New Vision (Kampala)

Uganda: Bonabana's Road to Maternal Death

The story of Allen Bonabana, the mother who died after giving birth quadruplets in Kibaale district, is still fresh in the mind of people in her community.

It is hard for many of them to comprehend how death could rob these helpless premature babies of their mother their only source of livelihood.

Bonabana, the wife of Ambrose Kamugisha had had three previous normal deliveries, but her fourth pregnancy took her life. All through her term, the 32-year-old woman did not know she was carrying quadruplets.

Sebastian Shabamukama, the village chairman Nyamuha in Birembo sub-county Kibaale district where the family lived told New Vision they had spent only oneand half years in the village, having migrated from Nkore. As a result, nobody seemed to know much about the family's background.

They lived in a makeshift mudand- wattle hut. Bonabana would do casual work in the village to fend for her three children aged between three and 12. Her husband was away most of the time, doing casual work too.

Peninah Kebirungi, a member of the village health team (VHT) said during pregnancy Bonabana went to her twice, in the company of her husband, seeking advice regarding her pregnancy.

"I remember the last time I gave her a form to go to Kasambya Health Centre III, which is 13km away from Nyamuha because it was the nearest facility around," Kebirungi said.

Bonabana and her husband had to walk from Nyamuha to Kasambya Health Centre III because there wasn't any mode of transport.

The antenatal register at Kasambya Health Centre III confirms that on January 21, Bonabana attended antenatal clinic and was given a client number 561/2013. She was attended to by Mildred Bwaligonza, an enrolled comprehensive nurse.

The antenatal register did not show any exceptions because everything looked normal. On that day she was told that she was 28 weeks and her baby was normal.

Comfort Amanyire, the midwife at Kasambya, said: "I was not around that day but my colleague handled her and nothing exceptional was detected." She said that any abnormality in a pregnancy can be detected when palpating a mother.

Bonabana returned home happily after being told her pregnancy was normal and did not expect to deliver any sooner.

The delivery

Ten days later, however, Bonabana felt pain in the abdomen and rushed to the nearby traditional birth attendant identified as Joy Tibaingana.

Tibaingana, 59, has been delivering mothers for more than 40 years, having started practicing in 1971, while still in Ntungamo district. She moved to Bunyoro a few years back.

Using her old tools, Tibaingana said she detected several heartbeats indicating that the mother was carrying more than one baby.

"I told her that she could be carrying more than one baby but she dismissed it because the health workers had told her she was carrying only one," narrated Tibaingana.

On the morning of January 31, Bonabana returned to Tibaingana for help because she could not make it to the health facility, 13km away.

Tibaingana said at 1:00pm Bonabana delivered the first baby and immediately another baby followed, then another and then the fourth in a space of just two hours.

According to Tibaingana, it was a normal delivery and the babies were normal. After the delivery, Tibaingana called Kebirungi because it was her first time to handle such delivery.

Kebirungi said when she saw the babies she immediately called the ambulance from Kakindo, but it was not available.

She tried to call Kagadi Hospital which is about 60km away but she was advised to transport the mother to Igayaza Trading Centre, about 15km away from Nyamuha.

"We hired two boda bodas and I sat with her up to Igayaza but she was bleeding," said Kebirungi. She said here, they boarded the ambulance but the bleeding had intensified and a polythene bag they carried was full of blood.

Kebirungi said they travelled thorough Kikwaya-Bugwara- Kyanaisoke to Kagadi Hospital. At Kagadi they were told that the mother needed a blood transfusion and there was no blood at the hospital.

They were referred to Buhinga Regional Referral Hospital in Fort Portal. Sister Olive Sabiti, the in charge of maternity ward at Kagadi Hospital said they assessed the condition of the mother and they could not handle her.

"We had to refer her to Fort Portal together with the babies because we do not have facilities to manage premature babies and even then, we had no blood at the time," Sabiti said.

Kebirungi who escorted Bonanbana and the babies to Buhinga said no sooner had doctors started attending to her than she was pronounced dead.

Dr. Charles Olaro, the director of Buhinga hospital, said the mother had bled profusely and efforts to save her life were futile.

"We received her at 9:25pm and at 9:30pm she passed on," said Olaro. The ambulance that had taken them to Fort Portal transported the body back home together with the babies.

Kamugisha, the bereaved husband, said they had to take the premature babies back home because they were not told of the next step after the death of the mother.

Dr. Olaro said babies were strong enough to survive outside the nursery or incubator. "We have a functional incubator but the parents decided to take back the children. We could not stop them," said Olaro.

Kamugisha later admitted that he could not leave his babies in Fort portal because he could not meet the costs, but at home, he discovered the babies could not survive under the environment.

He took them to Kakumiro Health Centre IV. At Kakumiro, they too could not keep the babies and they referred them to Mulago hospital from where Watoto Ministries picked them and is looking after them, though one of them died.

Edward Kyagulanyi, the coordinator of the Saving Mothers Giving Life, a project run by the Infectious Diseases Institute regretted the death of Bonanabana which he said was a big setback to the project's objectives.

The project aims at halving the number of mothers and newborns dying in Kibaale district. "We placed scouts in all villages to monitor the progress of expectant mothers so they could save their lives but people are not responding," said Kyagulanyi.

With the project's intervention, more health workers have been recruited at all health centre IIIs and IVs to ensure mothers are attended to. Those recruited include medical officers, clinical officers, nurses and midwives.

At Kakindo Health Centre IV and Kagadi Hospital, good structures to accommodate mothers as they approach their time of delivery have been constructed.

The public has been sensitised on the availability of health services at all health centres but some have not taken heed.

Kamugisha said they opted for the TBA because she was within their reach, just less than 200 metres away, and she never asked for money to handle them.

But the health workers at Kasambya, which is better equipped and has trained health workers said after attending antenatal, most mothers do not go back to the health centre to deliver.

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