Thursday, November 8, 2012

Negotiating the cost of giving life Joyce Banda's way

Felicia Yohane has sired four babies in her life, two of those did not live to celebrate their first birthday, two are living and now that she is 7 months pregnant, she is very aware of what can happen to her expected baby.

Felicia lives in one of the 197 villages that look to Lumbadzi Health Centre for assistance, she has to walk a long distance of about 2 hours to come to the health centre. And she is not alone; the hospital sees 160 maternity deliveries per month, 10 waiting cases per day and hoards of pregnant women coming for neo-natal care, that is the attention given soon before delivery.

Felicia’s pillar, Lumbadzi hospital however has only thirteen beds in the small maternity wing that has no waiting area, the 13 beds therefore service those that have delivered and those about to. It’s a case of hard rock and place because the next nearest health centre is 15 Kilometres away from Lumbadzi.

Felicia in a one on one with a nurse
The situation at Lumbadzi is just the summit that is visible; the real mountain spans across Malawi, almost all health centres in the country face what Lumbadzi health centre faces.

Out of every 100,000 women that give births in Malawi about 700 of them die in the process, this is high by all means, in Estonia out of the 100,00 only two women are expected to succumb.

Felicia’s deceased little ones are also part of a bigger nationwide problem, 80 babies die out of every 1000 before they complete their fifth year. She lost her babies at four and nine months and the worry for her next baby is written all over her baby face. 

Since Joyce Banda assumed real power after the death of Mutharika in April this year she instantly leapt to highlight the plight of the mothers and infants. If Bingu sang food security and green belt, Banda’s song is from the safe motherhood studio.

She set up her Presidential Initiative on Maternal Health Safe Motherhood. Though difficult to separate it from the politics that accompany its activities, the initiative is breathing in new life into the fight against preventable deaths of women and children around the pregnancy and birth period.

Misozi Jimusole is the Initiative’s media and advocacy officer. I asked him why women need to be given priority.

“Women make 52 percent of our population; they contribute the most to the country’s output its only fair that they should be safe guarded. In safeguarding women, we will also be advancing towards Millennium Development Goal number five.

“The role of women cannot be overemphasised, in any country excluding women from development means that nation cannot develop, including women and having a healthy involved female population means more development,” said Jimusole.

Felicia braves the October heat to travel to the hospital, she knows what dangers come with shying away from hospital; the rest are not that informed.

Jimusole said some women discouraged by distance, cultural beliefs and illiteracy go turn to traditional birth attendants who have little real knowledge about pregnancy complications and motherhood best practices, and he says this exposes mothers to all kinds of risks including death.

While 71 in every hundred women go to the hospital, about 29 seek the attention from traditional birth attendants, who obviously cannot perform a caesarean section and will be quick to point to witchcraft for simple complication.

Children born in the hands of traditional birth attendants are also likely to miss out on vital immunisation given to the baby in the early days of its birth, if the mother looses too much blood during the birth process there is little the attendants can do apart from watch the new mother die. 

But with only thirteen beds there to accommodate 160 women all in a month, it might not be culture or illiteracy that might be  forcing women to go deliver at home and this is what Banda’s Initiative is aiming to tackle.

“The Initiative wants to construct maternity waiting shelters to ensure close monitoring of pregnant mothers and encouragement to seek quality maternal care at public health facilities to avoid complications arising from giving birth at homes,” said Jimusole

And its not just talk.

It is also seeking to replicate its Mulanje feats in Dowa, Balaka, Karonga, Mchinji and Lilongwe and in Ntcheu. Lumbadzi will also get a shelter and funds are reported to have already been secured.

In the drive to attain an almost zero maternal mortality rate, infrastructure is on one hand, the other hand includes human resource, if all the women can decide to come deliver in the hospitals are there enough trained minders? 

At our case study health centre at Lumbadzi there are 13 qualified nurses to mind not just the maternity wing but the whole hospital such that the 160 or so pregnant women have to see the same people that people with Malaria have to see.

President Banda’s other goal in the initiative is to try and beef up the numbers of these minders. In a slow but significant move, she has already identified 200 young women, 10 from several districts have been identified to start midwifery training.

The project aims at increasing numbers of skilled and trained midwives. Maternal and neonatal rates are still high not only due to lack of sufficient health personnel but also untrained traditional birth attendants. 

“We also want to build capacity of community midwives to promote health seeking behaviour and attitudes of the communities towards family planning, reduced pregnancy, delivery complications and encourage girl child education,” said Jimusole.

Again, having trained personnel and building is never a guarantee that the village folks will flock to get expert care. In Malawi missionaries came with life saving drugs but the population took years to accept modern medicine, some still have not.

Jimusole said the third goal of the initiative is just that, trying to win over communities and to do that chiefs must be target. 

“In order to achieve the effective access to maternal and neonatal health care, Community mobilization and training to the chiefs and their subjects is of paramount importance. There is lack of knowledge on how to handle maternal and neonatal health care so chiefs as opinion leaders are good targets in accelerating behaviour change.

Felicia mounts the scale to check her pregnancy progress
“The chiefs promote cultural habits that influence health seeking behavior and attitudes of the communities towards family planning, pregnancy and delivery, preserve women dignity by stopping defilement, and other forms of violence that make women insecure and unstable in their lives,” said Jimusole.

One of the chiefs who is well won over to the side of progress in Inkosi Kwataine, he says his area of jurisdiction is on its way towards decreasing mother and infant deaths by employing a simple trick which he is now campaigning for.

“Local documentation of pregnancies will erase many problems. Chiefs will be cable to track the progress of the pregnancy and ask if the mother-to-be has gotten a vaccine, where she plans to go for delivery and to push her to go to the hospital when her time is near,” said Kwataine.

Hebeli Honde was also at Lumbadzi Health Centre when Nation on Sunday visited, she hails from kwa Chiponde and is only 18. She has never given birth before, she will do so in 3 months all factors constant.
Jimusole: Aiming for MDG number 5
“I cannot go trust azamba (traditional birth attendant), it’s my first time and I want all the attention, I will come wait here when I am in my advanced stage,” said Honde.

Joyce Banda knew that with her influence business people would be ashamed to ignore her initiative, already big companies have donated to the Initiative. And so far that is what is funding the Initiative.

Naturally big businesses cannot spend on causes without brands and the Joyce Banda trick is working, mothers have hope...the only question is how long will it take and what happens when Joyce Banda leaves power?
Honde sits among her mates possibly sharing stories of what labour feels like, it easy to see fear in her eyes. Her fears can easily be reality if no one springs to action to help address the current situation.

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