nile) where the women told me they had just lost a mother and her twins after the health center she went to deliver failed to provide the necessary emergency care. It is so disheartening when these services cant be provided. My friend once lamented that i'if men where just given the role of delivering children for only 9 months, them every maternal health service required would be made available'. Maternal health are human rights too.

Lucia, keep writing , I have learned so much from you.

Grace Ikirimat

"It takes the hammer of persistence to drive the nail of success."


Ikirimat,
I am so touched by your analysis of the story.Uganda has all the similarities.Infact today am in a conference with midwives from Uganda.It is a war that we must all try to fight and help families.Thank you

Lucia Buyanza
Reproductive Health

Marta Williams's picture

irthing in Kenya

Dear Okeny-Lucia. I was very moved by your article on women iving birth in Kenya, and how the new Constitution will help give more human rights to pregnant women. I grieve at what you, and they, suffer while doing the most basic responsability of women, bringing new humans into the world. Keep up your good work, and may all of us learn how to help you in the best way we can. I send my admiration and my love. Marta

Okeny-Lucia's picture

Birthing in Kenya

Dear Marta,
This has been my most rending moments to share.When I finally took paper and pen,I knew that women will be given a chance to give life in the most respectable way.
I was afraid at first of my thoughts and experiences.But when I looked back at all those experiences.I folded my courage and remembered these words"IT IS FOLLY FOR GOOD MEN TO SEE EVIL AND DO NOTHING ABOUT IT"

Lucia Buyanza
Reproductive Health

Rachael Maddock-Hughes's picture

Great Article!

I LOVE the line where you say "The governments the world over must treat maternal health with utmost diligence and conscience, as they do with defense force in readiness for war or a nuclear plant launch. No woman should die while giving life!". That is such a call to action!

You did a marvelous job of interweaving your experience with statistics from the broader context. Thank you so much for sharing this story with us.

Rachael

"In every human heart there are a few passions that last a lifetime. They're with us from the moment we're born, and nothing can dilute their intensity." Rob Brezny

Okeny-Lucia's picture

Great Article

Rachel,
I am honored today by all the midwives and touched by their silent suffering they have encountered in the line of duty.

The more I thought about this stories,the more compelled to write and the less afraid I was about my voice.

Thank you for your compliments.

Lucia Buyanza
Reproductive Health

Farona's picture

Caregivers are angels!

Once again, I am excited and impressed to read your piece!

I love how you explained so much emotions/happenings during pregnancy in just two words – ‘trials and temptations’. I have tremendous respect for health professional working 24/7, especially in public hospitals where the pay might never match up the level of work/energy/sacrifices. It’s obvious to see the pressure building up yet very few make the effort to understand and extend empathy – care givers need care too! And like so many care givers you graciously articulated the pressure one can be under such life-threatening circumstances round the clock. Loved how you juxtaposed two incidents (baby and the nurse) to highlight the situation in maternal healthcare.

I admire the breath of the piece, the link between constitution and maternal health was enlightening. I could not have learnt more on your country’s maternal health elsewhere – thank you!

The analysis of private hospital is spot on – it’s similar perhaps everywhere. I am not a mother but my mother has given birth to five wonderful daughters. 3-4 years ago when my sister gave birth in a private hospital, they mistreated her. And to get money even normal delivery cases are turned into caesarean. It’s outrageous! Is it similar there? do doctors turn normal delivery cases into cesarean too often ?

Okeny-Lucia's picture

Care givers are angels!

Hello,
Farona,Great to hear from you.The situation of private hospitals is similar,here too.The slightest opportunity to take for a cesarean is overwhelming.It has been higlighted severally how doctors are motivating women to undergo painless delivery,all in the name of mother,s choice of delivery.Thank you for sharing.I cannot deny it.It is happening on frequent times.

