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

Elevated mis-Adjudications

“Who are you to judge another’s servant? To his own master he stands or falls. Indeed, he will be made to stand, for God is able to make him stand.” Romans 14:4NKJV

DSC00059.JPGII

I strolled into the balcony earlier this morning, with a stool in one hand so I could breath…perhaps more accurately, so I could get some air into my head. And it worked. I stood on the stool and idly looked around the hood from an even more heightened vantage point.

I noticed that my neighbor had some men over to rebuild his wall. He had brought it down about three weeks ago to allow for the digging of a bore-hole in front of his gate. The three men were doing awesome work, from my vantage. They were also raised considerably from the ground and were plastering and measuring and really getting Tassia’s black cotton dust all over them. I noticed another man, cleaning up the road. Picking up papers and lighting small fires to burn them. He is not an employee but a good samaritan. My son Leroy opened the gate, noticed him, and quietly but resolutely went to join him in this task.That’s when the air began swirling round my head…for you see, as his mother, I should know a thing or two about him, right?

Anyway, I immediately installed myself as his supervisor. After all, I was standing on a stool on an elevated balcony, and am his mother right? I suddenly noticed seven small pieces of white paper that, as far as I was concerned, would the determine the success of his mission. He missed them every time, but what I failed to focus on, was that, from his vantage point, he was able to see and deal with a lot of rubbish. Including, ahem, my attempts at supervising him. After a while I kept quiet but continued to anxiously watch for him, willing him with all of my heart and blood pressure to notice the seven pieces of white paper. Suddenly this all seemed very familiar to me…I was Leroy. I heard God rebuke me saying, “let the lad be. You did not ask him to do this work, I did. I did not send you out to supervise, and you definitely have not been qualified by Me to adjudicate or  determine his success. Only I can do that.”

Okay, I figured out too, that since I had noticed the seven pieces of white paper that Leroy kept missing, it was probably my job to go down there and pick them up. So let’s just say, there was an air-leak in my head as Wisdom set in and settled quietly. The little fires have died down as I thought through this, and wrote it down, and the jarring existent of the seven pieces of white paper, can not change the fact that Leroy did something lovingly, as best as he knew how to. The area around our house and across the road looks a lot better than it did before he stepped in. I am proud of him.

I learned that I can not disqualify who I cannot qualify. I can only evaluate a project based on its set objectives and including the presenting challenges – when these have been presented to me and I have been blessed with the soundness of mind and wisdom to do so. I also learnt that sometimes we erroneously feel that just because we have done something before, or know the person who is doing it relatively well in our opinion (which may not actually be true) we automatically qualify to vet those who are bent over to the task. Just because I define success one way, does not always make it true, not even most of the time. Finally, that just because someone is perched at a higher point, it does not give them the whole true picture of what is on the ground. A more realistic assessment is made by those actually doing the work – without really ruling out the truth of that higher view.

As I go out to pick out the seven pieces of white paper, I continue to learn from this scene. I hope this helps someone else, even if its just one person.

This morning’s lesson is both humbling and comforting. When we get too much air in our heads, we get light-headed, and are in no position to judge weightier matters.

Shalom

vipslit@yahoo.ca

 

So…Are You Married? Really?

What unmake’s/invalidates a marriage? What is marriage? What is it that defines it in such a way that it does not matter what or where you come from, makes it still true? If the nation in which you live in, God forbid, was declared a non-state by those who claim the rights and ability to do so; if the policy context under which you married was drastically changed; if the religious institution which declared you married was in some way nullified or if it no longer held true for you; if the symbols of the legality of your union according to the culture by which you live were lost or destroyed in some way; if the authorities and witnesses – all of them – that authenticated your marriage were declared of unsound mind or lost their lives or were no longer relevant to you- or changed their minds/testimony about the validity of your union; what if one or both of you felt they made a mistake and no longer believed and lived in the honor of that union? Would you still be married? Is it possible for one to be married legally in one context and yet be illegal in another? What if you do not have any of the above in the first place? What/Who makes or unmakes a marriage?

BACK TO THE FIRST MARRIAGE RECORDED IN THE BIBLE – BACK TO EDEN: “Now the Lord God said, It is not good (sufficient, satisfactory) that the man should be alone; I will make him a helper (suitable, adapted, complementary) for him. And the Lord God caused a deep sleep to fall upon Adam; and while he slept, He took one of his ribs or a part of his side and closed up the [place with] flesh. And the rib or part of his side which the Lord God had taken from the man He built up and made into a woman, and He brought her to the man.

Then Adam said, This [creature] is now bone of my bones and flesh of my flesh; she shall be called Woman, because she was taken out of a man. Therefore a man shall leave his father and his mother and shall become united and cleave to his wife, and they shall become one flesh. And the man and his wife were both naked and were not embarrassed or ashamed in each other’s presence.” Genesis 2

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