A very senior female head of an health NGO some years back made a telling statement while presenting a Key Note address to a gathering at a humanitarian relief celebration which kept people thinking for quite a while. She said then that “the two most essential professions in the world in terms of human dignity and survival are Teaching and Nursing.” Think about this and you will gradually see the truism. Sierra Leoneans indeed used to respect the teaching and nursing professions because of their criticality to human development and survival.
Our performance on the Millennium Development Goals (MDGs) as a nation is rather grindingly snailish. However this is not to say that the Ministry of Health and Sanitation has not been making efforts at sanitizing the health outfit. What has doggedly plagued the Health Ministry to a large extent is persistent allegations of unbridled corruption. As recent as last month we understand the ministry has featured negatively in a survey that assessed the level of corruption as number one. This is perhaps not surprising when you consider that this is the ministry that has seen scandals of the mysterious fire burning down the Medical stores; expired drugs finding their way into health units and cost recovery drugs over-recovering more than the patients they are meant for. Indeed we have come really far with the negative side of things that now we seem to have a health emergency. It will not be out of place for government to declare A State of Health Emergency to allow stringent actions against people who frivolously meddle with the health service.
One major catalyst in bringing back on track the necessary direction to address especially the MDGs 4, 5, 6 is the Mid Wives Association. If there is any Professional Body we should support to be capacitated to perform, it is this association. At the moment they are working hard to revive and take their rightful position in the fight to prevent infant mortality, maternal mortality and the unfair mother to child transmission of HIV. We need to support efforts at reviving the Mid Wives Association, which for some time has been going through some functional lull. Many reasons can be preferred for prioritizing this aspect of health. As Africans there is a tight correlation between marriage and Child bearing. A couple that is not blessed with a child may form a center of ridicule and rejection and even curse. So child birth is as critical to successful marriages as women’s empowerment is critical to child survival. The interlinkages in the MDGs are so much that one needs to take them whole hog. This is where Sierra Leone has a herculean task in meeting the MDGs.
Child Mortality: Traditional perception in some remote communities is that one has to have many children because it is believed that some will die anyway. This perhaps is part of the reasons why in many homes pregnant women and children are not well taken care of. Look at all the naked kids playing in puddle and all the pregnant women whose rights are violated by the day.
Maternal Mortality: This is perhaps most unfair … how can someone suffer to give life to somebody else but then die in the process. How unfair also to the child not to know its mother. How can it live with the thought that the mother died because of it? How about the lack of medical facilities in communities having no access to health delivery services?
HIV Mother to child transmission: the HIV Pandemic which for long seem to defy every curative definition has added new twists to child survival. Knowing the HIV status of the pregnant woman goes a long way in taking necessary measures to support the child and mother.
What has been universally accepted is the inextricable link between poverty and HIV and AIDS. A huge spread of the epidemic in a country could affect that country’s productivity. Also taking care of a large proportion of People Living with HIV and AIDS may deplete a country’s resources. This makes it mandatory for the threat to be addressed. Political will is highly needed here. Just as priority was given to Freetown electricity, so also must frantic efforts be made to cut down on the infant and maternal mortality rates. If we are talking about attitudinal change, I think the best set of people to easily adjust is our children – not their parents. An investment in them could yield the best dividends.
May 5 is the International Day of Mid wives. The slogan for this year is the World Needs Midwives Now More than ever. For Sierra Leone there cannot be a more apt caption. Due to the gross inadequacies in the health delivery system Traditional Birth Attendants (TBAs) play a very pivotal role in rolling out much of what Midwives do. Mid wives are in very short supply and therefore have over the years worked with TBAs in order to improve the capacity of the latter.
Because of poor road networks and a corresponding lack of medical facilities the role of TBAs can hardly be overemphasized. In many rural communities referrals become very difficult because of transport problems, poor communication facilities, low awareness and poverty. In remote communities people do not risk struggling to take their pregnant women to far away hospitals. In Sierra Leone even families living in towns with referral hospitals are reluctant to take pregnant women and sick children to hospital. It is only when their conditions become critical that they do … sometimes too late for treatment. In most cases they actually refer dying people. A situation like this where people die not because the facilities are not available makes it difficult to cut down on infant and maternal mortality.
Sometime in 2008 the Christian Health Association, Sierra Leone (CHASL) facilitated a workshop for the Panguma Catholic Hospital for the staff and community outreach team, focusing on outreach. You see health service delivery is no more restricted to hospitals and clinics. There is dire need to involve communities themselves in outreach for the effectiveness of the system, ownership and sustainability. This is where the role of midwives’ comes in. The International Mid wives Association, for their May 5 event are calling for an additional 350,000 midwives if they are to tackle MDGs 4, 5 and 6! For Sierra Leone this number seems even small. Just think about the locations of referral health units and the number of nurses and mid wives available to attend to hundreds of pregnant women and lactating mothers. This is a very tough challenge considering that 2015 is almost round the corner! Even with the tremendous support that UNICEF and other child-focused agencies like Save The children are giving, the task of reducing the threat still remains most daunting.
Linked up with this whole issue of child and maternal mortality are value adding issues of good roads, food security and poverty reduction. What also needs to join in is women’s empowerment which is very critical to child survival. A whole lot of transformative thinking is needed. The present power dynamics dictating that the man takes all should be reversed to let women also share in the domestic command and control. Without this our children remains at the risk of not getting the care and support they need. As the Mid wives mark their day government should form a consortium of relevant MDAs to chart out a strategic framework for handling the problem. In all this, some work should be done on cultural diehards who may hazard some resistance to change. But as a first step make Midwifery training attractive and get qualified nurses to enrol for it … this cannot wait. Leave the facading and window dressing. If you are breathing right now, thank a midwife.
By S. Beny SAM