BUNGOMA EMBEDS TRADITIONAL BIRTH COMPANIONS IN ITS HEALTH DELIVERY SYSTEM TO SCALE-UP SKILLED DELIVERIES.

When 53-year old Beatrice Naliaka Nyongesa shakes your hands, you suddenly experience a naturally unique life force mysteriously linked to the many lives that have passed through her hands.

 Her short stature and low voice do not betray the long experience she has had attending to her thousands of female clients—some smiling with joy after successful delivery of  bouncing babies and others at the point of distress, over-bleeding and staring at death.

 Naliaka is no ordinary village woman. The widow is an experienced Traditional Birth Attendant in whose hands have passed hundreds of babies during her over 30 years as a TBA.

 Her journey as a TBA, now officially christened as Traditional Birth Companions (TBCs by the Bungoma County leadership to make their work officially recognized) started by coincidence when she was still a young girl , aged 17 years and bursting with vigour , youthfulness and curiousity.

 At that tender age, with little experience, she assisted a friend who was in distressful labour, to successfully give birth to a bouncing baby boy. She turned the experience of that successful encounter into a career of birthing life.

 As a young woman bursting with energy and confidence, Naliaka became an instant hit in her Lunao village of Bumula Sub-County in Bungoma. Her fame quickly spread like the proverbial bushfire across several villages.

 When we visited her, she was attending to Ms Jessica Nafula, a 25-year old mother who delivered three months ago and an expectant Josephine Nangile who had visited the TBC for consultations.

 Bumula Sub-County boasts of 93 TBCs whose services are sought daily by hundreds of women either in labour or coming for routine advice as they await the critical date of delivery.

 In Mteremoko Village of Kimilili Sub-County where the Beyond Zero was providing its outreach services, we meet with Albina Matele, 69, who talks proudly of her 5 years as a TBC.

 Bungoma has nine sub-counties and hundreds of TBCs under whose hands thousands of babies are delivered every year. These sub-counties include Bungoma South, Central, West and North, Bumula, Kimilili, Mt Elgon and Webuye East and West.

 Confronted with the culturally popular and highly acceptable TBAs, the Bungoma leadership had to either accept the reality that these traditional midwives account for 70 percent of all deliveries or push them underground through a ban at the risk of heavy medical and health consequences.

 The leadership took the former choice and embedded the midwives into their health delivery system followed by training.  Today, TBA’s are allowed to collaborate with existing health facilities and hospitals where they refer their clients for ante-natal services, post-natal care or emergencies soon after they have delivered them.

 According to Mrs Naliaka and Matele, the services of the TBCs cannot be ignored or pushed aside. They are popular, acceptable, accessible and less costly. Women of all levels including educated professionals seek them out day and night.

 Cultural issues about burying the placenta at the ancestral homestead plays a key role why most women in labour insist on the TBCs. At the hospital, culture is ignored and the placenta discarded amongst the hospital discharges and biomedical wastes.

 In this regard, the mother-in-law, a key influencer on where the daughter in law delivers, or elderly aunts and the husband of the expectant mother insist the delivery be made at home in the hands of the trusted TBC.

 Other factors at play include the popular traditional “massaging “ of the expectant mother in a slow, soothing, comfortable, less painful birthing process.  The professional maternity nurses have no time or patience for this personalized care!

 “ These cultural barriers are not addressed by the clinics. Even HIV positive mothers still choose to deliver at home”, says Steve Kathaka, the Regional HIV Coordinator for Bungorma and Busia.

 The HIV/Aids testing, usually performed at the hospital before and after birth is another deterrent to many mothers.

 “’Even HIV positive mothers still choose to deliver at home. About 79 per cent of of HIV positive pregnant mothers in Bungoma do not deliver in health facilities”, adds Kathaka.

 And because most expectant mothers are poor and have no warm clothing for their newborns that is normally demanded at the hospital before discharge, there is the additional phobia of seeking skilled deliveries at the health facilities.

 The rigidity of the hospital system where the expectant mother is not allowed to be seen or visited by groups of villagers like in the home setting is another problem that frustrates skilled deliveries.

 Geographical issues and the fact that some regions of the county especially the Mt Elgon area which is inaccessible   due to its  hilly terrain,  has poor roads and continuous rainfall  are other key factors that cannot allow women in the area get professional care when in labour.

