Clodagh Bieniek: Blog Four (September 2011)

 Safe Motherhood Project: Advocating for Referral to Biomedical Health Facilities

 At Mangochi district hospital I met with the Safe Motherhood Project Coordinator. She explained about one such safe motherhood project in Chilipa zone – a rural area in Mangochi district. This community project took a bottom up, participatory approach involving all members of the community, male and female. The main focus of the project encourages the use of maternal health facilities through increasing knowledge and awareness on Safe Motherhood. Traditional leaders, practitioners and husbands were encouraged to refer all pregnant mothers to deliver at maternal health services. Once Traditional Birth Attendants (TBAs) now act as signposts to health services rather then delivering themselves. The slogan used by TBAs “A Wise Mother will deliver at a Health Facility”. Through sensitization the demand for maternal health services increased thus in order to help with access to these services, bicycle ambulances were supplied. Thus through community mobilisation and participation delivery at health centres increased and the maternal mortality rate of the zone decreased.

A Different Scenario: Giving Birth in the Village

 Visiting a traditional birth attendant at her birthing house in the rural community helped me to fully realise and understand the complexities and dynamics involved.  Dr. Cecilia Nyrienda (ethnobotanist) previously carried out her Masters research for six months with Mrs Kamasuka a TBA in Mwanakhu village, Mulanje, thus she kindly arranged for me to go and visit her. We travelled there by vehicle, which meant turning off the tarmac road before Mulanje town and travelling for 5 or more kilometres long a dirt road. However on our way there we encountered a bridge, which definitely didn’t look stable enough to take a big vehicle so we went on a short detour, weaving our wave between houses. When we finally arrived we were met by smiling faces and lots of warm welcomes by the TBA, her husband and children!

The “birthing house’, a modest mud plastered building with a thatch roof, one room for ‘delivery’ and another for ‘post delivery’. An old frame of a once bicycle ambulance lay propped up against a wall outside, as there were no finances available to carry out the necessary repairs. Beside the birthing house, trees gave shade to family members who waited for their loved ones to be discharged. Another house next door used to act as the maternity ward, but because the TBAs house fell down, it is now temporarily used as the TBAs place of residence. With the heat blazing outside it was nice to enter the cooler, darker house where I was met by two women lying on reed mats, who held their healthy new born babies, accompanied by their guardians. As a visitor I was given the privilege of naming the two new beautiful babies, which I took as a big responsibility! After much consideration I decided on more Malawian names, Madilisto (girl) and Bright (boy), thinking that Irish names might cause complications! Inside the birthing house the atmosphere was very calm and relaxed, even though a woman was in labour next door! When chatting with the women they explained that they preferred to go to the TBA for she was friendly, mature and experienced and also the district hospital was 12km away, which meant finding transport. On market day (twice a week) matola’s (pick up trucks) /mini buses can be found, but on other days travelling remains a challenge. During the ban on TBAs delivering babies, Mrs Kamasuka explained how she felt she was put in an awkward situation as it was impossible to turn away expectant mothers who desperately needed her help.

All first time mothers and twin pregnancies are referred by the TBA to the district hospital, though sometimes with transport and financial problems these mums also give birth with the TBA. Resources for delivery are extremely basic, as the TBA no longer receives any support in the way of resources or equipment, from the hospital or NGOs. The equipment used for delivery: a black polythene sheet on the ground, and plastic sugar packets as gloves! Women bring their own food, blankets and basins for washing.  The birthing centre receives about 15 women a month for delivery. Also the TBA operates anti natal clinics where she determines pregnancy and the stage with her bare hands, skill and knowledge. As the centre receives no medication, mums are encouraged to buy necessary medication such as iron tablets to take during pregnancy.

The TBA explained that while she gained her knowledge of herbalism from her mother, her midwifery skills she gained from observing a “white lady” who was a visiting midwife. Thus the TBAs practice combines the traditional knowledge of her grandmother which that of medical science. As we were about to depart I also noticed a mum being discharged, her details being recorded by the TBAs husband. With the baby rapped up on the mothers back and their luggage strapped on a bicycle, the family walked away into the distance.

