The Child Would Not Die or Be Silent

How long does it take for one to forgive their mother or father for what they did to them?” the little girl asked me. I smiled, but not from amusement. I was trying not to cry. Which was impossible anyway…because ever since I had walked into this children’s home and rescue center in Nairobi my whole system had frozen. God had taken over…I had known to be in prayer about this particular assignment the whole week. I had been invited to replace Pastor Terry Gobanga who was away – and it was not really about filling her really large and excellent shoes. It was about being asked to share wisdom with about 67 children…who were there not because their parents were no longer alive, but had allegedly become predators that orphaned the children they had borne.

This was the second rescue center, mostly inhabited by children who were healing from sexual violence, that I had been asked to speak at in a month. I wondered about that. But as I held a five week old baby girl in my arms, then later looked around the circle of about 30 eyes (the rest had been excused from my session for a play session with other members of the group we had gone with), I wondered how I could answer that question. Most of us, resent those that call us to account for the way we raise our own children: Mostly because they catch us at a moment, and make it about our entire parenting. But these were not ordinary parenting moments…although it seemed that it was becoming more normalized, this was a crisis.

In this particular home, all ‘except one’ (and I shudder at the use of those two words – because it was still one too many) had been assaulted by a mother, father or uncle – biological. Most of these children were in delicate security situations since their parents’ cases were still ongoing, and there was need by some clans to either “mute or get rid of the evidence.” Most of them were girls…but there were boys too…one too many. There were others who were or had been admitted in hospital, to undergo multiple reconstructive surgeries to lend their lives some semblance of normality. Most of the girls were first borns of at least one of their parents, or their only female child. I looked at their Mum1 – the founder of this home…fourteen (14) years of mothering other people’s children in their worst states had not dimmed her life Light.

How could I answer the children? What would forgiveness look like for them? How do you answer a child who in one moment, or a hundred, had endured war in their genitals to satisfy the hungers of a parent who temporarily forgot that they were supposed to protect not prey on them? Does forgiveness mean that what happened to them was ok? That it should be forgotten? That the children should repent of these (Because they were so often stigmatized – Mum1 shared for instant how one ‘church’ had denied them baptism after going through the classes under the excuse of not being able to afford T-shirts.) Many of these children bore the brunt of these shameful acts against them again and again as they lived each breath with the rejection of the extended families to which they had once belonged – who had perhaps initially celebrated their births and birthdays – who now wanted to forget them for the shame they are accused of bringing home. “For why hadn’t they just died instead of crying out, or getting pregnant, getting an important benefactor and family member whose quaint habits could be ignored into ‘disrepute’ or incarceration for ‘just’ a moment? Why wouldn’t they just let this go and keep up the facade?” This seemed to be the attitude their families had towards them.  What exactly would forgiveness mean for these?

The nightmares needed to end, the healing to come. Forgiveness may be about the offender (e.g. When God forgives our sins it puts us in the best place with Him), but it’s more about the offended (Humanly speaking). You forgive even when the fault is not confessed or admitted to because if allowed to – one offense can define the rest of your life in the worst ways possible. Unforgiveness often translates to meditating on an offence and giving it the power to shut down the functioning of what is still functional in us to hit back at the offender and survive the offense. Meditating constantly on what was done to you gives a grievous injury even more power over you than  it had initially. It can colour, darken everything…take away your smile…your life. I cannot remember what I said to them, because I was praying a lot, and asking God to speak to His little ones.  But they smiled…and they spoke…and they gave me strength as well. There was nothing God could not heal. It was hard leaving the home, leaving them behind to go be with my own household…I had intended to leave by 2pm. I was there till 6:30pm. It was hard to leave these little ones that because they still suffered from parenting wounds had become part of my own story. Their hugs, the whispered stories after the main session, the tears they allowed me to see, and the feel of them as they held onto me while I prayed for them – made them mine – indelibly. As I left though, I realized that they were indeed in the best place they could be for now, having been rescued and that for this moment were truly safer because they cried out and refused to die.

But somewhere in this same neighborhood, in this country, in this globe, other children were unfortunately starting the journey they were walking. I prayed that their parents would be hit by Heaven’s Might, that they would not put their babies through this, and that the babies who had gone through this, would find Hope again, find God, in parental touches by those in whose hands God would place them in. I don’t know…

vipslit@yahoo.ca

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Our Twins Came Pre-Term

Tears and Triumphs Through The Muhami’s Journey with their sons

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Sam: I am a 43 year old Auditor working for the National Treasury. Mercy, 38 years and I have been married since December 11, 2004. We have four children; Dennis who is 10, Cynthia, and then the twins Alex and Felix. We experienced no challenges in our first two pregnancies. I attended pre-natal clinics with Mercy and even went to the labour ward for the birth of our second child Cynthia. When Mercy fell pregnant a third time, we thought it would be as easy. At the 7 weeks clinic, we were told that it was one baby, but the sixth month scan revealed that she was carrying twin boys. It was then that we started attending Gynaecologist Dr. Kagema’s clinic. We saw him twice or thrice before Mercy went into premature labour at 7 months. He was the one who prepared us for the possibility that the babies would be born early, and administered an injection that was intended to strengthen the lungs of the baby. We were to go for another but Mercy went into labour.

Mercy: I have never smoked, drunk alcohol, I had no issues with blood pressure and my husband is very supportive and nonviolent. When I was young, I had asked God that when it was time to name my father, He would allow me to have twins so I could name him and my eldest brother at the same time. This was before I got married. I was there for ecstatic when a scan revealed that I would be having twin boys.  My father had died while we were still young, and my eldest brother, who is about 20 years older than I, had taken us through school. I never missed a day of school due to fees.

