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Mothers’ pain of labouring in vain

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By Alick Ponje:

LOST HER BABY AT KOCHE HEALTH CENTRE — Sani

The night his daughter lost her baby just after arriving at Koche Health Centre in Mangochi District, Group Village Head (GVH) Mapata was reminded about how vulnerable his people were.

“She was bleeding and she also almost lost her life. The time she reached the health centre, about 27 kilometres away, she had lost a lot of blood,” GVH Mapata, in Traditional Authority Mponda, recalls.

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Such deaths and near-death experiences are not strange in the seven villages that he oversees.

Several pregnant women labour in vain as long distances to health facilities force them to either deliver on their way to the facilities where they lose their babies by virtue of lack of professional care or to arrive at hospitals with complications which end their babies’ lives.

They seldom comply with the requirement that they should spend the last days of their pregnancies in the maternity wings.

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“Most of them are poor such that it becomes difficult for them to divide the little food and money that they have and leave some behind while taking the rest to the hospital,” GVH Mapata explains.

At his house, a stretcher that used to conveniently take pregnant women to Koche Health Centre lies, almost abandoned.

The wheels and other parts which got it onto the road are worn out, pushing locals in this part of Mangochi to bicycle or motorcycle taxis which are mostly not available at night.

“In the case of my daughter, my son hired a motorcycle but it was still too late because of the long distance to the hospital. Many more women labour in vain,” GVH Mapata narrates.

With only a village clinic in his area, that serves under-five children on Tuesdays and Thursdays while also providing antenatal services once every month, optimal health care for his people is a far cry.

They rely on Koche Health Centre, situated 27 kilometres away, or Mangochi District Hospital, about 43 kilometres away, accessed using a rugged road—with small shrubs growing in the interstices of side rocks—which often leaves them sicker than when they started off.

That is the experience GVH Mapata’s daughter, Alice Sani, 35, had when she lost her baby.

“I faced a lot of problems. I fainted on my way to the hospital and could not regain consciousness until I reached the hospital where I lost my baby,” she says.

DILIGENT — Mwale (right) assisting under-five children

Her prayer is a communal one. It is what many other women in her location have been quietly saying with the hope that one day, joyless labour moments would be over.

Sitting on a windblown veranda of her grass-thatched house, her frail eyes staring in nothingness, Sani dredges up the pain that she encountered during her previous pregnancy.

“Well, I was lucky to survive; some women have lost both their babies and their lives due to failure to access health care services in time. At least, if we had a medical worker nearby, even without a big hospital, things would be better,” she says.

The tragedy that befell her is common in her community where family planning methods are not easily accessible to most women.

Idah Yasin of Mapata Village painfully recalls how her daughter lost her baby on their way to Koche Health Centre, 27 kilometres away, after delivering in the absence of professional health workers and an atmosphere fit for a new baby.

It was night time. The tensed-up moment of her daughter failing to hold a little longer ended in her baby dying just after being born.

“My daughter was picked up on a bicycle but, maybe because of bumps, she could not hold any longer. In fact, after delivering, she also got very sick such that we had to continue to the hospital while those who were escorting us returned home with the dead body,” Yasin says.

And fate has still been unkind to her family.

Last month, her sister had a similar experience. As her labour days approached, she started bleeding before she was taken to hospital where, after going under the knife, she lost her baby.

The long distance to the health facility, coupled with the absence of a health worker in the area of GVH Mapata, meant Yasin’s sister could not be cared for in time.

They are common occurrences in this part of Mangochi with the village clinic whose sole Health Surveillance Assistant (HSA) lives several kilometres away and works only two days a week.

His scope of work is also limited to a few groups of people.

Yet the National Community Health Strategy (NCHS) which is currently being implemented in Malawi states that the government is committed to improving health and livelihoods through community health— the provision of basic health services in rural and urban locations.

Billed as an ambitious framework for optimal health care, regardless of one’s socio-economic status or geographical location, the strategy recognises that community health contributes to improvement of health outcomes.

“However, the community health system faces resource constraints and inconsistencies around quality of service which negatively affect health outcomes,” part of an introduction to the strategy concedes.

And in the area of GVH Mapata, the absence of integrated community health services which are affordable and accessible to every household means more lives continue to be at risk.

People here feel marginalised by a system which is not ensuring sufficient and equitable distribution of well-trained community health workers to serve them.

“I pray for a day my people will no longer be dying because there is no hospital or health worker nearby to take care of them when they fall sick,” GVH Mapata says.

NARRATING TO THE AUTHOR HER DAUGHTER’S MISFORTUNE — Yasin (right)

With a shortage of at least 7,000 community health workers and those in the system unevenly distributed across the country, many more people in rural locations continue to be marginalised.

In fact, most of the health workers are largely left to use their own resources in the provision of services aimed at improving the health of people in communities where they operate.

“For instance, I use my own money, around K8,000, to travel to and from Mangochi District Hospital to get drugs which I use at the outreach clinic,” Steve Mwale, a HSA responsible for Mapata Village Clinic, complains.

His resolve to assist those who seek his services is, however, not relenting.

At the small facility, comprising one structure with an open hall and a small consultation, prescription and treatment room, the screams of children—some trapped on their mothers’ backs, others in their bosoms—fortify Mwale’s tenacity even when his body is failing him.

“Some of these people come from very far away, up to 10 kilometres away, so I can’t send them back even when I’m tired. So, I sometimes work up to 8 p.m.,” he says.

The workload weighs down on his shoulders but it does not outweigh his passion for assisting the sick, the vulnerable whose only hope, where he operates, is him.

“If I abandon them, who will support them? I am all they have here,” Mwale says with a trace of optimistic fulfilment in his tone.

More of such workers are what Malawians need, says GVH Mapata.

They are at the centre of meeting targets in NCHS which seeks that, by 2022, Malawi should decrease under-five mortality rate by 25 percent, from 64 to 48 per 1,000 live births, and maternal mortality rate by 20 percent, from 439 to 350 per 100,000 live births.

And, as World Health Organisation Director- General, Tedros Adhanom Ghebreyesus, states, harnessing the potential of community health workers means improving their working and living conditions.

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