After much reading about TBAs it was great to finally be able to meet one and experience the real life situation. The trip raised the issue of ‘choice’ in my head. While some mothers lived far away from the hospital, others by passed the hospital and choose to deliver with the TBA due to social and cultural reasons. Thus the familiar, friendly and culturally sensitive TBA lay juxtaposed with the scientifically trained nurses and midwives at the health centre/hospital. 

Concluding my Trip to Malawi

With my visit to Malawi soon coming to an end I have been busy, finishing my review of literature on safe motherhood. I also gave a short presentation to the staff of CSR and the Sociology Department on my general learning’s and thoughts on existing research that has been carried out and the possible areas and opportunities for further meaningful and collaborative research. Having the opportunity to visit Malawi a second time allowed me to develop a greater understanding of the social and cultural complexities and dynamics of providing ‘appropriate’ and ‘accessible’ maternal health care.

Eric Ssegujja: CDPC Fellow (May-July 2011)

My journey to Ireland wasn’t without strange   things, it started at a very low note as it was characterized by violence on the very day I was meant to travel. I left Uganda on April 29^th amidst violent protests that followed the brutal arrest of Uganda’s leading opposition politician.  Just like the whole Irish adventure, I wouldn’t have known how deep some of my closest friends cared so much about me had it not been for this experience. For a fact, It was  during that journey from  Kampala  to the airport that Chris Tumwine and Joseph Kyebuzibwa risked their own lives- literally with bullets flying over   their  heads and acted  as human shields all  in the spirit of seeing me arrive safely to the airport so that I don’t miss my flight- May the Almighty bless them.

Fast forward, I arrived in Ireland in May Just when summer was approaching and I must commend the CDPC administrator who ensured that I felt comfortable and had all  the assistance that I wanted  to settle down.  During my first week,  I embarked on the analysis of the data set that I had postponed for several months while in Uganda due to the multi tasking that has always characterized my work ethics. I am glad that the time I spent in Ireland enabled me to accomplish this exercise in a record time that would have taken me ages had I done it in Uganda.

For the larger part of my CDPC Fellowship I concentrated on developing two concepts that I had only managed to leave in their preliminary stages for months. This time enabled me to share these ideas with Senior people at the department of Anthropology at NUIM. Its worth noting that with the mentorship that I got, I managed to refine these concepts. I am currently developing them into full grant applications. I submitted one on my return to the Centre for AIDS Research Development Awards programme at the University of California San- Francisco. I am delighted  to note that it was passed during the first review to compete at the next stage.  I have been allocated a mentor to work with at this stage. I am now competing with other junior scientists across the globe that will compete for the final grant.

I am also working on the second concept that I will be submitting for another grant application. The library and online resources that I had access to played a vital role in accomplishing my primary objective from the CDPC Fellowship.

It was also during this time that we also got a chance to attend the  TIDI organized  African Day Conference  at Trinity College Dublin, one of the presenters was  the outgoing executive director of the Uganda Investment Authority  Prof. Maggie Kigozi. It was an important experience for me because for the first time I witnessed Uganda being marketed which isn’t the case when you are in Uganda. The presentation indeed took us through the natural beauty of Uganda’s flora and fauna, the wild life, the culture, the landscape and the people that we often under look. We had time to take a walks along the streets of Dublin and during one of those walks with my Ugandan Colleagues, a curious Ugandan Living in Dublin heard us communicating in our local language that she intercepted us to say hi. We were very humbled and delighted to learn that a stranger along the street could understand the language that we were communicating in.

Another adventure that will take a long to get out of my head is the  attendance of the Obama public rally at College Green. I was so excited to listen live to the man that caused fever across the African continent in 2008 during the presidential campaigns. While time was quickly closing in to our return date, I had another adventure that purposed on understanding Maynooth better. For a bigger part of my fellowship stay I had known Maynooth through the lenses of the campus, the church and the supermarket where we used buy our groceries. But this time round, here I was attempting to visit all the interesting sites around this township. The visit to the National museum of science was particularly interesting as I got to see for the first time  the versions of the very first radio set, telephone set, Batteries, type writer  and it was  a technological journey  that made me  come face to face with  how far civilization has come. My next stop was the Maynooth castle and learning gave me a sneak peak of the History that surrounds this township.