I started experiencing a pain on my right side, and the doctor said my small frame was being taxed by the twins within me. We had been to Dr. Kagema’s on June 22, 2013. He had told me that everything was progressing well with my pregnancy. So when I started having cramps the next day from around 10am, Sam and I were convinced it was not labour. We finally decided to go to hospital at 4pm. I had dilated 7cms already and had they delayed more, I would have had the twins naturally. I was in theatre at 10pm when I delivered them. Actually I opted for it since the babies were so tiny and I did not want to loose either of them through the birth process. They scored high during the birth, they cried well and Alex weighed 1650 grams while Felix weighed 1480 grams. They actually brought them to me soon after birth for a short while before I was wheeled to the ward and then to nursery. The next day, I was in a lot of pain from the operated area so I was not able to see them. Sam however came and told me they were well. I had no reason not to believe him. I was to find out later that Felix was admitted straight into the ICU. He reduced to less than 1000 grames and Alex to 1200grams. Neither of them were able to feed.

Sam: When I first visited them I was informed that the children were very sick. I was also advised not to share this information with my wife since she was still in extreme pain from the operation the previous day.

Mercy: The next day, however, I felt I needed to see them. I steeled myself against the pain, and walked the distance to the nursery. I was told that they were in the ICU as they were critically ill. They took me to see Felix first. I was horrified. He was tiny, and in respiratory distress, each breath lifted him off the bed. I fainted. I did not see Alex that day. The resuscitated me and took me to the ward. I wept and was not able to talk to my visitors. I didn’t think I would ever be able to look at my babies again. After some hours I gathered courage and went and saw Alex. He was helpless and in an incubator. I was advised to express milk, and I tried but could not since I was stressed up. I looked at the other mothers in there. They seemed to have their act together, and easily expressed, and fed their children.

Sam: They prescribed and administered Surfactant for the development of the lungs. It normally costs Kshs, 60,000 for a 10 ml bottle of which they only use 7ml. We asked the staff to keep the remainder for a parent who was not able to afford it for their child.  I would visit daily. The children were on I.V.s. Mercy is strong, and would diligently express milk for them as they were not able to suckle on their own. Preterm babies, cannot like other babies, suckle, breath and swallow simultaneously and risk chocking or even dying if they try. She would divide the expressed milk between the children according to the doctors recommendations. They started with 1 ml each through N.G. tubes.

Mercy: They would feed after every three hours. I had to go to the nursery despite the fact that my wound had not yet healed. To check if they had digested the milk we would stick a syringe into the N.G. tubes, and pull it back. If something was drawn from the child it would mean that they were not digesting well. Alex despite being the bigger of the two was admitted into ICU on his fourth day as he had lost weight due to his inability to digest food.

They need also to make smaller diapers for preterms. The smallest pampers almost covered their entire bodies. Huggies had a smaller one that fitted better but was still way too big.

Sam: The back and forth between the ward and the ICU every three hours was depressing for my strong wife. The doctors tested the babies’ blood constantly to see if infections had set in, in order to treat these.

IMG_3128.JPGMercy: KNH has about one nurse to 50 babies so we have to be involved. I would wake up and go clean my babies from that day. I forgot about my wound and have no idea to-date exactly when it healed. They had administered Surfactant to Felix and he was breathing more normally now. Since he was in ICU, the nurses would clean him but I still was the one to feed him. Alex on the other hand had not been able to digest food for four days, and was admitted into the ICU as well. After two weeks, a Professor recommended that he be taken to theatre the next day and be put on a central line. I was depressed. He was the bigger baby, and the one on whom I had hope and now he was scheduled for theatre.  I talked to another mother about this and she discouraged me saying that most babies died during the process of this procedure. I wept again. I made three calls to my brother, to my cousin and to my friend and didn’t say anything just cried and disconnected.  I then called my Aunt Nancy who is a nurse. She came to see me. She told me that God was able to do a miracle if I prayed. I asked God not to allow the operation but to heal Alex. I did not sleep that night but talked to God about Alex.

The next morning I determined to feed Alex which was not procedural before surgery. The nurses tried to stop me but the doctor finally allowed me to exercise my faith. I began with 2ml, then 5ml, and then 7ml. By the next morning he was taking and digesting all of 10mls. The doctor was amazed and in short, he did not go to theatre. He was fed and eventually put on 600gms. Putting on even 100gms for a pre-term baby is a miracle. I was also Kangarooing Alex, he was jaundiced and was also put under blue light.

Both my babies needed transfusions and my husband and brothers in law had donated blood for them. Bureaucracy made it sometimes complicated for them to be transfused. I remember one day just going mad and going to the nurses station when I discovered that they had not been. I made a scene and they ended up giving them the blood.

IMG_3041.JPGAfter a week Felix was discharged from ICU. One day I was feeding him in the nursery and the nurses came and asked for him. He was throwing his hands and feet. One nurse shouted something like ‘Apnea’. I did not know what that meant. I went back to the nursery after 3 hours and found so many doctors around him. One of them was telling the others that he hoped I would not walk in when I did. My baby was purple. I was shocked. I called my husband, my pastor and my cousin who is an elder. I would call, cry and disconnect. I run to the nurses room and hid under a bed. I cried bitterly calling out to God. He heard me. The now late Nurse Judy came for me. She simply said “Mercy, toka chini ya kitanda. Mtoto ameamka.” Felix was in ICU attached to a machine. His SPO2 – flow of oxygen was almost 100. This was a good sign. He was doing fine. My cousin had been at a Gospel outreach Pastor’s forum when I called. He interrupted his colleagues and they prayed for me without knowing what was the matter.

After this I could go the ICU and find the readings at 70, but as I stood there, they would rise steadily to 100. One mother noticed this and asked if I practised magic, I told her it was simply the power of prayer. I prayed a lot. I sang, and I cried.

One day my friend Grace’ baby who had been stronger than mine died. Not just hers, but three babies around Felix. I was not able to feed him that day. The other mothers were holding me and crying and calling me. Every three hours, a baby would die. They were taken to the Sluice Room. When we came in for feeding we knew whose it was by either checking into that room first or if a nurse called a mother aside to sit with them.

