Ahmad Salkida
12 March 2008
Maiduguri — According to medical doctors Maternal Mortality takes the lives of 150 women every month in Borno State.
But these statistics reflect hospital deliveries alone, and the reality is that about 70% of women in the state don't have access to hospitals. Thereby, this figure could even be higher. Yet, only Maiduguri, the state capital, boasts of a functional scanning machine in Government Hospitals or clinics. In the entire northern part of the state, there is not a single scanning machine, where women can be diagnosed of any likely complications arising from pregnancy.
This gruesome prognosis on the Maternal Health of Borno State given by a gynaecologist, which was corroborated by several medical personnel in the state, and reported several times by this reporter in different titles of Media Trust newspapers, is indicative of what women go through in the state, and in many developing countries.
"Why should women suffer and die because they want to make babies, when nearly 90% of these deaths can be preventable through words, not even expensive drugs" Mrs Nkiru Igbokwe, a gender specialist with the United Nations population fund (UNFPA), asked rhetorically during a visit to the state last year. Also according to doctor Abdulkarim Mairiga, a Consultant Obstetrician and Gynaecologist with the University of Maiduguri Teaching Hospital (UMTH) who doubles as a focal man for the Development Research and Project Center (DRPC) in the state, posits that "a mere access to a maternity centre for advice, not even drugs, in most cases, can save a life" .
Daily Trust investigations revealed that there is a noticeable increase in women attending ante-natal care across the state, but when it comes to delivery, many of these women deliver at home, and only visit the hospitals when there are complications. Doctor Mairiga argues that the trend has contributed to most of the morbidity and Mortality associated with motherhood across the state.
To understand the reasons that are responsible for Maternal Mortality in the State, Daily Trust explores the lives of three families in different communities that fall under the 70% or thereabouts of those that have little or no access to maternity care, which may provide the appreciation of the efforts to identify and resolve the problem in contention by NGOs, Donor Agencies and Governments in Urban Areas, as it is seemingly rippling to the Rural Areas, such as the recent free maternal care introduced by the first lady of the State.
However, critics say the free maternal care in six out of the 34 hospitals in the state, is a mere fraction in the resolve to reduce the incidence of mortality and morbidity of these vulnerable groups, and "if you ask the first lady or health officials in the state the population of female reproductive age, they don't know, so how can you provide free treatments to a population you dont have statistics on?" said a medical official, name with held.
Thanks to a new expression of pride in many rural areas, where part of the courting prowess of men is a promise of the luxury of visiting the Hospital in the township in case of any bodily infirmity to his would-be wife. This was the experience of a young couple in Yalmatamta village in Biu local Government Area, south of the State. "During the 9 months of my wife's pregnancy, she was okay, I was working very hard for her to rest and eat properly, and my friends and relatives laughed at me throughout her pregnancy. She never complains apart from the headache and weight gain in pregnancy, which is normal, and when I wanted to take her to the hospital during her late pregnancy, she and her relatives refused, arguing that, the cost we may incur should be used for a befitting naming ceremony instead" said the villager.
But at the last minute, the expectant mother who was nearly 16 started convulsing, and several elderly women were invited to her mud brick and thatched room "but it was the same way many women have died in the village and surrounding villages. So, I decided not to waste time, and we started heading to the township on two motor bikes late in the night. After nearly covering 5 kilometers of the 30 kilometer trip to Biu town, my wife died and I collapsed". The bereaved man woke up to see himself in his room, his relatives decided to go back to the village carrying him and his wife, because they felt there was no need to go ahead. "Most of the time, if we go to the hospital even the babies don't come out alive, and we still pay bills" said the Village Head of Yalmatamta.
Another pathetic case is that of a young mother who made it to the Hospital from the north of the state, doctors said she had preeclampsia, which provoked premature labour and considering her tender age and exhaustion, she needed a caesarian section, and about 20,000.00 naira was required. Her husband abandoned his wife, few minutes after her admission ,and never returned and when friends and relatives rallied about 70% of the required amount, doctors undertook CS on her. But she died shortly afterwards leaving behind a small baby boy. "Surprisingly the husband heard the news of the death of his wife in 'kasuwan Shanu' where he was pricing a ram for the naming ceremony of his baby," said a nurse who witnessed the incident in Maiduguri.
