The final two weeks of the month of February were so busy and quite draining for us at Kiyunga Health Centre IV where I am the lone doctor at the maternity wing. Though we usually get visitors, this time round they were not ordinary visitors but our funders for the Community in which Mothers and Newborns Thrive (COMONETH) Project of the Makerere University School of Public Health. So, it was between meetings and work.
It was during this time that a case that reminds us of the grim reality that Traditional birth attendants (TBAs) still pose to the delivery of safe maternal and newborn health service in Luuka District and the country at large.
For purposes of this blog, I will call this lady Pamela (not real name) whose story I am sharing. A call came through from a village health team (VHT) member that there was a lady who was in bad shape at a TBA’s home and needed urgent medical attention. An ambulance belonging to a local politician was dispatched and with in a short time, Pamela was ushered into the health facility.
Pamela was clearly in a lot of pain and kept begging health workers to save her life and that of her baby. I quickly put on gloves made a quick assessment of situation. And my primary examination showed that she had tenderness on touching her abdomen and this would mean two things; either a pending uterine rupture or a detached placenta from the uterine attachment wall. Also, her baby’s presenting part which was the head had swollen and in medicine it’s a sign of obstruction, meaning that the baby’s head was trying to pass through a narrow passage -the pelvis bone. Luckily, the baby’s heart could be heard faintly with the fetoscope.
With these findings I made a diagnosis of obstructed labour due to narrow passage, pending uterine rupture and foetal distress. Quickly with the help of the midwives, Pamela was prepared, and we rushed her to theatre for an emergency caesarean section.
However, during the procedure my heart skipped when the delivered baby was so silent with no activity. Within my mind I said to myself ‘God let there be life’, I felt the cord together with my assistant and there was a pulsation, a sign of relief and joy was felt in my heart. I detached the baby from the rest of the placenta, cleaned very fast and in due course a diminutive cry happened.
The baby was handed to a midwife who immediately started on resuscitation, to support and improve on the baby’s breathing. But as the midwife was resuscitating, I was anxious to hear that big cry, but baby couldn’t. I immediately instructed my second midwife in theatre who was at the same time my assistant to change tables and go help. Luckily, within the next two minutes, the much-sought loud cry I was eagerly waiting for came.
The entire operation lasted 45 minutes and when the mother recovered from anaesthesia, and tears of joy for being alive together with her baby overwhelmed her.
We later learnt from the VHT who referred Pamela that the mother had spent three days at a TBA’s where her husband had taken her to deliver. Over three days, the TBA kept promising them that the delivery would happen the following day, which would pass without any progress.
To this, what we learn from episodes such as this one, there is need for;
- For the Central Government to deal with the challenge of TBAs who are contributing to maternal and newborn deaths by holding on to mothers for selfish reasons.
- Strengthening health education urging mothers to always seek a high level of management if the primary one fails
- Timely intervention to save lives and reduce on preventable maternal and newborn deaths.
- Recruiting skilled health workers in lower facilities in order to attract the public to seek health services.