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I cried a lot during my time in hospital. I was known as ‘mama wa kulia, na kuomba na kuimba’. One time our couples’ fellowship – Precious Couples visited me. The women just came and cried with me. The nurses were shocked at this. The next day one of them pulled me aside and on confirming I was Christian, read to me from Philippians 4:6-7 “Do not be anxious for anything, but in everything, by prayer and petition, with thanksgiving, make your requests known to God. And the peace of God which surpasses all understanding, will guard your hearts and minds through Christ Jesus.” My now late mother coincidentally visited me at this time, on the insistence of my brothers who were concerned that I could not stop crying. She was 78 years then, a mother of 10 children. She told me that Kikuyu customs did not allow for tears to fall on nursing breasts. I don’t think this is true but it worked – I never cried after this; well not as much anyway.  My brothers have never let me forget this.

After this, whenever I was with my babies, I would talk to them telling them that they would survive their beginnings. I would create time between the feeding schedules that lasted one hour for each child to do KMC. My husband was only able to support me in this when the babies came home for hygiene reasons.  I was vigilant about accessing my babies to what they needed to survive.

Before we were discharged, the doctors ensured that the twins were able to suckle. Finally August 9, 2013 came round. I was called by a doctor and told I could go home. I was ecstatic. I just wanted to be home and sleep on a mattress. We were sleeping in the Mothers Mess where we shared beds or mattress on the floor by now. I just wanted to sleep in my own bed.  I could hardly wait for my husband, my sister Purity and my friend Nancy to get there.

Sam: I paid for most of the general drugs and test while NHIF paid about Kshs 500,000/ to cover their time in hospital. We are not rich but have never lacked for anything. God provides. For instance they were able to use Huggies throughout.

We had chosen Kenyatta National Hospital for the delivery because we had faith in the doctors there, and that the hospital was more than adequately equipped for any eventuality. It proved a good choice but I also think we also played a role; parents must follow the instructions of medical personnel. Upon their discharge for instance, the nurses demanded total hygiene on and around the children. Their room had to be disinfected and the nursing cups washed and handled only by my wife and myself. They were to have no visitors initially as their immunity was low. This was really hard to effect.

Mercy: I would plead with Sam sometimes to allow friends and relatives to see the children. Some came from really far away to see them but he was firm; especially when Felix got an infection two weeks later, and we had to be readmitted for a week. Some people took real offence.

When Felix got sick two weeks later and we had to go back, I was devastated. I refused to pack but somehow when we got to hospital, our things were all packed. He was put in the isolation room, diagnosed with mild pneumonia. Shortly afterwards another baby was brought in diagnosed with menegitis. I cried then but was told the kind of menegitis this baby had was not infectious. I was concerned also about Alex. How would he feed without me? Sam and the nurses assured me that Sam would be able to handle Alex. Still they would fight over the milk I expressed.

Sam: When one twin gets sick at this stage both are admitted along with their mother, so it gets really costly. The sick that is not sick gets exposed to infections and may end up unwell too. To avoid this, I requested to keep Alex with me, and signed him out into my custody. This meant I had to be at KNH thrice daily to get breast milk for him; at 6am, lunch time and evening. The milk needed to be warm. One time, I was flagged down by a police man for over-speeding at night. Alex had been crying and I had his milk. I told the police man to take my car and allow me to get food to my two month old son whose mother was in hospital. The policeman had compassion on me and released me. Sometimes the nurses in hospital wanted to keep the expressed milk for Felix, as he was their priority. We would literally tug over this.  Alex on the other hand would through fits throughout the night.

Mercy: Felix was discharged a week later, and thankfully the twins have never been admitted since.

Sam: We were grateful for the care of Drs. Miriam Karanja, Kihara, and Opondo of KNH, but met and have been seeing Dr Ngugi Maina at Kasarani’s Josma Medical Center. Since we were afraid of infections and hardly took the twins out in the sun, Felix got rickets at 7 months. Thankfully these were treated. He had to go through physiotherapy  and at some point had straps on his legs. He just begun walking on May 20, this year at the age of 3. Alex had started at 14 months and experienced normal milestones. We learnt from our doctors to never measure our children against the achievements of another child, not even each other.

Mercy: Felix also spoke later, and is now learning to form sentences.

Sam: The twins are both poor feeders. Mercy, who is a qualified accountant, has stayed indoors voluntarily since 2013. We try to feed them as many times as possible. They have even been on appetizers from time to time. One would wake up at night and then wake the others. We started taking shifts sleeping so we could face the next day.

IMG_3045.JPGThey are fraternal twins. They love being together but fight a lot too. Alex who is older is domineering and manipulative. He is also friendly and remembers faces and names of those he meets. Felix is a worshipper. He loves dance and music. He persistent, determined, focused and strong willed. He is a fighter. Alex fluctuates in his weight whereas Felix keeps the weight he has gained.

We keep two house girls; remember the two older ones are still babies themselves. We had our househelp Cugu who has been with us for 9 years, but needed a new one so we could handle especially the mornings. Initially for the first two months we did not sleep. Our other children understood why we gave most attention to the twins. Mercy’s elder sister Purity was really supportive and lived with us for 9 months.

Mercy: It was hard for Robert and Cynthia initially with me being away for two months in hospital with the babies, and their father trying to cope between home, office and hospital. He would bring them to the hospital to see me from time to time.

Sam: I have a very understanding boss who is also a parent. Understanding my challenges, he would allow me to work on flex time. I needed to be available for all hospital visits and emergencies.

Mercy: Back at home a week later, we were now even more paranoid about infections.  We would not take them out of the house. Felix developed Rickets. We found a good nutritionist and were given some powder from the UN called Prampinot I think, and another medicine.

Until they were three years, my life has been a whirlwind. I had physiotherapy with Felix and would cry when they massaged him. He finally began walking at the age of three and is now stringing words together to form a sentence. I can now think about engaging in income generation outside the house.

