Causes of maternal deaths in health centres listed

Rural women, part of the down trodden across Tanzania, are not certain whether once pregnant, they will be able to sail through  turbulent waters until delivery of the new  born  they carry in their wombs.

 

They worry whether they will not   miscarry on the way after only a few months of pregnancy.  And if they  ever  go  through the hurdle, they continue asking themselves whether the delivery will be safe, not only to a newborn but also to themselves.

 

It is not that the  worry  has  no  merit ……,  no it has.  The   anxiety  is in fact brought about by the reality that  dozens of women die everyday, presently 24, from pregnancy and  childhood complications.

 

The women or their newborn mainly die because when labour begins, there are no immediate facilities to ensure safe delivery.  In almost all villages in the country, health centres to cater for Basic Emergency Obstetric and Newborn (BEmONC) practices are  very few.

 

This is partly why, White Ribbon Alliance Tanzania is campaigning for life saving service – BEmONC at health centres in Tanzania and reminding the government to uphold  its commitment made in 2008 -  that 50% of health centres will offer life serving comprehensive emergency and obstetric  and newborn care.

 

White Ribbon Alliance – an independent body with hundreds of members worldwide,  says without midwives, doctors, blood banks, antibiotics  and other drugs – coupled with  functioning operating theatres at health centres, women  will continue to die while Tanzania citizens look on, according to a leaflet provided by  WRATZ.

 

Apparently, there are many causes for death to women and newborn during delivery, among them  obstructed labour.

 

“Obstructed labour happens when a baby cannot pass through birth canal during delivery.  This is common when the baby’s head is stuck on the pelvis canal, a situation brought about  by  narrowness of pelvis or a newborn whose weight is rather big”, says Stella Mpanda, Country Director for Childbirth Survival International (CSI), a Dar es Salaam based NGO.

 

“If  the baby’s head stays at the pelvis canal,  especially at vaginal  path,  the head can cause pressure and friction between the had and the tissue surrounding the canal, hence causing damage to bladder and rectum, ultimately  resulting to fistula,” said Stella, a  dynamic retired nurse/midwife and trainer at the 10th  Anniversary of White Ribbon Alliance (WRTZ) held in Korogwe, Tanga Region.

 

Stella, says the problem can be made worse when a woman with obstructed labour is far from health facility and where transport is poor – like use of motor cycles or three wheeled motor cycles on extremely rough roads.

 

During the 10 day  itinerary  which took a team of a dozen or so  health and medical officials  to four districts, namely Kilindi, Handeni, Korogwe and Tanga, WRATZ heard testimonies from women and men.

 

In a nutshell, the contributors  mentioned   long distance from home (villages) to health centres as prime cause of deaths of mothers and newborns.

 

Some of them said lack of awareness of the need to give birth in a health centre lacked in certain places – especially in remote areas – in communities where the people – both sex – were less educated.

 

“Public awareness needs to be increased – including involvement of male partners in matters related to maternal health,” said Mary Mbwana, a middle aged mother, living at Magunga Cheke in Korogwe District.

Another equally destructive problem mothers encounter, said Mary, is one of male chauvinism where husbands may dictate whether their wives should, or should not  attend clinics.

 

“In cause of time, such men succumb to pressure from their wives and  eventually allow their wives to attend clinic, but then it may be too late”, she told the well attended audience.

 

Another contributor, Selemani Bakari, who said his wife has two children, explained that at times the wives were to be blame for late attendance to clinics. “In my case, whenever I remind my wife to start attending clinic, she tells me to wait until sometime – that it was still early to do so.  She decides, eventually when labour has started”, revealed Selemani  whose sobriety was evidently in doubt.

 

Korogwe district  has, according to Dr Jerry Mwakanyamale, Korogwe District Medial Officer, four health centres within 20 wards.  The centres are  Magoma, Mombo, Korogwe and Bungu which is situated on the hillside of Usambaras.

 

Richard Mwendi, a villager of Kwagunda, testified  to the effect  that though the district council had two ambulances, they mostly arrived late whenever alerted of a serious health complication.

 

“Even the nurse at Kwagunda dispensary is not easily accessible because she stays far away from the health facility”, said Mwendi.

 

Another testimony was given by Sofia Sefu, also living at Kwagunda.  She said ‘Sometime in July 2014, when I felt labour pains, I was admitted at the dispensary – form 10pm to 2am.  My relatives hired a three wheeled ‘bajaaj” which took me to Magunga hospital.  But on arrival there, the baby had already died”.

 

At times, say  a  few  contributors,  ambulances  demand contribution of money which is, in most cases out  of reach of the villagers. “We go for Bajaaj (three wheeled) because it is affordable.  If you call an ambulance, can you afford the cost” questioned Musa Lugendo.

 

At this juncture Mwakanyamale rose up and explained that sometimes the district hospital faced budget constraints. He admitted that at times they faced fuel shortage.  “But when this scenario happens, we tell them to go to nearest dispensary while awaiting an ambulance”.

 

Mwalimu Beatrice Sangawe, a secondary school teacher at Kwagunda Secondary School said she had observed that poverty was also responsible for mothers to attend clinics.

 

“If a villager at a rural area can hardly afford one square meal a day, how do you expect her to travel some kilometers away on hired transport to attend clinic?” she said, adding that education on maternal health seriously lacked in rural areas.

 

“Let us disseminate education to remote villages, these  are places where mothers need it.  They need to be educated on the risks involved where they are attended  to by traditional midwives” lectured Beatrice in a serious mood.

 

Echoing  Beatrice’s  concern, Kassim Molle, a teacher at Mang’enya Secondary School in Muheza District, urged the government to come up with initiatives that would involve villagers in remote areas to access to education on the necessity to deliver at health centres.

 

“It is unfortunate that no education at all is provided to mothers who live in remote areas of the country – the rural poor.  The government should do something to avoid women dying unnecessarily from delivery complications”, said the teacher.

 

“Public awareness on the potential dangers that may show up before, during or after delivery should be a right of the mothers and their partners, not a privilege. Special emphasis should, he said, be on adolescent girls, pregnant women and young couples’.

 

A notable complaint raised in all the areas visited by WRATZ, is that of mistreatment of expectant mothers during delivery by midwives.  Nasty stories narrated in Korogwe, Handeni and Muheza had it that nurses were no longer providing health services with compassion.

 

“Where  is  Nightingales spirit of working? Is the profession still a calling…….I doubt”, quipped a retired woman teacher. Apparently, Nightingale was the pioneer of the nursing career.

 

“Nurses utter  nasty words to expectant mothers during delivery - not knowing that by doing so, they scare the mothers,  since anxiety is created, a situation which may cause serious health complications”, according to Amina Abdi, a resident of Kwamianga – in Muheza District.

 

Some women contributors in Tanga District said they preferred being handled by men nurses. “Men nurses work with compassion, unlike our women colleagues”, according  to  Alice Omari from Mikanjuni – a surburb in the city.

 

Clarifying on some of the accusations  leveled against  the health sector – precisely on maternal health, Esther Kimweri, Tanga City Maternal and Child Health Coordinator explained in cases where expectant mothers are reminded at clinics to come with certain  items, it   is simply  to avoid contamination during delivery.

 

“We tell them to come with, for example, buckets, vitenge or any piece of clothing, rubber sheeting - about 2 metres so they do not share the items  in the maternity ward to avoid contraction of HIV/AIDS”, elaborated Esther.SOURCE: THE GUARDIAN