Kenya: Why Expectant Women in Suba Dread Delivery Day

23 November 2021

Delivering in Suba sub-county can be a nightmare for expectant women.

The region is one of the most marginalised in Kenya and any slight delay in a medical emergency can easily lead to death.

So isolated is the area - in the farthest corner of Homa Bay County near the Uganda border - that some residents have never used or seen a single metre of tarmacked road.

Stories are told about children who only see tarmac roads for the first time in their lives when they go to boarding schools outside the county.

For expectant women, delivery day means gathering enough energy to walk many kilometers to hospital.

Those who get exhausted use donkeys to complete the journey as the animal can easily manoeuvre through the uneven surfaces of the dilapidated roads.

A few lucky women use motorcycles to get to the hospital. Luckier ones use cars. In all, it is a risky affair given the bumpy roads.

Families in Suba, including areas like Nyandiwa, Gwassi and Magunga, have had to endure bad roads and arduous trips to seek limited health services.

These challenges combined have been blamed for high maternal deaths in the sub-county.

Statistics from the health department shows that 130 infant deaths in the county are recorded for every 1,000 deliveries, with a majority of them in Suba.

As a result, at least 40 percent of pregnant women prefer delivering at home, which to them is easier than walking many kilometres to get specialised medical care at local health facilities, whose conditions are also wanting, as most are grappling with a shortage of medical equipment.

A good number of hospitals in Homa Bay do not have modern delivery equipment, and safe delivery with skilled staff is never guaranteed, even if one gets to the hospital.

The same challenges affect infants during immunisation, with only 70 percent of infants being fully immunised against a national target of 95 percent.

Maguna Level Four Hospital, where at least 10 deliveries are recorded every day, plays the role of a referral hospital as other health centres across Suba refer complicated medical cases, especially deliveries, there.

Ironically, the facility, because of a lack of tools, refers many cases to Homa Bay County Teaching and Referral Hospital, said the officer in charge, Richard Ojuok.

10 general ward beds

"Cases involving haemorrhage or premature birth are usually complicated. We mostly refer the patients to Homa Bay town," he said.

Recently, a sports betting company donated medical equipment worth Sh1.5 million to Maguna Hospital to help women in Suba deliver safely.

The equipment includes 10 general ward beds, two delivery beds, an incubator and 3,000 sanitary towels.

Before the donation, the hospital had one delivery bed.

"An incubator has been used here. We could not handle two deliveries at the same time because we only had one bed," Mr Ojuok said.

Lack of equipment at the hospital is the tip of the iceberg in the many challenges expectant women face.

During referrals, patients are told to pay for their transport because the hospital does not have an ambulance.

An ambulance was delivered to the hospital more than two years ago to take care of referrals to Homa Bay town, said Health Chief Officer Gerald Akeche.

Unfortunately, it was never used.

"It stopped working the moment it got to the hospital gate. It had to be pushed inside the compound, never to be driven again," Dr Akeche said.

Today, the only help Magunga Hospital can offer its complicated cases being referred to Homa Bay town is to alert the referral hospital.

It takes up to three hours to get from Magunga to Homa Bay town, a distance of 86km, including 22km of rough road to Sori town in neighbouring Migori County.

The journey is usually more dangerous and tiresome when it rains or at night.

Vehicles get stuck in the muddy roads for up to three days before they can move again, with the county government calling for more partnerships to help patients get better health services.

Electricity is crucial

Recently, the government launched the construction of the Sori-Magunga-Sindo road, which is expected to ease movement and transform the region into an agricultural hub as it will link farms and fishing villages in Migori and Homa Bay counties.

Suba Deputy County Commissioner Sebastian Okiring said the region needs special consideration to address the challenges and help expectant women.

"Water in Magunga town is from boreholes or rainwater. Other locations do not have a single drop of the commodity," the administrator said.

His office, he said, had written to the Kenya Electricity Transmission Company (Ketraco) to put up a substation in Magunga to address power outages.

He said electricity is crucial to operating medical equipment like incubators.

"We actually stay for longer without power than when we have it. Most activities in Magunga are usually at a standstill because there is no constant power supply," Mr Okiring said.

Support from the betting company came as the World Health Organization and the UN Population Fund announced five new targets to cut maternal deaths globally.

The initiative - Ending Preventable Maternal Mortality (EPMM) - will incorporate an expanded network of partners working in maternal and newborn health.

It has set new milestones that are to be achieved by 2025 if Sustainable Development Goals are to be met globally.

Four of the five targets are getting at least 90 percent of women to attend four or more antenatal care visits, 90 percent of births in an area to be attended by skilled health personnel, to have at least 80 percent of new mothers access postnatal care within two days of delivery, and that at least 60 per cent of the population of women in an area to have access to emergency obstetric care within two hours of travel time.

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