Saving Baby Olara Elisha: Improving Child and Maternal health in Uganda.

Saving Baby Olara Elisha: Improving Child and Maternal health in Uganda.

Peter Labeja

Sister Teddy has coffee and pop corn for breakfast. When you see her walking through the health center wards, with her neat white uniform, her shoulder pads with colors of Uganda - Yellow, red, black, her mustard colored belt – the one specifically for senior obstetricians – and her nurse cap, large figure, serious look, you would not dare go near her.

But then you see her working, welcoming tens of mothers who attend the antenatal clinic every day. Sister Teddy is right there. She spends some more time with the younger mothers, during their first visit, and provides them with all the information they need. 

They have seen their mothers, aunts, cousins deliver in their huts, helped by elder women, traditional experts in birth attendance. They think you only go to the hospital when you are ill. Sister Teddy insists: they should inform their neighbours at the village. Every pregnant woman should access antenatal care, since babies – even unborn babies still inside their mothers – need care.

Then there are mothers pregnant with their second, third, fourth child, the Prevention of Mothers To Child Transmission (PMTCT) mothers. Sister Teddy knows all their stories. The one abandoned by her husband. The one who was born HIV-positive and has been fighting against the virus all her life. The one who does not want to tell her husband she found out she is HIV positive. Every mother who has been here knows that she is around. Sister Teddy gives each of them special attention. A comforting nod. A smile of encouragement. 

Sister Teddy has been in charge of the PMTCT program at Agoro Health Center IV for nearly ten years, ever since she accepted to work in Kitgum district. She took the job to her heart so much that during each review meeting she comes up with new activities to improve the services, the increasing number of mothers, the treatment methods. She knows all too well that working in a region, where the average number of children per family is seven, pregnancies are common. 

Traditionally, a woman carried her pregnancy and delivered in her village, helped by traditional birth attendants. Some deliveries were complicated, but mostly children were born healthy. HIV/AIDS destroyed this possibility. 

The Birth of Baby Olara Elisha.

In Uganda, with an HIV prevalence of 6.4 percent, a total number of 90,000 HIV positive women conceiving every year, and the likelihood of 20 to 45 percent that without intervention HIV is transmitted to the child, approximately 24,000 children would be born with HIV each year. This would mean a vicious cycle of transmission and lifelong treatment. 

Elisha’s second name is Olara. The name is meant to bring luck: a life of sickness that is changed by a miraculous meeting. In this case, the fairy is Grace, a woman from northern Uganda who has been pregnant for 9 months. She lives in Kitgum district where life is affected by the worst virus of the Millennium.

Olara has small eyes sparkling with expectation. Two tiny rows of white teeth, hidden by a shy smile. You can only get a glimpse of them in the darkness of her hut. He quietly listens to her Mom narrate how he was saved from St. Mary’s Hospital Lacor in Gulu district. She excitedly talks in Luo the language of northern Uganda, about the high fever baby Elisha developed shortly after birth. 

Grace appreciated the importance of giving birth at a health facility during her first delivery. She saw a mother lose her child after prolonged labour. She was determined to bring another life to planet earth, another bunch of joys to her family and make her husband love her more. Elisha arrived at about 1PM after seven hours of labour on March 08th, International Women’s day. Women converged to cheer his grand mum. 

Expected mothers unsure of what lies ahead. Attendants praying under their breath for normal labour. Grace was due to leave the hospital the next day when the unexpected struck. That morning, Elisha was diagnosed with surprising high fever. His temperature went to 39.8 according to his Medical form. He lost the appetite he had after birth to breast. 

With waning hopes, Grace called her husband to mobilize more money to sustain them for the one week the medical workers require to closely monitor and stabilize the young man’s condition. Grace entered the next phase of battle to save baby Elisha. Waking up after every two hours to have IV fluids and drugs administered. The routine was being shared by many mothers admitted in the Children’s Ward of St. Mary’s Hospital Lacor. The intensive care unit was kept busy. 

