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Horror in the labour ward

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Khumbize Kandodo Chiponda

Alice still gets tearful when she recalls the pain she endured when she went to deliver her third child at Bwaila Hospital in Lilongwe in November last year.

She had to endure episiotomy without anesthesia as the hospital had no supplies.

Episiotomy is a cut or an incision through the area between the vaginal opening and the anus. The procedure is done to make one’s vaginal opening larger for childbirth.

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“I was told that the baby was big and the medics had to conduct episiotomy. The doctors told me that it would be painful as there was no anesthesia.

“Since I was already enduring labour pains, I told them to proceed with the process but what happened later was regrettable. I have never experienced such pain in my life. I literally felt a sharp knife slitting through my genitals,” Alice says.

Maggie endured the double pain in the labour ward when she suffered a vaginal tear.

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Also known as perineal lacerations, the vaginal tear occurs when the baby’s head is coming through the vaginal opening and is either too large for the vagina to stretch around or the head is a normal size but the birth canal vagina does not stretch easily.

She says she felt the full pain of the tear as medics had no anesthesia.

“I can’t explain the pain I felt. It was dreadful,” she said.

Alice and Maggie are just but a few examples of the agony that Malawian mothers continue to face in the labour ward when giving birth due to the shortage of essential drugs used during surgical operations.

Nurses and Midwives Council of Malawi (Nonm) and Association of Malawian Midwives (Amami) officials admitted, in a statement released last week, that there was an acute shortage of Lignocaine, a nerve-blocking anesthetic agent.

Nonm and Amami said other essential drugs in short supply included Gentamycin, Diclofenac injection, Ephedrine, Tetracycline Eye Ointment, Vitamin K, Vitamin A Intravenous Hydralazine, Iodine, Cidex and Chlorhexidine.

“Women in labour are being sutured under mayomayo without the necessary anesthetic drugs. Surgical procedures are being delayed or postponed due to lack of blood and other essential live saving products,” the statement reads.

Nonm President Shouts Semeza says nurses and midwives equally feel the pain when inflicting pain on mothers while fully aware that the pain could have been avoidable.

“What we are talking about here is that minus Lignocaine, it means every woman in labour, and whose baby is bigger than the birth canal, will have to go under mayomayo circumstances because we want to save the baby. We want to save the woman.

“What we do is to save the woman and the baby; we cut the birth canal without infusing Lignocaine anesthesia; so, it is under mayomayo. The woman is already in pain and, then, we are cutting the flesh, giving a wound to her. And, after birth, we have to repair the cut and we are repairing without the anesthesia. It is painful,” Simeza said.

Human Rights Defenders Coalition Women Chapter Chairperson Beatrice Mateyu describes the agony Malawian mothers are facing in labour wards as unacceptable.

“You know these women are already in pain due to labour. Subjecting them to more pain by helping them deliver without the essential drugs is the worst form of human rights violation,” Mateyu said.

But how did Malawi find itself in this unfortunate situation?

Amami President Keith Lipato says the situation has reached this stage because of a combination of both low funding and logistical challenges.

“We learnt from the Ministry of Health that due to Covid, there have been challenges with shipment of essential medicines, including Lignocaine.

“There were also funding challenges to the Central Medical Stores Trust (CMST),” Lipato said.

White Ribbon Alliance Executive Director Hester Mkwinda Nyasulu described the situation as totally unacceptable.

“We call on Government to address this issue as a matter of urgency. In Malawi, we are already struggling with high maternal deaths, most of which are preventable.

“The situation now will reverse all the efforts that have seen our maternal mortality ratio reducing,” Nyasulu said.

Sustainable Development Goal Number 3 seeks to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Currently, Malawi’s maternal mortality remains elevated at 439 deaths per 100,000 live births.

The goal also seeks to end preventable deaths of newborns and children under five years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-five mortality to at least as low as 25 per 1,000 live births by 2030.

Health Committee of Parliament Chairperson Mathews Ngwale said his committee was aware of the critical shortage of essential drugs in district hospitals and its implications on the lives of Malawians.

“We will be pressing the government at the next budget to increase the drug budget as well as the health budget. According to the Abuja Declaration, which Malawi signed, each signatory nation is supposed to allocate at least 15 percent of the national budget to healthcare.

“Malawi has never met this obligation. We have so far allocated 9.4 percent to health in the 2021-22 National Budget. My hope is that, in the next budget, the government will allocate more resources especially after the drug shortages experienced this year,” Ngwale.

But Minister of Health Khumbize Kandodo Chiponda on Monday said the government has procured 60 percent of essential medical drugs, including anaesthetics.

According to Kandodo Chiponda, the Treasury released K12.5 billion to CMST for the procurement of essential drugs and the remaining drugs will arrive in the next four weeks.

“We had serious problems, especially between November and December, because of drug procurement issues due to the Covid situation, especially in India, where we get most of the drugs. We could not get them on time.

“We received four containers [of drugs and suppliers] last week and all the drugs have been distributed to our regional central medical stores so that they can be distributed to hospitals,” Chiponda said.

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