Another case in point is that of a mother of six children who was married for only 7 years and had 6 children, and because of the absence of family planning in her life, she developed acute backache, and when she managed to visit a hospital, she was sensitized on the need for child spacing, but when she discussed this with her husband he scorned her. Interestingly, in her bid to save her life this woman inserted an Intra Uterine Contraceptive Device (IUCD) without the consent of her husband. Soon the device dislodged inside her pelvis. At that point, surgery was required and that was when the husband heard about his wife's little secret. It took the intervention of community leaders to convince the husband to pay for his wife's unfaithfulness to him, as he implied. These are the experiences of three women from different communities which reflect the ordeal of so many others. However this does not mean that, men in totality are insensitive to the plight of their wives. There are cases where several men support the culture of antenatal and hospital deliveries. Yet according to them, their humiliating experiences in the hands of Nurses and Midwives and the absence of drugs and other amenities in the hospitals, tend to discourage most of them from the gospel of accessing maternal health. According to Doctor Mairiga, it has been said that "The National and Demographic Health Survey in Nigeria 2003 that the Maternal Mortality in the north eastern part of the country is about 1543, higher than any part of the country, and even most countries don't have that bad indices, and when you come to Borno State with a population of 4.1 million with a growth rate of about 3%, we discovered 150 women dying every month let alone those who are having permanent disabilities like the VVF and other pelvic infections. All these made the DRPC to concentrate in Borno State in their bid to strengthen the capacity of NGO's, and improving the survival of women in the state" said Doctor Mairiga, adding that the aforementioned stories of these women are mere understatements, compared to what they see coming every day in the hospitals, and even the statistics are only hospital based.
Daily Trust was part of an advocacy visit with a team of DRPC members to the State House of Assembly, the Head of Service of the State and Ministries of Heath and Women Affairs, to solicit for government support in forging a new partnership to confront the "sorry state of maternal health in the state" said Doctor Mairiga. The state government conceded to their failure in the past to confront the problems of maternal health, and emphasised that the ministry of health has the third largest budget in the State with over 7 billion naira, which is an indication of the state governments determination to improve the health of the people.
Meanwhile, Daily Trust engaged doctor Mairiga, Malama Adama Ibrahim, the Amira of Fomwan and Hajia Binta Konto, a prominent health worker in the state, in a debate on what could be responsible for the plight of women across the state, especially rural women, and they advocated for male participation or involvement in both ante-natal and post-natal visitations to the hospital "since most women in this part of the country do not have control over their maternal rights the involvement of the couple will prevent the incidence of women increasingly seeking different contraceptives without the knowledge or consent of their husbands" said Konto
"It is a pity that women have to sneak out to save their lives in such a situation. If I were her I will inform my husband before taking such an action, because Rasulluh said stealing is Haram, but if a man refused to feed his wife, she can steal from him" said Malama Adama who urged men more than women to attend maternity centres."As you have said, if a woman is sensitized without first sensitizing the man, it is difficult for him to consent to certain medical advice, as to how best his wife will improve on her maternal health" said Malam Adama.
However, Doctor Mairiga advocated for something slightly different, even though, he said that in the north eastern part of the country, only about 36% of women come to the hospital, and only 17 to 19% of this percentage deliver in the hospital. Infact, we have seen cases where the husbands will tell the women not to go the hospital at all". But inter-spousal communication not men to attend maternity centres, remains the best way to improve maternal health, doctor Mairiga implied.
For Doctor Mairiga, being an obstetrician and gynaecologist, and his involvement in maternal health related crusades, has made him not only closer to these problems, but sometimes "I nearly feel their pains". According to him eclampsia is the single major killer of women in this part of the country, and preventing it is as affordable even to the poorest Nigerian, if there will be improved access to maternal health services, he implied.
According to medical explanations, eclampsia occurs in late pregnancy, or it may begin during labour or even after delivery. When convulsion happens all the signs and symptoms of pre-eclampsia are present. High blood pressure, Oedema, protein in the urine, abnormal high weight gain, severe headache etc and according to Mairiga, prevention is the best treatment of eclampsia.
But the question is, how many have access to the hospitals, and in the few available hospitals, in there adequate man power and facilities to effectively cater for the health needs of these vulnerable groups? This reporter under took a survey, and as at 31st December 2007, only Maidu-guri, the Borno state capital boasts of scanning machines. None of the Government Hospitals across the State has a single functional machine, and only in less than 10 local Government will you find a full fledged Medical Doctor based in a government hospital. The remaining 17 councils or thereabouts, either depend on nurses or chemist assistants for the treatment of various illnesses. "But these are all in the past, we have commissioned several hospitals and clinics, and currently we are constructing new ones and very soon we shall rehabilitate the old ones and equip them with facilities for the benefit of our people" said Ayuba Iza, the Commissioner of Health in the State, during a recent interview with Daily Trust.
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