Back Home in Kitgum District. 

Back home in Kitgum district, at 6 months of pregnancy, she learned from radio news that Kitgum district lost 1,628 mothers and children at the Main government hospital in 2013 during labour. The report by the Ministry of health made the hospital second in the country with the highest maternal and child mortality rate. This is where Grace would be referred in case of complications. 

It is fed with patients from 12 lower health facilities and other neighbouring districts. All ill equipped to handle medical emergencies. Grace does not want to be among the unfortunate. She saved money and left for Gulu district. The district has been trying to clean its name over the last three years, through recruitment of more health workers. It hopes, tackling personnel gaps will bring in more dedicated midwives like Sister Teddy, and more gynecologists. Achieving this dream has turned in to a nightmare that haunts this district all the time. A recent advert for 20 midwives ended up with just eleven shortlisted for interviews. But why the nightmare?

David Omulangira Okuraja, the Kitgum district Chief Administrative Officer says Kitgum hospital has failed to attract and retain medical specialists. Two reasons; low pay and remoteness of the district. “We get some few specialists who often abandon their positions – preferring to work in other districts. Currently, Kitgum main hospital has only two doctors that we borrowed from lower health centers”, he asserted.

All civil servants are supervised and headed by the chief Administrative Officer (CAO). He says “doctors prefer to work in lower health centers where they attract better remuneration compared to Main hospitals where they earn peanuts”. 

A medical doctor at a health center IV (lower health center) is paid about 2.5 Million shillings as compared to a doctor’s 800,000 Uganda shillings in a Main hospital. The ministry of health believes that the bulk of the work is at community level where the health center IV is situated. This is not true in the case of Kitgum district. 

David Omulangira Okuraja says “the only two doctors at Kitgum Main hospital are surprisingly overwhelmed with referrals from the few ill equipped lower health center IVs in the district. Most of them lack functional theatres to handle complicated labour.

Low Wage Bills.

Uganda slapped a ban on civil service recruitment in 1990 citing low wage bills. Where recruitment was absolutely necessary, approval by the Head of Civil Service was required. 

Chris Kassami, the Secretary to the Treasury said three years ago that “the hiring freeze is one of several proposed austerity measures contained in 10.8 trillion Shillings budget for 2012/2013 Financial Year”. Government is yet to lift the ban since the 2011 economic depression eased. 

It is not all doom and gloom. The country is making a stride towards achieving the UN Millennium Development Goal 5 before 2015. Progress is however slow. By 2010, Uganda’s maternal deaths stood at 310 expectant mothers, over twice the 150 target set by the UN to be realized by 2015 compared to 600 in 1990 and 530 in the year 2000.

In Kitgum, available data puts the infant mortality rate at 106 per 1,000 live births while the maternal mortality rate stands at 365 per 1,000 deliveries. The children are left motherless and vulnerable. They are up to 10 times more likely to die prematurely than those growing up under the care of their mothers, according to the United Nations.

Margaret Aryemo, the Kitgum District Assistant Health Officer says there are many drivers for the high infant and maternal mortality rates including low up take of family planning and Antenatal services, high household poverty, lack of male involvement and inadequate numbers of medical personnel, high domestic violence leading to unplanned pregnancies among others.

To fast track the achievement of the Millenium Development Goal 5, government need to take deliberate efforts to protect pregnant women from domestic violence; involve more men in maternal health and wider reproductive health, increase access to contraception. In Addition, sexual and reproductive health counseling for men, women and adolescents must be encouraged to accelerate efforts to prevent child marriage and ensure that young women postpone their first pregnancies. 

The Write is a Pan African Climate Change and Environment Reporting Aware Winner 2013. He is the Bureau Chief of Uganda Radio Network in Kitgum District. For Comments on the Article, Use: peterlabeja@gmail.com

 

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