 However, there is need for changed mindsets and behaviours by re-educating men, the key decision makers  on why they should go for HIV testing and also why  their women , wives, sisters and daughters needs to seek skilled deliveries.

 “It will take a number of campaigns to change these attitudes. We also need to initiate health education programmes targeting the mothers”, says Kathaka.

 But since the launch of the Beyond Zero initiative in May 2014, through the collaboration of other partners including the County Government, the Catholic Church  and Afya Plus Kamili among others, the scenario  is changing slowly through education, advocacy,  and sustained mobilization. More and more women are now seeking skilled deliveries .

 “Interventions by the Beyond Zero (clinic) and other partners has improved the level of skilled deliveries in Bungoma. It is currently very low but we shall get there”, says Deputy County Nurse Ms Hendrick Wasike.

 She is however optimistic that under the new strategy to transform the TBAs into TBCs will greatly improve the skilled Delivery attendance.

 During the many outreach missions that the  Beyond Zero mobile clinic conducts in the county every month, residents of Bungoma can now access such services as skilled birth, ante-natal and post natal services, family planning, cancer(breast, cervical, prostate ) screening, HIV testing, immunization of children and treatment of other infections like Malaria.

 Other services provided by the Mobile clinic include  diagnosis and treatment of Typhoid, Respiratory Tract infections, Sexually Transmitted Infections (STIs), Pneumonia, Skin Infections, Hypertension, Diabetes, Diarrhoea  and the  high incidence of  the jiggers menace.

 Bungoma County Executive Committee member (CEC) for Health Stephen Kokonya, says the Beyond Zero initiative  is a great idea which any forward looking Kenyan should appreciate.

 “Many health gaps existed before the initiative was started.  Whereas the target by the First Lady was maternal and child health, Beyond Zero is an answer to all health responses in Bungoma”, says the CEC.

 Other health inspirations  spurred by Beyond Zero initiative  in Bungoma include the innovative ‘Kangaroo Motherhood’ concept where pre-term babies are placed on their mother’s bosom to avoid separating them and their premature new-borns.

 The Kangaroo care technique may be restricted between  a few hours to many hours depending on the medical stability of the infant.

The  concept, named for its similarity to how certain marsupials  (especially the Kangaroo) carry their young, was initially developed to care for preterm infants in areas where incubators are either unavailable or unreliable.

The Maternal and New Born initiative (MANI) ,where mothers are facilitated to attend ante and postal natal services besides delivering in health facilities is another  initiative inspired by Beyond Zero campaign.

MANI deliberately enlists all pregnant mothers in all areas of Bungoma, creates a data-base including the dates of travel to seek services. Transport is facilitated for all in the MANI programme.

The involvement of the Community Health Units (CHUs) is another response to the Beyond Zero initiative.

The CHU is a networks of volunteers at the grassroots who have a list of all mothers in their regions and their  critical gestation dates including the delivery date. Those in need of facilitation are assisted to access health facilities as need arises

In Partnership with Beyond Zero, the partners have initiated a Public sensitization programme over the need for residents to go for screening rather than seeking medical attention at the critical stage.

This allows the residents to take care of their primary health and cuts costs and time.

The County First Lady Mrs (Dr) Margaret Makelo Lusaka has initiated another important initiative dabbed the ‘Skip a Lunch Initiative Foundation’  under which all expectant mothers receive clothing for their new-borns and a lesso each—as a incentive to  attract  more clients to skilled delivery.

Under the initiative, all nursery kids receive a bowl of ujimix porridge every morning-an initiative that has increased enrolment, attendance and health of children in the nursery schools.

The Foundation has also started a conversation on the need to seek services of the mobile clinics for preventive services.

“We need to reduce the numbers of people in our  hospitals. People need to appreciate being treated in a moving hospital”, says Dr Makelo whom we caught up with at Nakalira Centre, Kimilili Sub-County where the Mobile Clinic was on providing services during an outreach mission.

The Beyond Zero initiative has also witnessed the scaling up of boys seeking circumcision in health facilities compared to those who still prefer the traditional cut. Male circumcision reduces the risk of male to female  HIV infection by 60 per cent.

Bungoma County, administratively divided into 8 sub-counties, has a population of over 1.5 people.

The County’s HIV prevalence stands at 2.8 per cent with an estimated 30,000 people living with Aids. The prevalence among women is higher than that of men.

ENDS.