As a maternal, newborns and children’s health advocate, you once in a while get an opportunity to leave the comfort of Nairobi to go to the field and see firsthand the state of maternal health in the country.
Mwingi was the destination this time round. For starters, Mwingi is a town in the Eastern Province of Kenya approximately 200Km east of Nairobi. Our visit was to two health facilities; Nyaani Dispensary and Kakululo Dispensary where the ‘putting African Mothers, Newborns and Children First’ project is currently implemented by AMREF Health Africa under the European Union funding.
Under this project, AMREF Health Africa provides on-going training and support for Community Health Workers, who are from time to time given guidance on how to encourage behavioural change within communities, to help the local population better understand how to stay healthy. In Nyaani dispensary for example, 50 Community Health Workers have since been trained. The CHW visit the community and refer pregnant women to the dispensary so that they can be attended to by a skilled attendant. I found this very encouraging considering that there is a global shortage of 7.2 million midwives, nurses and doctors, one of the reasons why51 percent of births in Sub-Saharan Africa are not attended to by a midwife or other properly qualified health worker.
Mwingi is one of the counties in Kenya where many women still deliver at home and without the assistance of trained birth attendants despite the fact that trained birth attendants at delivery are important for preventing both maternal and newborn deaths. According to Sister Damaris Wanjiru the only midwife who also couples as the community nurse of Nyaani Dispensary, there were only 4 deliveries in the month of June a way too small a number compared to the number of children brought to the facility for immunization and other services!
‘Pregnant women come for antenatal but they suddenly disappear only to reappear next time with babies. When you inquire further why they did not come to deliver at the dispensary they simply tell you the distance from their home to the dispensary is too long and they feared they could deliver on the road’ said Sister Damaris
Sister Damaris agrees that poor road infrastructure and the distance to the dispensary is a major reason for many women still preferring to give birth with the help of a traditional birth attendant. Nyaani is in the remotest, poorest and isolated place approximately 100km from Mwingi town and of the 100km, only 30km is tarmac the rest is rough road.
Here, an obstetrician, basic means of transport and water are considered a great luxury. Women here, whether expectant or not do a lot of manual work like herding and walking over 10km everyday to fetch water. The lucky ones at least have donkeys to carry the water and the not so lucky ones carry the water on their backs.
Poor families often cannot afford the cost of transport to health facilities and walking, even during labour remains the primary mode of transportation for women and this severely limits their ability to reach the needed care during laboring and birthing.
In the event that the midwife detects complications early she refers the women to Mwingi district hospital which has better facilities and more staff. In other cases, women wait until they are unable to deliver on their own due to complications before rushing to the dispensary. Getting an ambulance becomes a hustle due to network problem. Even when she finally gets the much needed ambulance, it takes up to 4 hours for the woman to reach the district hospital as the road is rough, and the ambulance has to cross river beds and difficult paths that are impassable during rainy seasons.
Majority of maternal and newborn deaths result from a combination of biological, medical and social factors which are inextricably linked and with less than 6 months to 2015 the year in which countries should have reduced maternal deaths by 75 percent, I strongly believe that improved transport and roads for poor, rural and isolated communities coupled with interventions supported by organizations such AMREF Health Africa, will greatly contribute to reducing maternal and child mortality rates in Kenya.