Any woman who has been pregnant knows too well that those nine months are trying: Things you once loved to do or thing you once loved to eat are suddenly forbidden. Your life is suddenly a roller coaster, and everything can feel like it is changing, chameleon-like.
In my country of Kenya, a pregnant woman and her womb have great respect placed upon them. In public places, men and women spring from their seats to allow a pregnant woman to rest. ‘Mama, Keti hapa,” they say. “Have a seat, Mum!”
Growing up, I was fascinated with pregnant bellies and thought pregnancy was sacred. In my childish mind I wondered how these women felt: Was this Baby Jesus (that’s how adults described the unborn to me) heavy? Did he cry for milk? And as a woman’s tummy grew—what a wonder!
Now, it is clear to me that women face great challenges to give birth. In my community, the care, concern, and respect a woman experiences during pregnancy does not exist when it comes to labor and delivery.
There I was, some years ago, serving as Nurse Supervisor in a labor ward of a public hospital. With a capacity of 200 beds, we had plenty of patients and adequate equipment to save a mother and her baby. But being a public hospital, the number of patients would sometimes surpass capacity.
It was a busy night that promised only to get busier. As I hung up one phone, another would ring.
“I need an anesthetist fast, sister!” “Matron, there is a child in respiratory distress!” “We need an ambulance!”
Toward 11pm my energy was draining and pressure was mounting. A mother had been referred from another a city. She presented with complications of reduced fetal activity and breech presentation and required an emergency caesarean section. I called for the doctor to immediately attend to this woman, as it was important that we move hastily.
Moments later, the mother-to-be was in acute labor pains, kicking her hands high up and screaming. “God! Oh Lord!” she wailed. “Save me, save my baby!”
There were only two midwives on duty. There were seven women in early labor, three in active labor, and one waiting in the operating theater for the very doctor we needed. It was utter chaos. My patient was losing strength, and we could only wait and watch her torment.
I summoned the courage to examine her and found the infant’s foot confirming that she was breeching. I’d have to go skillfully around the foot to loosen it with an incoming contraction. I was able to draw the legs out and to free the forehead of the baby out of the birth canal. The hardest part of the delivery was over and we breathed sighs of relief.
Yet, the baby never cried! I felt butterflies in my stomach, and a thin streak of sweat on my forehead confirmed my worst fears. The mother raised her head. With a weak voice and tears flowing from her eyes she asked, “Is my baby dead?”
I couldn’t answer. The doctor had arrived and was attempting to resuscitate the newborn, but it was futile. The baby was lost.
And all this due to delayed access to the facility.
A second death that night dealt a hard blow. A fellow nurse lost consciousness following a delivery that was too much for her to handle. She was taken to the intensive care unit, but never woke up from the deep sleep. It was the last time I saw my colleague, a nurse and a diligent young mother with many dreams for her life. In this case, our healthcare system had provided life for one newborn but brought death for another mother. [paging]
The Healthcare System in Kenya
Looking at the trials of these two women sheds light on the disparities of maternal healthcare services in Kenya. For the last fifty years the government has been attempting to respond to these concerns.
There have been positive changes as well as pitfalls: In the 1960s, the government provided free health care for all. As the population grew in the 1980s, there was a need for primary health care to focus on family planning, health education, and promotion. In the 1990s, the population continued to grow and rural facilities sprung up across the country. With this expansion came the introduction of a user fee paid by individual clients of public hospitals. User fees paralyzed primary health care, because it meant the poor could not receive medical care due to lack of resources.
In 2003, the Minister for Health brilliantly dropped the cost of Level 1 and 2 deliveries as low as Ksh 30 (1 USD = Ksh 80). The significantly lowered cost was meant to encourage women to seek labor care in hospitals over traditional birth attendants.
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,” she said. “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?”
In an ideal world, health care would be robust and holistic. In healthy communities, there would be a dispensary headed by a nurse practitioner, with limited equipment. The next level of care would be a health center offering basic, emergency obstetric care. These would be staffed with nurses, clinical assistants, and doctors and would have a laboratory offering simple diagnostics. At the highest level of care, there would be a comprehensive and specialized medical team that offers both curative and preventative treatments.
In reality, healthcare services are largely concentrated in urban areas, which means the majority of Kenyans, including pregnant women, continue to have limited access to proper medical treatment.
The mother who lost her baby that busy night in the hospital lost her child because she had had to endure a long wait to reach a center that could provide the necessary level of care for her condition. Part of the problem is that healthcare professionals are drawn to work at the urban facilities.
The government recognizes the problem and has attempted to provide more nurses, midwives, and clinical officers to non-urban areas through an economic stimulus package; however, the challenge to curb the migration of nurses/midwives to Europe, America, and Australia has been huge.
A schoolmate of mine from nursing school recently explained to me, over Skype, her rationale for leaving Kenya for the US. “As long as there are greener pastures out there to explore, I will go,” she said. “After all, it is about the dollars and good living. I don’t want to die in poverty.”
Hope in the Form of a New Constitution
In comparison to other East African countries, Kenya has made great efforts to compensate and support health workers. Through reforms such as the National Health Policy Framework for 2011-2030 and the New Constitution, the restructuring of the salary and remunerations scheme has awarded health workers a fair deal, even though it is not exhaustive.
During the constitutional referendum, I was—along with a team of nurses and midwives—very involved in the grassroots civic education movement. We urged Kenyans to vote wisely and to remember the Bill of Rights that promised clean water, a quality environment, and the highest attainable standard of health care. This last item was paramount. Without a healthy nation no better agenda could be moved forward.
Gaining the support of the majority and drawing the attention of other African nations to Kenya, these constitutional reforms represent the height of achievement in democracy in the Horn of Africa. The people of Kenya displayed to the world an understanding of how to improve the well being of a nation.
The subject of women’s health is more prominent in the media, where it has reached an unprecedented level of debate and controversy. Two years later, the New Constitution remains a popular topic and the Kenyan government has since ratified many international treaties that address women’s health.
Light at the End of the Tunnel
Both civil society and government are making major strides in addressing the issues with maternal health care. Currently, a consortium of non-governmental organizations is reaching out to women in the most remote areas by providing basic training to the community on how to deliver women safely to hospitals.
Walking across the slums, I meet amazing women who are using tools such as phones and simple charts to explain danger signs that can occur during pregnancy. These positive steps hold the promise of reducing maternal mortality in my community and beyond.
I believe that governments must treat maternal health as they do readying a defense force for war or a nuclear launch. No woman should die while giving life!