Sam: We have actually been able to get away twice on our own without the children. For three days each time. It is important for me that my wife is happy and rested.

Mercy: Sam has supported me throughout this journey. We are grateful to God, to the staff at KNH, to our siblings , our pastors, and the very many visitors who came and who sometimes did not get to see me. I was touched by the plight of many of the mothers of preterms. Some were married but were never visited by their husbands. Some of their husbands would encourage them to abandon their babies there – hence the presence of so many KNH babies. Some mothers loose all their babies, like one who remains childless as all her three babies have been preterm. One time a mother stole her own child out of ICU presumably to go throw it away.

On the children’s first birthday we went back to celebrate with the mothers then at the nursery. We had noticed in our time there that they had a shortage of heaters so we gifted them with a few, and brought cake for the nurses. It really encouraged the mothers there to see Alex and Felix. I remembered while there I had wished that I could have a mother come back and just say “Mimi nilikua hapa and these are my babies”.

Pre-term children can survive and thrive. I know one who is now studying at JKUAT, and one who was born in KNH at 900grams and is now a doctor there. Once they overcome, they perform well and are like other children. As a parent, the words you say over your children stick to them. Be careful therefore. Never give up on them – even when the doctors do.

Sam: In the last three years, we have lost four people who stood with us during this ordeal. My father, my eldest sister who even lived with us for a while, My mother and my mum- in law. Its been difficult but we know to be strong. My late mother in law told us at the very beginning that she knew the boys would be well enough to visit her fun and she could see them in her mind’s eye running around. This prophesy has come to pass, many times.

vipslit@yahoo.ca

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From Traditional Birth Attendant to Birth Companion – Jane Mukuyi’s Story

Jane Mukuyi4.JPG“My Grandmother was a ‘Mkunga wa Nyumbani’ in Chepkaka where I grew up,” begins the elegant 66 year old mother of four. “Of my many siblings I was closest to her. From the time I was 12 years old, I would assist her perform her vocation. She would send me for things while I watched her deliver women of their children. When I got married at the age of 21, and moved to a nearby location, I too, started practicing. My grandmother’s reputation had preceded me and they assumed rightly that I was likewise gifted and inclined.”

Jane was a nursery school teacher. She, however, gladly volunteered her services helping women through pregnancy and the delivery of their children. “When a woman, in the places where my husband and I lived, suspected that she was pregnant, she would seek me out for some sort of clinic. I would wake up at around 6am to find them waiting outside my house, most of them not having even washed their faces. They wanted me to touch their bellies and let them know the progress of their babies. They would come for me to massage them with oil, or just because they had woken up from an uncomfortable night. Many came in as many times as thrice a week during their pregnancies. In the latter parts, I would massage them to ensure the baby was presenting well. I have since learnt that this could mess things up for the baby and the mother.” She says sadly.

“When a woman went into labour, depending on our agreement and her condition, I would either go to her house or she would come to mine. In mine they would deliver in the kitchen. In theirs, it depended how many rooms they had. The idea was that men could not be part of the process. If there was only one house, they would make themselves scarce.” She remembers.

“If one of my women was due, I would prepare a herbal concoction to rub her down with during labour. The woman would get down her knees, legs apart. She was not supposed to have had a bath before labour. I would guide her to push down the baby. Twice there were complications that led to the babies coming out leg first, but thankfully I successfully managed all such cases without a single fatality. I never delivered a child that was in breach. In a normal situation, I would wait for the head of the baby to present, then using my thumb nail, cut her down there to allow the baby to come out. Once the baby was out, we would use one of the mother’s garments, normally a dirty one, to cover it. We would cut the cord using the bark of a sugar-cane. The woman had to stay indoors for three days. She would not bath. She would use an item of clothing that she had worn to get to the Mkunga’s house to catch her flow. It was all very dirty and unhygienic, and yet I knew no other way. Some of the children I helped birth are now married or even in university. I know of five that died before the age of three years.”

Nine years ago, Jane was one of the TBAs that the Ministry of Health reached out to, in response to a WHO policy, to train in emergency child birth and transform into Birth Companions. Until then, she had never met or known of any other TBA except her grandmother. “That is when I realised that we were conveyors of ill health and not of life as I had previously thought.”

abraham-wanyonyi1Behavior Change Communications Coordinator Abraham Wanyonyi of Save the Children elaborates on this. “More than 50% of unskilled deliveries are conducted by TBAs. They have gravely impacted on the Ministry of Health and their partners’, GlaxoSmithKline and Save the Children – Kenya’s attempts to get women to deliver in hospitals under sanitized conditions. They can therefore not be ignored in our efforts. The National  Health Policy 2007 – 2012 provides that they stop providing deliveries and accompany expectant mothers to health facilities. This was just a statement, and there was nothing to support it in terms of making this a reality.” This is where the partners came in. They use the training curriculum adapted from AMREF’s Linda Afya Mama Na Mtoto to reorient them on their roles, give them a small reimbursement towards transport, and have monthly meetings with them.” He says.

“For many of them this is a calling. I remember that when HIV became widespread many TBAs in Western and Nyanza provinces were wiped out by it. You can imagine the hygiene issues, the infections, I mean many health facilities are still struggling with hygiene control. These challenges are more than doubled in a poor old woman’s house.” Abraham laments.

Jane is now an unrelenting firebrand with regard to getting women to attend clinic and deliver in health centers. From being the one sought out to offer clinics, she now accompanies those who do, and seeks out those who are resistant sometimes to the point of having interventions that involve the husband or the chief to get the women to go. “They are tough but I am tougher. I go with them for their initial clinic, then for the fourth of the five mandatory times, and then for delivery. I will ride with the woman on the bodaboda ambulance, and will only deliver if there is a roadside emergency. Otherwise, I go with her to the health center, and stand by her taking care of her needs throughout labour. I act as the link between her and the health facility staff on how far she has gone, and also alert them if I sense there is trouble. I will also accompany her back for post-natal clinic.”