Lucia Buyanza
Reproductive Health

Farona's picture

Re:

It’s perplexing to hear how some doctors misguide patients on caesarean and attach the ‘painless’ incentive –but does cesarean really reduces pain or just rearrange them? It was after my sisters’ delivery I began to learn more about birth practices. Men do not seem to take any part in the process; so many women want their husbands to play role but the process here and men’s reluctance to ‘interfere’ into wife’s pregnancy leaves no room for their involvement.
A recent survey by a midwife here showed overwhelming number of women wants their husbands to take part and increasingly, women are turning away from highly medicalized to more natural birth practices.

I completely fell in love with your last line, a passionate call for action " The governments the world over must treat maternal health with utmost diligence and conscience, as they do with defense force in readiness for war or a nuclear plant launch."

Okeny-Lucia's picture

Farona,Health is expensive!

There is an aspect in the healthcare system that might not be well known to the public.The provider induced demand for a service.In Health Economics this situation only creates a divide and rule situation where the poor will get partial service but the rich drive that demand because of the money factor.
It is only in developing countries that we have encouraged private hospitals to flourish at an expense of the poor society.
Thank you

Lucia Buyanza
Reproductive Health

Wonderful work here Lucia. I especially resonated with your powerful conclusion! If men were the ones giving birth, would it be so depressingly neglected?

Money should not determine health outcomes. Everyone deserves the dignity that comes with full access to quality treatment. I look forward to seeing a world where the promises in Kenya's constitution become a fully lived reality.

Thanks for sharing your candid insights on this important issue.
Best,
Scott

Scott Beck
World Pulse Online Community Manager

Okeny-Lucia's picture

Important Issues around the world!

Health is a huge politcal driven factor within the developing countries.I hope people will continue to fight for their rights.

Thank you!

Lucia Buyanza
Reproductive Health

Farnoosh Fathi's picture

thank you, Lucia!

Dear Lucia,

Thank you for opening my eyes to the severity of the maternal health-care challenges women in Kenya face. Because of the care and courage you put into communicating your own experiences, both tragic and hopeful, and the research you have found and organized for us here, I feel newly aware and motivated by your vision for change, in Kenya and the world over.

Thank you and your community of inspiring and compassionate professionals for your hard and valued work!

Farnoosh

Farnoosh Fathi

Okeny-Lucia's picture

Thank you Farnoosh!

Dear Farnoosh,

Thank you for taking time to read my story.It is a story for all of us in different countries.Health has so many disparities,it is big business and the most neglected area where the society should invest more in .

It was really reassuring to hear from you.

Lucia

Lucia Buyanza
Reproductive Health

Ruun Abdi's picture

Dear Lucia, Thanks for

Dear Lucia,

Thanks for writing such a Great and Informative piece! I enjoyed reading your post as always its so touching!

I also loved the title :-)

Cheers!

Okeny-Lucia's picture

Hi Ruun

Hey,
Thank you I was still running up and about with the op-ed.

This piece was partly dedicated to women in the marginalized communities whose delivery is challenging and fatal sometimes.

I agree with you

Lucia Buyanza
Reproductive Health

MaDube's picture

Dear Sis Lucia

Indeed I have always wondered that if men could give birth, would maternal care be so expensive and not easily accessible or if women were to choose to just keep their female foetuses and get rid of the male ones as a way of ensuring that they breed generations of sensitive people to childbirth, would that help. I know my thoughts are quite drastic, (huge grin) but I have no idea how to make men more sensitive to this issue. You are lucky to have a constitution that now embraces socio-economic rights. Our main problem is that we dont even have the right to health in our constitution and it's become more of privilege than a right for women to have access to quality maternal care.

Keep doing what you are doing sis. I know Kenya shall thank you one of these days for all your efforts.

Best,

MaDube

Okeny-Lucia's picture

Great Big Up!

Dear Sister,
It has taken me long to reply to you,out of job schedule.I am lucky to be a VOF ,When I think of my country I see great potential,I believe we should not take for granted the Constitution,it is our pride and weapon for justice.I hope there is light at the end of the tunnel for the people of Zimbabwe.
Love

Lucia Buyanza
Reproductive Health

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