Life is Strange:
"Shoes we wear are sold in Air conditioned rooms, Vegetables we eat are sold on dirty footpaths, and a pizza reaches faster than Ambulance"
CHALLENGES AND OPPORTUNITIES IN MATERNAL HEALTH CARE
Improve maternal health is often referred to as the heart of the Millennium Development Goals because if it fails, others fail too. The functionality of the Health sector of any country will determine its rate of maternal mortality, but in a situation where unregistered, toothless, dirty nailed septuagenarian holds a rust blade, standing over a dying woman in labor on the floor while another old woman is illuminating the room with a lantern or candlelight definitely this cannot be compared to a highly skilled nurse supported by a well trained doctor with functioning equipment, constant power supply in a conducive environment. That is why the risk of dying in Africa is 1 in 22 and 1 in 7,300 in first world countries.
Nigeria is just 2% of World population but has 10% of world’s maternal morbidity rate; in actual fact an estimated 59,000 Nigerian women die yearly from pregnancy or child delivery related complications also known as "obstetrical death." there are different causes of this death, amongst which are; patronizing unskilled midwives, underage marriage, complication during pregnancy etc.
If there is access to excellent care before, during, after childbirth, if there is access to ambulance in case of emergency after delivery, if the poor have access to professional care just as the rich in my country, then Nigerians will say here we come in 2015. Majority of women in rural and urban areas patronize Traditional Birth Attendants (TBA) mostly uneducated, no surgical equipment, (widely circulated in June, 2009 that an unskilled midwife cut an umbilical cord with her teeth when women were fleeing the Niger delta region).
TBA is affordable, charges less than one third of government’s owned hospital; others believe they will be protected from evil. Fundamentally, illiteracy, poverty, taboos, ignorance and inadequate medical facilities are some of the reasons proffered by these women.
Every traditional Birth Attendant will proudly declare that he/she has never recorded any death but Mrs. Olaniyi Shakiru said that “stillbirths are strapped to the back of an older woman, cover with new shawl, no weeping or wrapped in a basket and pack some loads on it, add maternal mortality from TBA’s”. Visiting some of the Traditional Birth Attendants gave clearer picture of woman’s predicaments and uninformed decisions of advocates of traditional Birth Attendants.
Mama Agbebi, as she is popularly called is an elderly woman, highly respected and popular among the women in Satellite Town area of Lagos state but uneducated and unregistered. The street is generally dirty coupled with the blocked drainage system filled with garbage; the gutter is green and filled with all sorts of dirt. The house is a bungalow; it is the usual face to face rooms in Lagos.
Two clients came in within minutes, the general greetings shows that there was an appointment stipulated for that hour, the old woman brought out a sack behind the door, the first client, laid on her back, brought a jar of yellow oil, poured some on her palm and rubbed it on her stomach, she screamed sharply, she dug three fingers into her navel and the woman screamed again, “you have a small fibroid but it cannot affect child delivery” declared the woman, she placed the back of her palm on the stomach and repeated again by placing the palm on the stomach, she rubbed the yellow oil on her ankle.
The same was repeated on the second client but after inspection, “you have nack nack that is why a worm has coiled around your navel, can you hear the sound?” There was a strange silence and the client affirmed that she could hear the sound. The next appointment is in three days time when they will come for their concoction, according to her it is five liters and they were told to come along with a certain amount of money.
The old woman confessed that there was no formal or informal training but her art of child delivery was learnt in her dream. There was no registration, she had never been privileged to touch a stethoscope and did not know the implication of any sickness on a pregnant woman,; she has concoction for every ailment, no measurement, “here a woman drinks what her stomach can contain”
The delivery room is the floor, “the concoction that shrinks placenta and grants babies thorough passage is “easy birth” and surprisingly, there are clients from all over Lagos but no register. She uses herbs to arrest hemorrhage, for threatening abortion there is a special local chalk a woman must rub on her back and lower part of abdomen immediately the pregnancy reaches the seventh month; another type is a local egg specially tied and hung on the wall; it must not touch the ground until the day of delivery. It works, she affirmed.
