Affirmatively Disruptive: Yili acts to prevent more maternal deaths
Nobody seemed prepared for the tragic note on which the story ended in the room full of health workers, community actors, Yili district assembly officials and improvement advisors.
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In the beginning, we thought it would be one of those near misses in healthcare where a labouring woman opts to have her baby in the community instead of under the care of skilled health personnel, runs into complications, almost dies, but never quite succeeds. This was, after all, 2013, even if in rural Ghana.
When the new medical assistant (MA) in charge of the sub-district health centre started, he confessed not initially knowing the number of deliveries Big Mama conducted in her house, what previous complications she had encountered or what great trust the community had developed in her birthing skills.
In part, the latter had been fostered by a strong belief that Big Mama was gifted with a strong spiritual power and salubrious concoctions that could accomplish the impossible.
As a result, many referrals from distant health posts would make her their first point of call despite not being a midwife or even a trained traditional birth attendant (TBA), even as the health system frowns on deliveries by the latter. Big Mama was also loved for many things.
Back from duty one day, a man rushed to MA’s door looking extremely unsettled.
“My wife is in labour”, husband said.
Initially thinking he was in need of transportation, MA offered assistance whereupon the husband clarified that his wife was in labour in Big Mama’s house and that MA needed to go and see her “because the way my wife is bleeding, I am afraid!”
When MA reached Big Mama’s house, there was this heavily pregnant woman lying lifelessly on the floor of an almost empty room. In the centre of the room was a hole filled with a pool of blood mixed with water. Big Mama was seated by this hole, scooping out bowls and bowls of blood into a bigger container.
On the pregnant woman’s body were ripples of water, remnants of what had been poured on her when the labour became more difficult.
“I felt her pulse. There was none. Her conjunctiva was paper white. Her tongue and lips were paper white. I concluded that the woman died from severe bleeding. She was covered by a cloth.
The baby was still inside! It had not come out!”
In the immediate aftermath of this tragedy, it emerged that the relatives of the husband appeared more concerned about not violating traditional beliefs than about taking measures to avert further tragedy.
It was forbidden to bury a dead pregnant woman while still for which reason, ironically, the family began consultations on how to bring the dead pregnant woman to the district hospital for the doctor to “remove the baby for them so that they could bury the mother and the baby separately.”
When they got wind that contact with the formal health system might result in unholy brushes with the law, they changed course. Rather, they consulted a local juju man, who for a handsome fee and choice livestock, “dissected the dead woman and removed the baby!”
At a meeting called as part of an improvement learning journey to foster closer ties between community actors and the health system to ensure prompt referrals for similarly distressed pregnant women and newborns, MA fielded questions on how well he had leveraged community resources to tackle this and other problems.
MA recounted reporting the incident to the district director of health services, who then asked for a meeting with the community leaders to “tell them the law doesn’t permit the woman to be doing those kinds of deliveries. Either she stops or he will let the law take its course.”
He then made a report to the chief of the community, a key ally in this new community-facility collaboration. The chief was very sad; lamenting that what had happened was a taboo. He then promised to summon Big Mama and her relatives for a stern warning and to ban her from conducting further deliveries.
This he did when he told Big Mama, “that the land belonged to him as a traditional ruler so whoever is doing anything that will promote the welfare of the community is welcome but if you are going to do anything to destroy the good name of the community, he has the right to sack you from the community,” recounted MA. If any news reached him of further deliveries by Big Mama, she would be banished from the community forever with all her relatives!
By indirectly stimulating demand for the services of the formal health system, MA is now sharply confronted with the reality of its dire shortcomings. The health centre has had no midwife since 2012, when the previous one was transferred to an even more remote area where she is still the only midwife. MA conducts what he calls emergency deliveries when “a woman arrives with head in vagina.”
By June 2013, he had conducted about nine such emergency deliveries. The newly established District Ambulance Service (DAS) has also been very supportive. When a woman goes into early labour, he simply calls the Emergency Medical Technicians running the DAS who then come for the pregnant woman to the district hospital for prompt care.
Written by Sodzi Sodz Tettey
Email: [email protected]