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.