Although, it may be funny, there are several traditional Birth attendants’ methods of stopping hemorrhage during delivery, one of which is pouring robin blue powder on the vagina or mixing raw pap for the woman to swallow with high speed, the efficacy of which several women attested to, though those who died in the course are labeled as witches or the will of God has prevailed, He gaveth and He taketh.
Mrs. Olaniyi Shakiru regretted attending TBA in Baba Aiye’s Palm Avenue delivery home in Lagos,, She registered and attended ante natal; she performed “the mandatory ritual of three nights sleep and bath” when her pregnancy was exactly eight months and two weeks (this is called easy bath, a bit different from easy birth by the reason of tribe)
At exactly one midnight, she was awaken to have the bath, rubbed with palm oil from hair to toe and given three balls of black soaps with stern warning from baba, ”there must not be any leftover”. On her way home the third day, she fell into sudden labor, bleeding profusely and was rushed back to Baba Aiye, he instructed the good Samaritans to take her to the Lagos state general hospital because he has no drug for the arrest of hemorrhage It is a well known fact that the General hospital in Lagos will not attend to any woman in labor without regular ante-natal visit. She was saved by a young doctor who separated her from the dead fetus.
In the same vein, Mrs. Atinuke narrated her ordeal with Baba Agbomola in Mushin Area of Lagos, registered and attended antenatal, but she was scared of the only midwife who is above eighty years, (toothless with very dirty nails) because of rust blade.. His concoction contained worms which you are allowed to remove before drinking but those who can freely drank the worm too. The last stage of the antenatal is the egg eating phase, to be washed down the throat with a slippery, greenish mixture. The day came with trembling, the old man said that she either eat and drink the concoction or leave. After three attempts, she was able to swallow the egg, she wasted two, all clients’ must drink from Baba’s cup.
Fortunately her labor came in the midnight and was rushed to a private clinic where she was delivered of the baby by a medical doctor,;the story did not end there because the baby suffered attacks at night and was taking to the herbalist who chastised the mother for not delivering the baby in his dirty room and ordered Mrs. Atinuke to pay the delivery charges. He made some incision (with the rust blade) in the baby’s chin and the attack stopped. “It is our belief” concluded Mrs. Atinuke.
Also, Mrs Adepoju Eniola, a graduate of Economics who shared her close encounter with a Traditional Birth Attendant, said that her mother in law advised her to register with baba elewe omo in Ogba Area of Lagos because of the mandatory blood donation during antenatal visit in Lagos state general hospital.
She was discouraged by the stench at the delivery home when they got there; she had to beg her husband to donate his blood in order to be registered at the General hospital. According to her “it is blood donation that scares women from the state general hospital”. She concluded that if nothing is done to address maternal death, then bringing up a girl will be like watering the plant in your neighbor’s garden” this time around with blood”.
In Ondo state, Mrs. Adejuwon Jumoke confirmed that some TBA administers "ergomentrine injection in upper parts of the buttock which results in abscess formation while majority of them cannot arrest hemorrhage”. She continued “in most cases, some of them will recite incantation when there is abnormal presentation of the incoming fetus but imagine one Federal Medical Centre in a state is insufficient, the only one is in Owo, just one specialist hospital is in Akure, and each Local government has one general hospital and a comprehensive health centre for a population of 4,475,316 (1997)”.
According to Adejuwon, most TBA are adamant, we have to train severally on the usage of gloves, which training will change an herbalist to a midwife, incantation to surgical instrument, concoction to drugs? There is always a good side to every alternative, Mrs Ojo confessed that she used the traditional birth attendants and she will never desist, citing her own example, “I usually have postdated pregnancies, medical doctors are impatient with clients, they will perform operation without waiting longer than EDD, TBA is always patient and he understands my body system” .
Is there any record of traditional birth attendants in Africa? What are their limitations? What are the compositions of the concoction administered to these women? What is National Agency for Food and Drug Administration and Control (NAFDAC) doing about the registration of these mixtures? When will the government demand to know the content of those medications in five litre kegs? Are records of death and birth not necessary? Should poverty be the sole reason for burying seventeen women daily in Nigeria?
