The safe motherhood question

Mariana Phiri will live to remember the birth of her second baby on January 1 this year. While everyone was celebrating the new year, she was looking forward to having her baby.

“My mother rushed me to hospital but while there, I was shocked to see that although my labour was quite advanced, I received no attention from the medical personnel. There were three other expectant women on waiting to be examined in the nurses’ room,” says Phiri, who gave birth at a hospital in Lilongwe (name withheld).

She ended up delivering her baby with the help of other guardians in the hospital corridors.

“The nurses only came after I had given birth. It was a miracle,” she says.

On March 15 this year, relatives of a pregnant woman who had died at Mangochi District Hospital after alleged negligence by medical staff besieged the hospital, causing unrest.

“They chanted songs to the effect that they would rather take their women to traditional birth attendants (TBAs) rather than let die unattended to in hospitals. The situation was quite tense, with relatives denying hospital staff from touching the body of the woman,” said Elijah Kachikuwo, Mangochi Police officer-in-charge who went to calm the situation.

Such cases of negligence and ill-treatment are standing in the way of President Joyce Banda’s efforts to promote safe motherhood in the country. During her recent visit to the UK, the President told health experts and UK parliamentarians that Malawi is committed to promoting safe motherhood and reproductive health in Malawi.

“I am determined to see that there is proper infrastructure for the safe motherhood initiative. My government is working closely with traditional leaders who sensitise communities,” said Banda.

According to UNFPA website, strategies to prevent maternal mortality start with providing quality maternal healthcare services, including family planning, skilled birth attendance and emergency obstetric care.

Currently, Malawi’s maternal deaths rate stands at 675 per 100 000 live births. Although government has banned TBAs, women such as Kachingwe claim that TBAs are more caring than nurses at the hospital.

College of Medicine Research and Ethics Committee (Comrec) administrator, Lucinda Manda-Taylor says it is not right for a midwife to be shouting at an expectant mother during labour or delivery since this is not part of compassionate health care.

“According to feminist ethic of care, we expect that midwives exercise and display kindness, love, warmth, attention and empathy during a painful and distressing time in a woman’s life,” she adds.

District health officer for Lilongwe, Dr Mwawi Mwale says he is not aware of any of such incidents.

“It’s sad that the accusations go to the midwives. There have been instances where medical staff have helped women who delivered at the depot or on the road to the hospital because we are there to serve people,” Mwale said.

He said the hospital in question is a busy facility which assists, on average, 70 pregnant women in 24 hours and there are eight to 10 nurses on duty in 12 hours.

Mwale encouraged abused patients to report such cases so that the medical staff can be disciplined.

Malawi Healthy Equity Network (Mhen) executive director Martha Kwataine says while government is encouraging mothers to deliver at health facilities to reduce maternal and new born deaths, it is discouraging to note that the same health workers, who are supposed to advance government agenda, are sabotaging it.

“This is violating Malawians’ right to health. The same nurse or clinician is an angel in a private clinic and becomes a devil in a public facility. Life is more than money and this is the message we would want to send to our nurses and health workers,” she observes.

Kwataine urges government to enhance supervision at health facilities.

She reveals that MHEN is getting feedback that rural women would rather go to a TBA than at the hospital because of the nurses’ attitude towards them.

“Whilst we appreciate challenges that nurses and other health care workers face in providing care in our facilities, it is not a license to harass and abuse patients. The nurses and health care workers are paid by our taxes and the least we expect is for them to abuse their employers, who happen to be the patients,” Kwataine said.