Source: The Herald
AN old rusty black pot sat in the corner of a dark room, its contents slowly seeping from three small holes forming a meandering "stream", which flowed onto a reed mat. On the mat Agnes Rukawo of Muzarabani, who had just given birth to a baby girl, lay motionless, tired from the five hours of labour.
Her baby had come out legs first something that made her worry as this was considered taboo.
A traditional midwife, Mbuya Marvelous Chaita, Rukawo's mother Matilda and her aunt Rosina clean the baby using the water from the pot.
The women are not wearing latex gloves and are seemingly not worried about it.
It is their daughter's blood and above all the unregistered traditional midwife has been given a goat as payment of her work.
But as they clean the baby, they notice that she is not breathing properly and her short life is slipping away. The nearest clinic is 20 kilometres away and getting transport there is difficult given the bad condition the roads are in.
The Hoya River Bridge nearby collapsed in 2010 and has not been repaired since. Motorists are shunning the route.
The only means to the clinic is by using an ox-drawn cart but the journey might take longer if the situation they are in is anything to go by.
The family members scatter in the village looking for a cart to hire.
In the moments to follow, the baby dies and screams of anguish are heard.
"This is bad news. I have never witnessed such an incident in my 32 years of traditional midwifery. My hands helped half of the women in this village give birth and nothing went wrong," says the 78-year-old Mbuya Chaita as she stretched out her wrinkled hands.
The death takes a heavy toll on the old woman who has the burden of explaining what happened to her "patient's" husband.
Rukawo is one of the many women who travelled up to 20km to Hoya Clinic and wait for their delivery dates.
She said the waiting shelter at the hospital was not comfortable and she had no one to assist her with cooking and fetching water.
She eventually abandoned the clinic visits resulting in her seeking the services of Mbuya Chaita, whose home is a stone's throw away from hers.
"The nurses did not treat me well when I went to the hospital. This is why I decided to go to the traditional midwife as she treated me better. I also felt that she understood me. The distance to the clinic was also too long," she said.
Their trust grew each day they met under a musawu tree and they even started calling each other using their totems names like Chihera and MaSibanda.
This is the story Chaita tells many other women in her area on the challenges she went through when she gave birth.
She had a taste of both worlds - the public hospitals and traditional midwives.
But her ordeal is just a drop in the ocean.
Many other women in both urban and rural areas continue to lose their lives and those of their children during birth.
High maternity fees, negative attitudes by some midwives continue to push pregnant women out of Government health facilities.
This is despite the country launching the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) under the theme "Zimbabwe Cares: No Woman Should Die While Giving Life!" last year.
CARMMA is an African Union initiative which grew out of a commitment made at the 12th AU Assembly of Heads of State and Government held in Addis Ababa, Ethiopia, in 2009.
The launch of CARMMA in Zimbabwe promised to focus attention on the adoption of the interventions that can speedily reduce the maternal mortality and morbidity rates within the Safe Motherhood and Three Delays model.
It requires the need for pregnancies to be registered with a health facility within 16 weeks of gestation, go through antenatal care (including HIV testing), delivering in a health facility, skilled attendance at delivery (including staying in maternity waiting homes), and access to post-natal care within 48 hours as well as providing quality newborn care at home.
But, despite these efforts, there has not been much to celebrate and some women continue to face challenges.
Some hospitals still detain women over the failure to pay maternity and hospital fees forcing them to seek the assistance of unregistered birth attendants.
To make matters worse, maternity wings at most public hospitals are operating below capacity because of a serious shortage of midwives.
This greatly endangers the lives of pregnant women and the new-borns.
Zimbabwe Confederation of Midwives (ZCM) president Mrs Grace Danda told The Herald that maternity wards in most rural hospitals are run by non-midwives as there is a shortage of trained ones.
"Primary care nurses are covering up for trained midwives and our association is not happy. I recently went on a tour of hospitals in Matabeleland and the situation is pathetic. One or two primary care nurses are covering up for trained midwives.
"We want someone who is properly trained so that they can handle all cases with extreme caution and professionalism," she said.
Mrs Danda pointed out that poor midwife training is a cause for concern.
"Only Harare Central Hospital has a qualified midwifery tutor.
"This is a crisis. You will have 100 midwives being trained by one tutor. What will be the quality of these midwives if you look at the student/tutor ratio," she asked.
Mrs Danda added that institutions should be given what they need in terms of drugs and delivery packs.
Currently, she said, most hospitals are facing severe resource shortages thereby compromising their work.
These include gloves, delivery packs comprising sterile towels, cotton wool, bowls and sterile cord scissors among others.
"We have a crisis. Imagine a midwife helping a woman deliver with no latex gloves. We have a situation where a midwife who has no gloves uses a towel to help deliver a baby. Midwives are using anything at hand and this is a major health hazard," she complained.
This, she said, could explain why some of the midwives have developed a negative attitude towards patients.
She bemoaned the detention of women who fail to pay maternity fees by some health institutions saying this practice is wrong.
"It is sad to read stories that mothers are being detained for failing to pay maternity fees. This is not right if we consider that Government launched CARMMA last year and some money was raised. What happened to that money?" she questioned.
The National Health Strategy (2009-2013) indicates a shortage of over 80 percent of midwives in public hospitals. Zimbabwe has a maternal mortality ratio of 725 per 100 000 live births, the highest in the region.
This translates to about 2 500 women dying each year or eight deaths a day, according to the United Nations Population Fund (UNFPA).
The Multiple Indicator Monitoring Survey (MIMS) (2009) says 39 percent of women who underwent the survey gave birth from home and this is a cause for concern.
"It is desirable that all deliveries take place in a health institution under professional care.
"Home deliveries expose both mother and child to the risk of death since complications may arise which require institutional attention and professional care," warned the survey.
The survey pointed out that cases of home delivery have generally been on the increase since 1999, in the context of economic hardships and a weakened health delivery system.
"Sixty percent of births which occurred in the two years preceding the survey were delivered by a skilled health worker (urban 90 percent and rural 49 percent.) Three percent of the women delivered themselves. "Slightly above 52 percent were assisted by nurses or midwives, 14 percent by relatives and friends, 12 percent by traditional birth attendants, 8 percent by medical doctors, another 8 percent by untrained traditional birth attendant, 2 percent each by community health workers and other personnel," added the survey.
Mashonaland West Province had the highest proportion (20 percent) of women assisted by traditional births attendants, whilst Matabeleland South had the lowest (5 percent).
Harare and Bulawayo provinces had very low proportions of births assisted by traditional births attendants with 1 and 3 percent respectively.
According to the Zimbabwe Demographic health survey, home deliveries have been increasing in Zimbabwe.
Although according to the Maternal and Child Health Policy, maternal health services are free, in rural areas, the high costs of user fees, transport and upkeep costs at the health institutions and other constraints may be the prohibitive factors to women accessing such care.
Early this year, The United Nations Population Fund (UNFPA) got a timely boost of US$500 000 from the Japanese Government and the money is aimed at supporting the refurbishment of 20 maternity waiting homes in areas with high maternal mortality rates.
The sites were selected by the Ministry of Health and Child Welfare and these are Morgenster mission hospital, Neshuro district hospital, Bikita rural hospital, Chiredzi district hospital, Musume mission hospital, Mutora mission hospital, Chireya mission hospital, Esgodini district hospital, Lady Stanley rural hospital, Manama mission hospital, Mrehwa district hospital, Mutoko district hospital, Nyadire mission hospital, Luisa Guidotti mission hospital, Marange rural hospital, Makoni rural hospital, Nyanga district hospital , Mary Mount hospital, Kamutsenzere health centre and Rosa rural hospital.
UNFPA says a rigorous planning and consultation process was done and requirements for refurbishments carried out according to the specific needs of each site.
"This was facilitated through site specific rapid assessments to verify the bill of quantities and refurbishment requirements, in collaboration with officials from the Ministry of Health and Child Welfare and Ministry of Public Works.
"The refurbishment ranges from building of blair toilets or rehabilitating existing toilets, repair of bathing areas, building or refurbishment of cooking areas, refurbishment of sleeping areas for the pregnant mothers as well as distribution of the nutritional support and repair of ambulances," said UNFPA.
UNFPA added that due to the increasing demand for the services, most of the waiting mothers shelters are having challenges of accommodating all the women and have been requesting expansion of the existing structures so that they can meet the demand.
"UNFPA is planning on continuing to support this project within the coming years so that all pregnant women can access these facilities and deliver at health institutions with access to emergency obstetric care services," said the UN agency.
While all the challenges faced by pregnant women may not seem to end, Government should come up with policies to help retain midwives and stop the high turnover of health workers into the private sector.