More than a number

I know the statistics relating to maternal and newborn health in Sierra Leone are among the worst in the world. It is possible to be slightly removed from the reality of what the statistics mean, while acknowledging they are shocking. However, two events this month reinforced the reality that every number is a personal tragedy for a woman and her family. First, when carrying out training for 27 fistula advocates and secondly, the maternal death conference we facilitated recently.

At the beginning of the fistula advocates training, all of the women introduced themselves and described how they developed a fistula, living with the condition and life after their surgical repair. It was incredibly emotional, many of the women were young, illiterate and came from incredibly remote areas, which is typical of women who suffer a fistula. Some of the women were moved to tears as they told their stories, the women described labours lasting between two and six days, sadly for many, their baby did not survive the labour, having survived this ordeal they described the humiliation and distress they faced living with the fistula. One woman in her fifties who had recently undergone repair surgery had been living with the stigma and disability caused by this condition for 33 years before being repaired.

In fact, the training was very positive, all of these women are committed to preventing other woman from suffering in the same way. The training was a lively affair with songs, dance and role play. We were very happy to have a number of small babies with us at the training, as some of these young women had given birth by caesarean section to healthy babies since their repair surgery.

One of the strategies Health Poverty Action is using to reduce maternal mortality is to facilitate maternal death conferences. When a woman dies in the area we are working in, we hold a meeting in the village to try and understand what happened and learn lessons to prevent another death. We involve the family, community, hospital staff, health centre staff, community health volunteers and community leaders. The conferences are held after an appropriate period to give the family time to grieve.

Both of the women who died were young, in their late teens and pregnant for the third time. These deaths felt like such an incredible waste of precious lives, which had held so much potential. The vast majority of maternal deaths in Sierra Leone are preventable and these two were no exception.

Delays were apparent in the events surrounding these young women’s deaths. There was a delay in the decision to seek care due to not understanding the danger signs, such as bleeding and the seriousness of persistent headache.  There was also delays in reaching a health facility due to their remote locations, lack of health staff, time spent obtaining money for user fees and mis-communication between the family and ambulance driver regarding the location of the village. On reaching the health facility, one woman died of an eclamptic fit soon after arrival. The second woman died of haemorrhage; difficulty in finding donors meant she was unable to be given enough blood to save her life.

It was distressing to hear the stories of these young women, seeing the grief that was so apparent on the faces of the young women’s husband and mother. We must try to channel some positive change out of these losses; Health Poverty Action is already working with communities to increase knowledge and understanding of maternal and child health issues at a grassroots level. We spent four days recently training 25 maternity care health assistants and this included recognising and managing emergencies, such as severe pre-eclampsia and obstructed labour. We are meeting with our partners at the hospital to work on further improving the ambulance referral system. The health centre closest to these women now has two new health workers. We are also encouraging communities who live outside of the area that our community emergency obstetric loan fund operates to save money to develop the scheme in their area. 

User fees for pregnant women have been abolished nationwide; although they will continue to pose a threat to women in our remote operational area for the time being. The only referral hospital in our area in Northern Bombali is a mission hospital, and thus exempt from the free healthcare initiative. It is many hours drive on a very poor road to reach the nearest government hospital. Discussions are under way to include the mission hospital in the government’s free healthcare initiative, and we are working with our partners at the hospital, civil society organisations and the district health management team to advocate for inclusion. Women in our area are still required to pay for emergency obstetric care and the prices at the hospital are set to rise. As the stories of these women show, this barrier can literally result in one delay too many for some women to access life-saving treatment.   

Add a comment to this blog posting

Comments are added to the bottom of blog postings. They are moderated and will not be published until approved by the Midwives team. They may be edited.