Nurse Violet Nyongesa.JPG58 year old Nurse Violet Nyongesa, of the Bunyala Sub-County Hospital dons the Birth Companion Apron in solidarity with Jane for this interview. She describes the Birth Companion’s role throughout the maternity journey as crucial but thankless in terms of remuneration. “With all they do, we are not even able to offer them a cup of tea. They have really helped raise the number of women giving birth in health centers from 30 to about 100 in a month. We are normally understaffed, with about three nurses on duty at any on given time. When they come in with the mothers in labour, they stay with them. They get them water to shower, clean them after delivery and give them clean linen. They are also usually much better able to communicate with the women than we are. They are really part of the team.” She speaks softly. “I know it is better for a woman to deliver at a health center, despite the challenges we face, because of the sterile environment and because we are able to deal faster with any challenges during the process. The baby is also kept warm. When a child does not cry at birth, we are able to resuscitate them. It is also easier to register a child who has been born in a health center as opposed to at home.”

Jane now makes a living from her farm and also receives support from her four grown children of whom she is very proud. “The training that the partners have given us have earned us renewed respect within the community. The uniforms they have provided makes us stand out in a good way. We are also involved in Table Banking. I love that I am now helping give life the healthy way.” Concludes a smiling Jane.

vipslit@yahoo.ca

Why Women Preferred Being Delivered by Traditional Birth Attendants, By Abraham Wanyonyi, Behavior Change Communications Coordinator and Communications Point Person in Save the Children Kenya, Bungoma Office

  • Facilities often understaffed and have little attention during labour whereas with a TBA it’s just the woman. She receives a lot of tender loving care, the backrubs and encouragement.
  • The language often used by the TBA is gentle as compared to that used by the overworked, little appreciated Health worker.
  • Men who find health facilities crowded have access to their wives during labour to support them.
  • Socialisation, everyone in your family has been delivered by a traditional birth attendants, its difficult for women to start a new trend especially at her in-laws.
  • The TBAs are part of the community. With Devolution in particular people may prefer to be attended to by someone from their own communities than a well-trained ‘outsider.’
  • Distance to the health centers make it preferable for women to walk into the TBAs house during labour.
  • People feel safer with older, and more experienced women.
  • Perceived high cost of delivery even in public hospitals whereas TBAs are compensated with what you have. A leso, a chicken etc.

Story and photos by NaMeD Afrika Studios, Kenya

First Published on The Standard Newspaper’s Wednesday Life Pullout, September 28, 2016

http://www.standardmedia.co.ke/lifestyle/article/2000217596/no-more-giving-birth-at-home-for-women-in-kenya

 

The Boda-Boda Saint Named Gordy

gordy-and-the-12-bodaboda-men-of-bunyala2The man arrives at the health center late into the night. He is helped by a community health volunteer, and between them, they support a wailing pregnant woman. All of them are wet, and bloody. A nurse takes the man’s place and supports the woman to the labor ward while the man gets someone to sign a little book and then leaves into the night. He is back two hours later, in different clothes, equally wet, equally bloody, this time he is holding a baby in one arm, while supporting a tired woman with his other. The nurses rush towards him and relieve him. They know him well. He is here almost every night. He is not staff, he is a perpetual good Samaritan.

gordy-with-baby-hildaWe traveled to Bumula sub-county, Bumula village to find out from the 34 year old married father of three Godwin Simiyu Wanyonyi (Gordy) just why he does what he does. Many men would probably rather walk through fire, than be with a woman, for any period of time, who was in labor, especially in the latter stages, even when it is their wife or close relative. But in Bungoma County we met, not just one, but 13 of 23 men with a different perspective. And just in case you are thinking that Bungoma County has hoarded Gynecologists, you are wrong. These are ordinary men, Boda-Boda riders with a calling that leads them to choose to be around pregnant women in labor, to support them by taking them, free of charge, to a health center for medically assisted deliveries.

“I don’t know why, but most women give birth at night,” begins this hero in Kiswahili. “Some nights I get as many as three urgent calls. I respond to all. Many of them are in advanced stages of labor and this for me means that we sit on blood and water all the way to the health center. Sometimes we make it. Sometimes the baby comes on the way to hospital, and I never shy away from the challenge of helping out. Most times the lady is accompanied by a Birth Companion, a Community Health worker, her mother in law or a female relative. Sometimes, like last week, it’s just the two of us.”

Even in the best of times, the rush to hospital when in labour is, to say the least, uncomfortable for most women with the ever present risk of losing the mother or child to the journey. This is even more challenging in the counties outside the capital. In some places, women are ferried on the back of Lorries transporting quarry stones in attempts to save their lives and those of their soon to be born babies. gordy-taking-a-woman-into-healthcareBernard Mare, a Transport Officer with the Ministry of Health Bungoma explains “Many places in the County are inaccessible to regular ambulances due to climatic and infrastructural challenges. Many homes are at least 5kms from the nearest health centers and can only be accessed through footpaths, sometimes mountainous like in the Mount Elgon areas. When it rains, and it is night, family and community members here either use makeshift stretchers with blankets to carry women either  to the centers or to a waiting Bodaboda at more level places. Some are brought in on wheelbarrows. Bodabodas, though considered dangerous by most, is the way most people get anywhere these parts of the country, so it makes sense to encourage their use, with caution of cause.”

“I have been a Boda-Boda man for 9 years, and whenever I see someone sick, I help  them – for free. I think this is what built my regard in this area, but I didn’t know just how much until the election. In June last year, the sub-chiefs angordwinnounced in the markets and in the villages around that they were looking for a Bodaboda man to help the villagers get to hospital, especially in the night. They, the Government, GlaxoSmithKline and Save the Children, had laid out about ten requirements that this man needed to have.  He was to be dependable, a man whose phone was never off, with a volunteer spirit, not a drunkard or criminal, someone who would best represent the community. I had a funeral on the day the election was to take place so I went” Says Gordy.

