September 28, 2016 Leave a comment
“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.”
Behavior 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.”
58 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.
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