Before you were born… And after
“Before you were born
God wrote your days in a book, and when you arrived
we wrapped you in white
and introduced you to the dawn”
(Nancy W. Carlstrom)
“Were you the doctor who lived in Africa?” Sometimes at night in the hospital I encounter this question, and I have a chance to recount (and revive) all my experiences in Mali and of the Young Champions of Maternal Health program. And when I try to retell the experience, I realize how it all marked my life: it brought me values, other opinions, and made me see the world in a different way.
The day I stepped into Mali I had no idea how my life (including myself) would change. In a different culture, that at times was a challenge in itself, the African women taught me to discover a world full of colors and hope. I learned with them that joy, strength and art exist in any place! And in exchange for their lessons for me, I taught them about the valor of the woman, the importance of the moment of gestation and how to strengthen the bond between mother and child. The care begins well before being born, and continues down a long road.
It’s been almost three months since I started teaching at a Youth Center in Hawassa. The idea to teach part-time occurred to me a couple of weeks after I had moved to the city. I have always loved teaching and thought it would be a great way to learn about the youth, their experiences and the region.
Initially, I had the idea that I would teach them about various public health issues in Ethiopia, with a focus on sexual and reproductive health. As conversation about this initiative ensued in the office, I would learn that more than anything, the students wanted to improve their English. I would start with about 30 students, most of them currently in public high schools, and teach 5 hours a week. A week before my first class, I prepared various learning materials including assessment tests.
After the first round of introductions, reviewing the assessment tests and getting to know them better, I realized that the initial lesson plan I had prepared had to literally ‘go out the window’ or be thoroughly modified. In order to be effective, I strongly felt that I had to get to really know them. Asking them to tell me what they needed was not giving me the information I desired. I had to forget about my initial plan, observe them keenly, listen with an open mind and at times, read behind their silence. Continue reading
My data collection had been fun and the interesting bit is the way I pick up factors that could affect health workers attitude on entering each facility. First and foremost, for all the facilities I visited to all the health workers were friendly and warm and the warmth came not just after introductions but even before it. Introducing myself and what my study is about made them more receptive. In all the Primary Health Care I have been to, all the In-charges are community health extension workers (CHEWS). Most are indigenes of the State, so language and culture is not so much of a barrier.
Factors both within facilities and outside facilities affect health workers attitudes. The most noticeable thing about all the facilities is the size and capacity. They were mostly one/two rooms and the rooms are relatively small.
So how do they cope and how much of activities are they able to render in them?
Most of them render:
- Antenatal care
- Postnatal care/family planning
Delivery in the facilities is quite interesting. One of the health worker said, “….. When they come in labour we refer them to the General Hospital because it is close by….”
How will a woman who wants a trusted attendant feel, when she is referred to another facility, not because she is in danger but because the environment is not conducive for her?
As they all suggested, dealing with the factors that affect health workers will go a long way in making their services more clients centred and culturally sensitive or better still friendlier. Infrastructure goes a long way in determining the type of service a client get because it can improve respect, dignity and equity or lessen it.
Beyond the provider, other factors contribute to the delivery of maternal health services? How do we handle these with limited resources? How can health workers develop positive attitude when essential resources and capacity needed to work with are lacking?
Join me in subsequent series for my findings from the field
Here it comes again. Another great day to honor midwives all over the world. Midwives who have made impacts in saving the lives of our dear mothers.
May 5th is a great day for us all . its international day of midwives
Here below is the link to read about my feature on MamaYe page; please paste the two links on your browser and read the story:
FUNBI : So how do you advocate for family planning when men don’t want it?
LOVE : We try to explain to them that family planning does not stop their wives from having children, it will just help them space child bearing. We tell them that if the child is well spaced, s/he can help look after the junior one’s when the mother gives birth to the next one. Like that, the mother is strong enough to take care of all of them.
This week I started my data collation and I am humbly assisted by Love (real name). She is a lovely lady and I don’t think I can have a better assistant. She volunteers for a number of NGOs and her stories from the field that impressed me the most is her advocacy for family planning.
The North West Zone and the North East Zone have the highest maternal mortality ratio in Nigeria and several factors that influence maternal mortality can also be indentified in the zones. In the 2008 Demography and Health Survey, in the North West and North East zone of Nigeria, 97.2% and 96 % of married women, respectively, between the ages of 15 -49 year do not use any form of family planning. While the national fertility rate is 5.7 and that of the North West and North East zone is 7.3 and 7.2 respectively. Unlike the remaining zones in Nigeria, mortality occur more among married women and more largely from haemorrhage and Eclampsia. The culture permits early marriage. Coupled with this, is low literacy level among females and gender inequality because of the strong patriarchal system. These factors contribute to the high unmet need for family planning in the zones. This ultimately gives room for frequent pregnancies which cascade other direct factors/medical conditions that contributes to the high maternal and child mortality in the zones.
Family planning is one of the strategies for improving maternal health and one that has found some strong resistance in the Northern part of Nigeria. Between September 2003 and November 2004, polio vaccination was stampeded in Kano State because the vaccine was believed to have been laced with anti-fertility drug. This led to an escalation of the virus to 17 other countries that were formally declared polio-free. It took advocacy from various stakeholders in the world to resume the activity. So advocating for family planning uptake is a difficult task. The above statement shows how negotiation is done with the head of the household. With such statements, pleading for head of household permission and sometimes giving money for transportation, she and some other volunteers have been able to get women to go for family planning. Is she not an unsung hero?
Indirectly, she is advocating for the improvement of maternal health in her community.
Join me in my subsequent series for more stories from the field.