Enjoying the Maynooth castle Experience.

Standing  at the Entrance to Calton square

Taking a walk around the NUIM Campus

Clodagh Bieniek: Third Blog

A Popular Topic!

The topic of safe motherhood definitely is in the public conscience. Coming into Blantyre city I noticed a big billboard saying, “Women shouldn’t die during Pregnancy”. Also in the daily Malawian newspapers there are regular articles related to maternal care in some form or another. One such article noted how the First Lady, ‘Callista Mutharika’ Foundation for Safe Motherhood donated sewing machines and water pumps to a women’s group to aid their development.  Another article by Francis TayanJah-Phiri (The Daily Times 2011) examined the “Role of Culture in Maternal Health”. This article explores in particular the different customs and cultural practices of the Yao tribe of southern Malawi and the Mang’anja tribe (lakeshore dwellers), in relation to maternal health. He refers to key players in the community such as the chief and the traditional birth attendant as ‘cultural custodians’. Through conversations with Yao and Mang’anja community leaders/members the author details how cultural practices and traditions have both positive and negative effects on maternal health. For example: Pregnant women are supposed to wear red beads -“Luchenga” (Yao language) to signify their being between life and death, and thus should be treated with kindness! Other beliefs discourage pregnant women from eating catfish (mlamba) a common and nutritious fish in Malawi. Also the article states that while Mang’anja elders use traditional practices they are also open to incorporating modern maternal health care methods into their culture. This leads to another topic, which I encountered while reviewing literature, Traditional Medical Practice.

Traditional Medicine

In Ntcheu I went to the local market to chat with a herbalist ‘A sing’anga’ (in Chichewa language) who is registered with the Herbalist Association of Malawi (HAM). While I was somewhat familiar with the medicinal qualities of plants such as Eucalyptus or Tea Tree oil and would often use them for the common cold or minor ailment, I was intrigued by the wide range of medicines on display by the herbalist. All parts of the plant (leaves, roots, bark, seeds etc.) are used to treat both physical and social problems. The herbs used though are not cultivated but rather are taken from their natural environment. While the herbalist had medicines for stomach pains or other physical conditions there were also medicines to treat those affected by witchcraft and charms to deal with other social predicaments. Thus his medical practice embraces cultural and spiritual components as well as physical. Kayne 2010 who has written on Traditional Medicine in various countries, states that the key question of Traditional African Medical Care is to discover the underlying cause of illness. “Why is the person ill?”  It maybe due to: a normal stage in development; the person in question has offended his/her ancestors in some way or has been affected by a supernatural force such as witchcraft. Thus illness doesn’t just happen by chance but rather there is an underlying reason why someone becomes ill. Rather then seeing traditional African medicine as an alternative form, Kayne debates that it should be treated as a complementary one, which complements basic western medicine. Thus I began to realise that African medicine is not just herbalism and to fully understand the factors influencing or affecting maternal health I also had to understand the social and cultural context in focus.

 

  Blantyre City

After visiting Ntcheu and Zomba I went further south to the ‘big bustling city’ of Blantyre, which is the main commercial centre of Malawi. The city dates back to 1876 founded by Henry Henderson as a mission station for the Established Church of Scotland (Bradt 2010). Thus the street names in the city such as Henderson Street or Glyn Jones (former Colonial governor) reflect a historic significance. However Blantyre also has a modern city feel, with multi story buildings, lots of traffic and noise, hotels and restaurants. It has a very large ‘Queen Elizabeth Hospital’ and also a College of Medicine and Kamuzu College Nursing (KCN) which both come under the University of Malawi. KCN named after the former President, Hastings Kamuzu Banda, opened in 1979 as the first Malawian training institute. Prior to this nurses and midwives were trained outside of Malawi. At KCN I met Dr. Angela Chimwaza director of research and postgraduate studies, who directed me to various places where I could find literature on safe motherhood and the use of traditional medicine, such as the College of Medicine library.