“We have a nation where giving birth is like a death sentence”; “no woman should die while giving birth”. “Malawi is performing poorly on maternal health issues”. These are some but a few statements that our leaders have been making to describe the maternal health standards and their political will to reduce maternal deaths.
When all is said and done, we still need to ask ourselves what we have achieved as a nation in the fight for safe motherhood. Words itself are not enough but rather action. We need more action and less talk if we are to make progress in this fight.
In the year 2011, a case was told of a woman Abiti John aged 15 years old who was 9 months pregnant with the first pregnancy. Abiti John was staying in the remote area of Malawi where the nearest health post was 10km. The health post had no any health worker after the only medical assistant who was posted to the site had just run away the past three months (without any explanation) and was reported working at a mission hospital near the Boma area. The other health centre was 15 km away.
There was some outreach antenatal clinics that was happening weekly but was suspended because the road was impassable for their ambulance due to the heavy rains affecting the area and Abiti John had stayed 3 months without attending antenatal clinic.
Then Abiti John started developing leg swelling and was turning pale. Her grand mother noticed the changes and took her to a nearest herbalist who offered some traditional medicine for Abiti John to drink. During the last outreach clinic, Abiti John was advised to go to the district hospital at 8 months and wait for delivery but failed because the granny was reluctant.
The granny was reluctant to go and wait at the hospital because she had once stayed at the hospital with Abiti John’s elder sister under unbearable environment.
The granny remembered how congested the hospital was. The district hospital had no guardian shelters and they used to sleep outside the hospital and in the hospital corridors as well. During rainy season the waiting mothers were forced to sleep in a very congested room whereby three to four women were sharing beds, if that is not enough, the granny also remembered how the midwife (the same age as her grand daughter) used to shout insults at her and her daughter.
Abiti John developed a bad headache and persistent lower abdominal pains. The swelling of the legs was progressing to the abdomen and she was also developing facial swelling. When the granny noticed the body swelling and the abdominal pains she took Abiti John to the nearest traditional birth attendant. Three days passed without giving birth and the headache worsened.
She later developed fever and started fitting. The traditional birth attendant with the help of some village men organized a bicycle to carry the patient to a health centre that was 15 km away. Abiti John kept convulsing on the way and was getting weaker and weaker.
Upon reaching the health centre, the nurse midwife had an impression of severe malaria and eclampsia. The blood pressure and temperature was very high and Abiti john was unconscious. The midwife thought of referring the patient to the district hospital but she was told the district hospital ambulance had no fuel due to the fuel shortage that the nation was experiencing at the time. The guardians were told to look for transport and after six hours later, they managed to hire a car and a higher fee and arrived at the district hospital four hours later.
On arrival at the hospital, Abiti John was found with malaria +++ and also with eclampsia and was still having repeated fits. There was no quinine at the hospital to treat her and no any anticonvulsant. An emergency caesarean section was ordered and the guardians were advised to go and buy at a nearest pharmacy while he patient was being taken to theatre. While in theatre electricity went off and the hospital generator had no fuel to supply power. Abiti John developed cardiac failure and died on theatre table.
Why did Abiti John die?
This is just one of the cases that happen in our setting that needs a practical effort and timely interventions. This calls for combined effort from all the sectors of our society. The fight for maternal deaths and safe motherhood requires that every citizen plays apart in this fight.
For a nation that clocks 50 years of independence in 2014, a nation which boast of being a warm heart of Africa, it is imperative and demeaning to still be registering high numbers of maternal deaths.
It is said Malawi has the worst maternal mortality rate of any non conflict country in the world with other statistics in 2010 showing that 16 women die daily from child birth and pregnancy-related complications.
At the same time we also need to prevent and avoid birth complications that our mothers continue to face while giving births. The erratic drug and fuel supplies, the poor infrastructures, the attitudes by some health workers as well as lack of political will from our leaders are some of the factors that can be drawn as the cause for maternal deaths that we continue to face at high numbers.
This drive for maternal health requires political effort by those in power and the governing team. This fight must be a relay race where each new government must continue the efforts and mechanisms put in place by previous government in reducing maternal deaths. There is need to develop long term national reproductive health policies that will help the nation to attain meaningful achievements.
The private sector, religious leaders, traditional leaders, citizens and all powers that may be needs to join hands in this fight. We need to ask ourselves why we are still having a very low number of nurses and doctors in our hospital.
Why do we still have areas where sexual and reproductive health services are inaccessible? In this 21st century, do we still need to have mothers delivering using a candle or do we still need to have health workers doing operations in theater using a torch or candle?
………..to be continued…