“The requirements were deliberately stringent. With the challenges in the area, including security, we needed mature men, with good reputations, with valid Riders’ licences, Insurance and a log book showing that they owned the bike they were riding.” Explains Felix Makasanda a Community Development Officer with the Boresha Programme that rose up to respond to Gordy’s initiative.

“When we were just about to bury, I got a call from one of the community health volunteers who knew me well. They told me to hurry back to the market and try my luck. There were about 60 riders who had responded to the call. Some had been campaigning and had come with their supporters. When I walked in, their morale dropped, and one or two asked me what I was doing there. The short of it, is that most of my competitors became my supporters. At the end of it, the community shortlisted five of us, and I got the most votes,” smiles Gordy. At least, Gordy could now fuel his bike on his mercy errands and have a something left to care for his family.

gordy-with-his-wife-janet2“It’s not easy,” his beautiful wife Janet Nafula contributes. “Many of the women get pregnant in the food season and give birth in the drought season. Sometimes these calls come in at night. As a human being of cause there are times I feel bad, but I have learnt to wake him up and release him, with a prayer. The night holds many issues. I am proud of what he does. Sometimes it rains, and in those nights, he could get as many as three calls. Which means I get to wash more clothes, but I do not mind it. I know he is out saving lives, and I trust him totally. He has never been one with a wandering eye, so that does not even worry me,” she says playfully. “He is a responsible father and husband. We have never slept hungry, he has bought and built on this plot, my children are all I school by God’s grace, the last being in a private school. He has helped set me up in a small hotel business where I have 4 employees, and where he comes in to help from time to time. We also farm goats, chicken, maize and beans, which is where we started off.”

How do they get to know his number? “My mobile number is like a hotline around here. The Chiefs announce it during funerals, in churches, at the hospital during clinics and at meetings. Former traditional birth attendants as well as community health volunteers have it.” Gordy explains. beneficiary-1-mildred-simiyu-with-baby-hildaOne of his beneficiaries Mildred Nanjala Simiyu, not a relative of his, who had her baby in March this year shares how on the day she went into labour, they had no way of getting to the hospital. The young mother of three, had walked to the health centers in the company of her loving mother in law for the first two births. This time though, it was raining, dark, and the path to her home in Bonambobi village in Bumula is full of twists and turns and narrows to barely passable footpaths closer to home. It is about two and a half kilometers from Gordy’s. She had challenges with pregnancy related hypertension. Her mother in law had heard about a BodaBoda Ambulance that transport’s people to hospital for free. “I was surprised by how fast he responded. He rode fast, it was just the two of us that night. My mother in law had to stay back to care for the other children. He saved my life and that of my baby Hilda. If it was not for him, I would have died in the process of trying to have the baby here. She kept presenting her chin first.”

beneficiary-2-jessica-wamalwa-with-baby-prosperJessica Wamalwa had a similar experience. She got Gordy’s number from a neighbor at around 11pm in the night. It was a rainy night. “I was overwhelmed. He was gentle and encouraging. He would ride at the pace that was comfortable for me, but would not stop when I asked him to. He said it was important to get me to hospital. Sometimes he would use one arm to hold me steady on my back. We rode also with my mother in law. By God’s grace I had baby Prosper at 3am.”

Gordy confesses that there have been some challenges. The weather, the roads especially on rainy nights, his susceptibility to frequent bouts to malaria and pneumonia. The lack of proper riding and safety gear is also a challenge for him. “I wish also that they would train us in basic first aid so that we could be more useful in cases where the babies come before we get to the health centers. I have so far, in the past years, had four women give birth when I was taking them to hospital.” gordys-colleague-pastor-wilfred-sifuna-otunga-1The other Riders agree with him on these challenges. Pastor Wilfred Otunga who has been doing this work for 20 years due to his love for children says “There is also said to be a ghost rider who terrorizes road users. Many who have seen it describe it as a jacket riding a bodaboda. I have never met it. I believe God has been with me. Many of us have also met with thugs and thankfully none of us has lost their bikes.” Lack of clarity on the role they are playing, by police on patrol was previously a challenge, but since their partners gave them branded reflector jackets with government and partner logos and branded as Ambulance.

Gordy’s twelve colleagues are grateful to him for his perseverance, and good example that impacted all of them to do the work they do. They also appreciate the assistance that has come as a result of their love for their communities. Like Gordy, many have bought land and built their simple homes on them. Some are educating children at all levels including at the University. They have also initiated businesses for their wives in which they work when they are not on the road. Most importantly, it has enamored them to the communities that chose them for this noble work and are committed to supporting them. They echo Gordy’s sentiments as he concludes our day, “I am convinced I was born to do this. I am grateful for the help I have received from the partners, but I did it before and I will do it long after they leave.”

vipslit@yahoo.ca

 

What They Said

Mildred – Gordy is the kind of person who reacts urgently to every call. If it was not for that, I would have died in labor. He is helping the women here, they will not have their children at home unless they do not have Gordy’s number. The number of deaths of mothers has also reduced significantly. I have his number and would recommend him to any woman in labor.

Jessica – Gordy’s work is meaningful. I don’t think my neighbor would have helped me without transport.  I had seen his number on display during clinic. But on that day, I got it from the community health volunteer who is my neighbour called Martin.

dr-brian-inima-moh-bunyala-subcounty-hospital

Dr. Brian Inima

Dr. Brian Inima – MOH Bumula Sub-County: The BodaBoda Ambulances have increased greatly the number of hospital deliveries.

transport-officer-moh-bungoma-county-bernard-mareBernard Mare –Transport Officer MOH Bungom: Gordy has a lot of passion for the work he does.  He has a big heart.

img_0031Dr. John Papaya – Coordinator of Community Health Services, Bungoma County: Gordy has a lot of humanity. No man would otherwise volunteer to do the work he is doing.

