Being pregnant places every woman at risk of being one of many who die while giving birth in a world where more than 600,000 women die of almost completely preventable illnesses and injuries related to pregnancy and childbirth each year around the world. The risk is triple quadrupled if you live in a remote Kenyan village with the nearest clinic 80 kilometers away (49 miles). Complications related to pregnancy and childbirth constitutes the leading cause of death among young adolescent girls in the developing world (WHO, 2009). UN report ranks Kenya in top ten on maternal deaths with a reported 6300 women's death from pregnancy related complications last year.
And as we all know, these numbers are way lower than the actual statistics due to under-reporting especially in remote areas where these deaths most often happen at home and are never reported. Most maternal deaths in Kenya are due to causes directly related to pregnancy and childbirth, unsafe abortion and obstetric complications such as severe bleeding, infection, hypertensive disorders, and obstructed labor.
This is the ugliness we encountered everywhere we turned during our recent 2014 summer medical mission trip to Wamba, Kimanjo and Kitamany villages which are both very remote and inaccessible.
It’s hard not to get angry and point an accusing finger when you are faced with such difficulty and devastating situations. It’s hard not to shed some tears. Its hard not to blame somebody, anybody. We can point our finger at the Kenyan government’s inefficiency in providing adequate resources and medications to its citizens. With a population of more than 43 million people, Kenya is one of the most popular sovereign nations in Africa boasting some of the most impressive scenery in the world, including vast savannah, rugged mountain ranges and stunning national parks with beautiful wild animals; an undisputed top choice for African safaris. Data collected from the World Bank indicate that Kenya’s national gross domestic product (GDP) was an estimated $33.6 billion in 2011 which is quite impressive when compared to some other developing countries. However, according to the World Health Organization, only 4.6 percent of the nation’s GDP was invested in its health care system which is quite depressing.
The Kenyan government has clearly turned its back on some communities and healthcare is not a priority in a country where the nation’s top leaders are known to travel to the US and Europe for medical treatment while the vast majority of Kenyans are drenched deep in poverty and have no access to basic health care services. The government has a legal and moral obligation to provide health care services to its poor and marginalized citizens. But clearly, that responsibility has gone down the drain with allocated funds disappearing somewhere between the ministry of health, the central government and the county governors leaving these Kenyan citizens deprived of their basic human right. The Kenyan government should implement plausible institutional delivery systems, provide resources for antenatal and postnatal care, and provide access to family planning services. These simple measures can help improve maternal health outcomes and reduce preventable deaths in rural Kenya.
But lets keep up the blame game. Why stop now? We can go further and blame Neoliberal globalization which clearly heightened economic inequalities and widened health inequalities in developing countries with women taking the wrath of its effects due to reduced health care services and increasing poverty, both which leads to devastating effects on women’s reproductive health. We can blame the West and other power nations for turning a blind eye on women in these communities who are dying every single day from maternal related complications. We can blame the non profits for not taking a bolder step in highlighting these delicate issues and advocating for women’ s causes. We can go back to the communities and blame traditional patriarchal practices that brought along unequal power relations between men and women. Unequal power relations is toxic to women and results in women’s lack of autonomy, is buttered with domestic violence, and is manifested in women’s poor reproductive health. We can go on and on with this blame game. But the reality is, instead of being overjoyed with the prospect of bringing another life into this world, these young girls and women are terrorized with fear of death the moment they discover they are expecting.
And these are the devastating circumstances that Oreyia Lekurio was soaked in on the morning of May 1st 2014 during our first day at Wamba village. Oreyia walked for more than 60 miles away to our clinic with obstructed labor pains and uncontrollable vaginal bleed under the heat of the unforgiving African sun. A mother of 8 children with no control of her reproductive health, she confided to us that she did not want any more children but can not decline her husband (or his age mates), when they come knocking through her manyatta (traditional hut). She had been in labors for almost two days and only came to the clinic when she started bleeding. She looked dejected and crowned in painful abdominal pains. Her demeanor was quiet with dark pinned eyes that spoke of untold suffering. She looked older than her estimated age of 25 to 30. Yeah, I know what you are thinking, but bear in mind that in this community, girls start having babies as early as age 13. Her frail small framed body had clearly taken the toil of multiple pregnancies and childbirth, as well as the hard labor of fetching for water and raising a big family.
Dr Alfred on assessment immediately determined that she was at least 38 weeks pregnant and had placenta abruptio and needed an ultrasound and probably a C-section in a HOSPITAL. She was hypotensive at 70’s systolic as a result of the blood volume loss and was tachycardic above 170’s. She was this close to crashing, she was going into hypovolemic shock.
How she managed to walk that many miles to our clinic without passing out is mind boggling. We immediately started her on intravenous fluids with Megan holding the IVF bag high with her hands, a tiring task. The clinic had no IV pumps and only had a single pole that was currently being used by a septic toddler who was getting IV tylenol for high fevers and IV antibiotics.
After we stabilized her, Dr Martha and I drove her to a mission hospital that is run by Italians and she was immediately admitted. Dr Martha Ingles and I covered her initial hospital deposit bill while Traci, Lexi, Agnes and Megan were all fighting to settle the balance. The volunteers knew very clearly how Oleyia’s story would have ended if we were not in that place at that time and they couldn’t have been more happier to help.
When we offered her the option of tubal ligation while at the hospital, the look of relief in her eyes was evident. She naturally asked us not to share this with her husband for obvious reasons.
Before we left the village the next day, we stopped by the hospital to check on Oleiya. She had received blood transfusion and IVF overnight and the pain and bleeding was under control. She was whispering words of gratitude over and over again saying that we need to come back to her village so she could slaughter for us a goat; the ultimate sign of appreciation in this community that values livestock more than money.
There are so many other Oleyias in Kenya. Last year in Shompole, we watched helplessly as a 13 year old struggled with a non progressing labor, scared to death, while all we could do is just monitor her. If she were in the US, she would have had a c-section the moment she walked into a hospital. But yeah…we were in Shompole. We just had to cross our fingers and bite our tongues.
A day later, the hospital called me and informed me that Oreyia had delivered baby no.9, a beautiful baby boy weighing 2.6kgs and both mother and baby boy were in stable condition. We all had an audible sigh of relief. We knew how easily things could have gone the other way and we knew how close to death she had been, her and her baby. In a world where maternal related deaths are the order of the day, we were grateful to God for this positive outcome, and for having had the opportunity to help an otherwise helpless woman.
Gathura, G. (2014, May 1o). UN Report Ranks Kenya in Top Ten on Maternal Deaths. The Standard Newspapers. P13
Murray, A. F. (2008). The Maternity Death Road: Reproductive and Sexual Health. In P. Farmer (Ed.), From Outrage to Courage (2nd Rev ed., pp.85-101 -)
WHO (2014). Country Cooperation Strategy at a glance. Retrieved from http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_ken_en.pdf
WHO (2009). Women And Health: Today’s Evidence, Tomorrow’s Agenda. Manuscript submitted for publication. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf