Bennett Oghifo
8 January 2008
analysis
Lagos — Bennett Oghifo writes that former President Jimmy Carter of the United States moved his Foundation into Ebonyi State with a resolve to eradicate the guinea worm scourge ravaging the poor population.
Encouraged by successes recorded by the Foundation, Mrs. Elechi, wife of Ebonyi State governor, has also put in motion plans to eradicate Vesico Vaginal Fistula and other maternal morbidities
Whenever a woman goes into labour, everyone, particularly her immediate family, expects to see mother and child in good health. Meanwhile, in the labour room the woman screams, propelled by excruciating birth pangs, oblivious of time. After the process, the mother, though exhausted, manages a faint smile at the first scream of her baby, which dulls her pain.
However, this happy union and the next few minutes could be critical for the mother who may have suffered some form of accident while performing this honourable life-sustaining role. Recent health statistics indicate a disheartening phenomenon of mothers on the birth table arresting during or after delivery. Records show there are more chances of this ugly occurrence in rural communities where medical facilities and trained personnel are grossly inadequate or absent.
Maternal mortality and morbidity are avoidable with adequate health facilities and personnel. Rural birth attendants understandably run into dilemma when faced with prolonged labour and when it becomes obvious the application of caesarian section is inevitable. This is the bane of women in Nigeria's rural communities and particularly that of Ebonyi women.
Prior to its creation on October 18, 1996, Ebonyi State suffered age-long neglect. Mrs. Josephine Elechi, wife of the state governor said consequently, underdevelopment, with attendant medico-socio economic, backwardness was identified with the new Ebonyi State. "That explains the devastating abject poverty, ubiquitous illiteracy and the inhuman pangs of several diseases being more of an endemic rather than an epidemic issue in the area," she said.
The women dwelt in terror and torture of resultant disorders from child bearing in a generation that must procreate. Out of these include an unacceptably high indices of Vesico-vaginal Fistula (VVF), high maternal and child mortality rate, terminal cases of breast and cervical cancer inclusive, rural girl child illiteracy and the present cultural moral decadence that plague the state.
Previous governmental efforts proffered solutions to some of the peoples' plight. However, still outstanding today are the challenges of women and children, which are begging for intervention, an intervention that has evolved as the Mother and Child Care Initiative (MCCI), Mrs. Elechi's pet project.
Disturbed by incidences of needless deaths and injuries women suffer in addition to other heath complications and privations, Mrs. Elechi resolved to tackle the challenge headlong, employing the platform of her pet project 'Mother and Child Care Initiative' (MCCI) for the eradication of maternal morbidities like Vesico vaginal fistula (VVF) and a reduction in needless maternal mortality.
Existing records in Ebonyi State show a high neonatal/infant and under five mortality rates, while the maternal mortality ratio is unacceptably high in the state. Maternal morbidities caused by VVF have remained silent in the state, said Mrs. Elechi. Mothers, she said have also continued to succumb to the ravages of breast and cervical cancer as the level of illiteracy is far from the desired, and the girl child education has continued to bear the greater brunt of the endemic household poverty. There are a lot of unengaged youths with incessant communal clashes rampant in the state. The challenges of HIV/AIDS especially among teenagers and young adults are great cause of concern.
Preceding administrations have courageously made efforts in confronting the enormous challenges of state building, "especially my predecessor, Mrs. Ukamaka Egwu for her pivotal role in women and children development. I acknowledge that these daunting challenges cannot all be addressed in one day".
Mrs. Elechi, a concerned mother who is abreast with the yearnings of her people, and in recognition of the vulnerability of women and children in the state articulated the Mother and Child Care Initiative (MCCI) as a vehicle for galvanising needed public and private partner sponsorship to the benefit of women and children in the state.
The various projects under this initiative and others would be executed in phases as available funds would permit. The initiative has a vision to facilitate the creation of an optimised environment that would allow for the attainment, fulfillment and self actualisation of the Ebonyi woman and child.
Its objectives are to empower the Ebony woman; reduce maternal mortality; promote an environment that will allow for the eradication of maternal morbidities arising from VVF and to facilitate the establishment of functional primary/comprehensive health facilities in the state and promote effective referral systems.
Other objectives are to facilitate the establishment of cancer screening centres in the state; create public awareness on unhealthy life styles; facilitate the development and empowerment of the Ebonyi youth; and to promote mother and child survival. The mother and child care initiative has in its fold the vesico vaginal fistula eradication project.
VVF is an unfortunate condition that results from prolonged obstructed labour (difficult childbirth), leaving a hole between the vaginal and the bladder and occasionally the rectum through which urine and faecal matter trickle down continuously and uncontrollably. It is a degrading condition that takes away the dignity of the woman and makes her an outcast in her community.
Prevailing factors in the state that has encouraged this scourge include early marriage, teenage pregnancy, female genital mutilation, ignorance, and poverty. Other facts include the poor state of health facilities, inadequate facilities with no provision for emergency obstetric care, the activities of quacks and of unskilled birth attendants.
In 2003, the United Nations Development Programme (UNDP) determined that VVF was prevalent in Ebonyi State and 68 indigenes benefited from the UNDP organised treatment programme. Subsequently, a VVF unit was established in Ebonyi State University Teaching Hospital in 2003. The initial funding and some of the surgical equipment and consumables for the unit were provided by UNDP and UNFPA for repair of some patients.
The unit organised two sensitisation workshops on maternal mortality and VVF for midwives, community health extension workers, traditional birth attendants and doctors within the state health sector. The principal resource person was Dr Kees Waldijie, the world's leading VVF expert. Mrs. Elechi said on assumption of office, her attention was drawn to the degrading condition among Ebonyi women.
"This condition, which is largely preventable, has remained quietly in the state and victims have continued to bear their burden until the recent past. I fully identify with this scourge because it is preventable, a plague that is stigmatised, an affliction of the poor, the down trodden and the voiceless," explained.
She will also focus on public attention on the disease to help destigmatise it; and to repair all identified cases and focus on modalities that would help in the prevention or formation of new cases. A sustainable mechanism would be established to ensure victims do not pay for repairs and a physical structure would be built and equipped for Ebonyi State and make Abakaliki a centre of excellence in VVF repair in south eastern Nigeria.
MCCI plans to mitigate the scourge by constructing and equipping a VVF Centre at Ebonyi State University Teaching Hospital (EBSUTH) to cater for the treatment and rehabilitation of VVF patients. Part of the initiative is the Ebonyi Safe Motherhood Project (ESMP) designed to curb maternal mortality, which she said was unacceptably high nationwide and also alarmingly high in the rural areas of the state. "The reason for this unacceptable fate may include illiteracy level, ignorance, wide spread poverty, and inadequate facilities for emergency obstetric care, among others.
To assuage this challenge, MCCI intends to promote community participation in issues relating to maternal health; promote the development of affective referral system; promote the development of primary healthcare in the state; establish functional comprehensive health facilities; facilitate capacity building of medical personnel to handle obstetric emergencies; and to among others, generate awareness about complications of pregnancy.
MCCI would also institute a project for early detection of breast/cervical cancer. Breast cancer, she said could be detected at its early stage and managed appropriately, but "unfortunately our women are dying from these conditions because they present late to the hospital when it cannot be remedied. Cervical cancer, which is a malignant condition of the neck of the womb, she said is largely preventable and could be detected at a very early stage when it could easily be treated. "Regrettably, our women die needlessly from this condition because they present in advanced stages of the disease and are constrained financially.
Mrs. Elechi said as a mother, she was greatly disturbed by "the loss of moral and value system among youths and lack of respect for constituted authorities exhibited by our future leaders. I also find uncomfortable the level of unemployment. The non functionality of our school system in producing self reliant youths has led to a large population of unengaged youth whose energy ought to be channeled into purposeful and productive ventures".
On account of this, MCCI would embark on Ebonyi Youth Development project, which would incorporate a Youth Development and Vocational Centre "to help mould the character of our youths, inculcate in them the much needed norms and values; help in counseling and rehabilitation; assist them in acquiring functional life and vocational skills that would make them self reliant adults.
The initiative would also focus on rural girl child education. She observed that the education of the child was a basic fundamental human rights issue. "There will probably be no more effective tool that can improve the nutrition, reduce the spread of HIV/AIDS, lower maternal and infant mortality and improve economic productivity than the education of the girl child".
Over the years, because of the widespread level of poverty in Ebonyi, girls from the state were known to be house helps and street hawkers in other bigger cities in the country. In rural communities, girls were kept at home to fetch daily rations and to improve the family income by working in the farms. She said other local beliefs and cultural practices have hampered the education of the girl child, especially the rural girl.
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