Photos and Stories by NaMeD Afrika Studios – (Nashon David Dwoya and Vip Ogola)

First Published on The Sunday Standard’s Sunday Magazine on September 4, 2016

http://sde.co.ke/article/2000214893/birth-by-boda-boda-bumula-riders-who-provide-free-emergency-transport-to-women-in-labour

The making of … a hero

How long it takes to shoot a 30″ TV commercial? It takes months and months of preparation, concept development, testing, drawing, shooting, post production. And a huge team: client, agency, p…

Source: The making of … a hero

My Battle with Multiple Slipped Discs

By Vip Ogola

IMG_9650.JPGPetite, Sicily Wangari Mugo walks comfortably into her living room. It is difficult to imagine her ever being unwell. She is straddling the last of her three children, 15 month old Shammah Waiguru on her hip. She hugs us and then sits. Her house manager Sarah comes in for Waiguru and we get right into the interview. “When Sharon, my second child was born through C-Section, my husband had to travel internationally after two weeks. My house manager at that time left suddenly. I am a perfectionist, so I got up, and kept my house in perfect order. I didn’t feel it then, but this marked the beginning of my journey.”

Her journey with multiple slipped discs began in July 2012 when she was first diagnosed of the condition. “I had back pains that would come and go. I also felt tired all the time and numb sometimes. But I thought it had something to do with women’s issues, having had surgery thrice, once to extract fibroids, and twice to have my daughters. I did not take it seriously, even when they referred me to Dr. Gakuo. I was busy. And a woman.” Wangari has been a Financial Advisor with PanAfrican Life for ten years. She is passionate about her job which involves visiting clients and giving insurance advice “I love my job and my supportive employer. I would target ten meetings a day, and make it through.”

Some conditions cannot simply be ignored away.  One October morning Wangari got up to get ready for two crucial meetings. “I struggled out of bed trying to ignore the pain. I went to the bathroom but when I bent over to pick up the soap, it was too painful to try. I screamed without meaning to, and my husband heard but I made as if I was okay. This morning’s meetings were too important to me. I struggled through dressing up and even drove to pick up my colleague near City Carbannas for the meeting on Mombasa road. But I could not pretend anymore, I was weak and in pain and I left, allowing my colleague to go on with the meeting. I knew I just had to go to hospital, via my meeting with Muthoni.” Muthoni, her friend, had been recently widowed, and needed advice on how to follow up with her husband’s insurance issues.

“I could not let Muthoni down. She needed people around her, and I did not want her to think I was using illness as an excuse for not being there for her.” She noticed her legs numbing as she drove. Her lower back was aflame. She parked at a Petrol Station near Bellevue and sat waiting for this wave of discomfort to subside. She was unable to reach her husband who was at a work meeting. None of her friends was close enough to reach her. Remembering Muthoni, she prayed she would not disappoint her and set out again. At the City Council parking opposite Barclays Plaza her distress drew the attention of an elderly man. He helped her out of the car, and out of the parking area. “I was glad I had not worn my usual high heels.” She convinced him that she was strong enough to cross the road, and took the lift to the second floor of her office building. She made it, courageously, through her long lunch hour meeting with Muthoni. Two male colleagues walked in on her anguish and rushed her to Menelik Hospital on Ngong Road. She was admitted on arrival.  “By this time my vision was blurred and I slipped into unconsciousness at some point. I appreciated that the hospital prioritized my health not payment.”

“My colleague contacted my husband and waited until he arrived. I was admitted for 14 days that time. I underwent the second of three MRIs in this journey, and several other tests. They stretched me out on the bed, with things that looked like stones, which pulled my legs. I was told that the idea was to stretch out my vertebrae so that the flesh that was lodged between my discs would be released. It was extremely uncomfortable. I did not leave my bed, even to go to the bathroom for seven days” Her trauma increased on her second day when an elderly woman was wheeled in from surgery, for a spinal condition similar to hers. The woman regaled her with tales of her journey, the necessity for surgery and the amount of medication she was on. Wangari laughs. “We put ourselves through more that we are going through when we allow our minds to dwell on the worst case scenario. I was terrified. I decided the following morning to make positive declarations over my life. I prayed. I reminded God, like King Hezekiah in the Bible, of my life, how I had served Him and helped those who needed my help. And I began to feel better. It got so that when I was released from the stretching thing on my bed, I would now serve her, doing things like serving her medication.”

Upon discharge, she still had to go for follow up for about a week, and as her outpatient insurance was exhausted, to pay cash. About Kenya Shillings two thousand per session. This involved massage, continuous traction and buying medication. She was soon able to go back to work, sometimes. Her husband would send a driver to get her there and bring her home, but there were days she had to take the matatu. The medications were very strong and many times she passed her destination and had to be dropped off on her way back. She can no longer wear high heeled shoes for more than a few minutes, go to work and hold down the fort as she used to. Her employer and her clients have been supportive. She cannot hold or play with her really young children as she is discouraged from carrying anything heavier than two kilos. “I often had relapses when I carried my children. They now understand, one is in Standard 2 and the other in Pre-unit. It’s just this one…” she says smiling at the baby on her lap. “But God has given me grace.” She loves hosting, but now allows guests to serve themselves.

Her pregnancy with Shammah was nothing short of a miracle. She had to go off her strong medication for the entire duration and although the pain was severe, it never got her admitted. In fact, she only succumbed after his six month “and it wasn’t as serious as the other ones. I fell in the bath tub and relapsed. My house manager stayed with him while I was admitted and had the task of introducing him to solids. This is when I discovered Dr. Ruto of Kenyatta National Hospital Doctors Plaza. He is a gifted Physiotherapist and affordable too. I wish I had known him from the beginning.” She has also received dedicated support from her neighbour Dr. Stella Bosire of Avenue Hospital, Embakasi as well as her Gynacoelogist Dr. Yamal of Medi Plaza in Parklands.

“I am so grateful to God, to my parents, my in-laws, and church members at House of Grace Embakasi led by Pastors Dodzweit and Mary Achera for their support through this journey. I have made it this far because of their love and support. My husband Mugo Kariuki, has been priceless. He has prayed for me, declared God’s Word into my life, and taken on the roles, regarding the children so I could recover.”

vipslit@yahoo.ca    Dr. Stella Bosire on Herniated disk with Radiculopathy

Photography by: Nash of NaMeD Afrika Studios

First published in the Sunday Standard’s Sunday Magazine on Sunday, August 28, 2016

http://sde.co.ke/article/2000214258/i-shouldn-t-be-alive-my-battle-with-multiple-slipped-discs

Kangaroo Mother Care: What is it

IMG_9841.JPGBy Dr Angela Muriuki, Head of Child Survival, Save the Children – Kenya

Definition and History: KMC is continuous, prolonged, skin to skin contact between a baby and a mother or any other adult for at least 18 hours a day for several weeks. It provides warmth, promotes breastfeeding, reduces infections and links with additional supportive care, if needed. It is a powerful easy to use method to promote the health and well-being of infants born pre-term as well as full term. There are two types s KMC- contious which is skin to skin contact for at least 18 hours and intermittent where contact is brief and at least for 3 hours.

KMC begun in Bogoa, Colombia in 1979 by Dr. Edgar Rey and Hector Martinez in response to a shortage of incubators and severe hospital infections.

Who qualifies for KMC? The current Moh recommendation for KMC in Kenya is for stable babies (not on oxygen, not receiving intravenous medicines) as long as they meet the criteria: baby less than 37 weeks or completed gestation and the mother willing to provided KMC for at least 18 hours, mentally sound, not ill etc. It is hard to objectively say who is most likely to use it i.e. which mother is likely to accept KMC, early involvement of their partners and family in the process and promotion of support systems at home but also using mothers who have successfully practiced KMC.

Challenges that face premature babies and which of these can be resolved by KMC: In the simplest forms, small babies are at risk of death due to hypothermia (they are not able to regulate their body temperature very well), hypoglycaemia (also not able to regulate their blood sugar very well as their systems are not fully developed),and respiratory diseases (they get severe problems with their respiratory system in part due to the fact that their lungs are not fully developed and that they get infections very easily) as well as problems with their eyes, brain and gastrointestinal systems all because of being born too soon.

Some of the benefits of KMC for the baby include thermoregulation (the constant contact20150303_183400 between mother and baby keeps the baby warm), it promotes exclusive breastfeeding (hence addressing the issue of hypoglycaemia), babies gain weight faster (due to better thermoregulation, feeding and bonding which reduces stress for the newborn) and therefore it shortens the hospital stay (reducing the risk of exposure to infections). For the mother, it gives her confidence in caring for her newborn, it improves bonding between mother and baby and empowers the mother to be the primary caregiver. It also reduces stress for the mother since she is with her baby constantly as opposed to conventional care in the newborn unit where the mother only comes to feed her baby every 3 hours (and in between feeding times is constantly worried about whether her baby is still alive). For the hospital – engaging mothers in the care of their babies means that the nursing staff available can focus on the very sick babies and work with the mothers to care for the stable babies, incubators are in short supply and often shared so KMC ensures that incubators are left for the sick babies who really need them and the shorter hospital stay for babies is also advantageous
Some of the benefits of male involvement: There are several reasons why men should be involved (especially when mother is discharged to practice KMC at home)

–        Financial support for the care of the baby especially if the mother has to be away from work (her daily source of income) to care for the baby

–        Emotional and psychosocial support for the mother

–        Fathers themselves can practice KMC giving the mother some time to rest or carry out other household activities

–        They can help around the household so that she focuses on care for the baby (or get some help for the household)

–        Financial resources so she can attend the monthly follow up visits at the health facility

Women experience the lack of male involvement differently depending on their support networks.

When is the best time and for how long? KMC is initiated immediately (and as long as mother and baby meet the criteria described above). KMC is practiced for at least 18 hours a day. When a baby gets to 2000gm, they can be discharged to go home and continue KMC until the baby is 2500gms (with frequent visits to the facility to make sure the baby is ok and gaining weight).

Can it be practiced instead of/along with incubator care and when?KMC is not a replacement for incubator care or an intervention for poor countries/communities. It is the current recommended care for small babies (in the west, even unstable babies are put on intermittent KMC – can send pics from internet though copyright could be an issue). KMC is practiced alongside incubator care because as I mentioned, there are babies who still need incubator care and don’t qualify yet for continuous KMC according to the Kenya guidelines  – very sick, on oxygen, on IV medicine etc. even these sick babies can be put on intermittent KMC and returned to the incubator.

Is KC beneficial for babies born term? No, term babies don’t tolerate KMC at all.

KMC should be differentiated from skin to skin care for all babies – this is where any baby born should be put skin to skin with its mother to keep it warm until it can be wrapped warmly. This is standard practice for all babies at delivery. KMC on the other hand is for small babies (preterm, low birth weight), and is continuous (at least 18 hours)

Which institutions within and outside Nairobi are equipped to and encourage KC?

I can only speak for the ones we support. We have supported county MoHs to set up KMC in Bungoma and Busia counties and provided technical support to other organisations to set up KMC services. From August 2016, we will be supporting Nairobi County to do the same and Wajir County later in the year.

We also extend an offer to any organisation/county which requires technical support to set up KMC services. If they get in touch with us, we are happy to provide this support (technical support since financial resources are limited).

End

Photography by: Nash of NaMeD Afrika Studios and Family File

https://viphealthyleadership.wordpress.com/2016/08/23/kangaroo-mother-care-saved-baby-winnie/

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