According to World Health Organization’s approximation, 500,000 women die annually from complications resulting from pregnancy, 99% of these deaths occur in developing countries. UNFPA (United Nation Population Fund) and the World Bank say in Nigeria alone, up to 59 000 women may have died nationwide in cases related to maternity. One of out every 18 deliveries carries the risk of death and an enormous 1,100 deaths were estimated from 100 000 live births.
This is a continental problem therefore a general solution will be appropriate. Traditional Birth attendants patronized by these women are incapable of handling complications though very affordable while poverty and poor transportation keep pregnant women with TBAs in their communities.
It is alarming in Togo, where maternal mortality is 500/100,000; this is a country where the weight of maternal morbidity is heavy on the Togolese economy, because 57% of agricultural work is done by women, and children depend totally on their mothers in this region.
World focuses on the number of deaths recorded but nobody is actually talking about those suffering from afterbirth complexity, disabilities that result from prolonged labor, a woman showed the difference between the height of her two legs, the right leg became four inches shorter after the delivery of her last child, there was no apology or reason proffered.
It must be borne in mind that for every maternal death there are many more women in whom, after childbirth, disabilities develop that impair their general health and reproductive functions with possible reduction in their economic activity. For example it has been estimated that in sub-Saharan Africa for every maternal death, another 15 women are disabled or permanently crippled. Between two and three million African women are left handicapped from obstetric complications each year. Additionally, some women who survive delivery become chronically ill and eventually die from post natal complications e.g. post partum hemorrhage, dementia. etc
CALL FOR NEW REPORT
The gloomy figure is so disheartening that the First lady rejected the report at the launch of 2009 State of the World Children’s Report in Abuja, Nigeria, the first lady disputed the data on maternal mortality on the ground that she did not see corpses in the few hospitals she visited during her pet project.
Although some obstetricians say the maternal mortality rate in Nigeria is scary, and it will be the best interest of Nigerian women that the first lady who incidentally is a woman, mother and grandmother should come out with accurate statistics and way forward. According to the first lady, Federal republic of Nigeria the government recognizes the high rate of maternal and infants mortality deaths and has come up with new strategies to address it. And went further to say that "Come out with new reports, we do not want those reports again. I hope the minister of health will conduct a new research."
Ignorance cannot be accepted as an excuse; whosoever challenges any report must first be armed with her correct statistics. Nigeria should first come up with the statistics of untrained midwives, train and register them, and then we can address the issue of the living.
The Federal Government of Nigeria allocates (N103billion), equivalent of 5% of the federal budget to the health sector, if 50% of this meager allocation is judiciously utilized, we will not be counting our dead but jubilating. The urban centers do not have access to good medical facilities that is why the rural areas make do with what they have. Visit to five local communities in riverside area of Lagos, Ilado, Ibeshe, Ibasa, Imore, Ikaare, Irede, Ilaje and Igbojegun communities leaves a sour taste in the mouth -- there is an isolated government health centre with two nurses, under equipped and in competition with a big, expensive private hospital.
In order to reduce maternal mortality rate, the construction of 100-bed maternal and child health care centers in five local government areas – Ifako-Ijaiye, Ikorodu, Surulere, Ajegunle and Shomolu has commenced in Lagos state.
Amazingly, what the Nigerian government thought was impossible was performed by Ms. Stella Iwuagwu of Centre for the Right to Health. She brought “Health on Wheel” to the rural areas where no one believes doctors will reach. If a Non Governmental Organization can, then the government has no excuse for not establishing current medical infrastructures in rural communities. And with empowered women working for Nigerian women and children, reduction in maternal morbidity is certain.
Mrs. Adejuwon stated that “there is no training good enough to change a TBA into a licensed midwife but stakeholders should wake up to righteous work, commence developmental project in hospitals and create awareness, staff the facilities with adequate staff and drugs bonus and allowances for job retention and satisfaction; we stopped Female Genital Mutilation, we can again”
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