Improving childbirth in Tanzania

| July 2, 2018 | 0 Comments
Zaituni and her baby, Mariam, in the post-natal ward at Kiomboi Hospital, Iramba, Tanzania. The mother almost died in childbirth from post-birth sepsis likely caused by washing in dirty pond water. (Photo: WaterAid, Anna Kari)

Zaituni and her baby, Mariam, in the post-natal ward at Kiomboi Hospital, Iramba, Tanzania. The mother almost died in childbirth from post-birth sepsis likely caused by washing in dirty pond water. (Photo: WaterAid, Anna Kari)

It was Mother’s Day and I had enjoyed a treat of breakfast in bed when I found myself suddenly transfixed and fighting back tears. The anger Will Grundy — a character on the popular BBC Radio Soap The Archers — had over losing his wife, Nic, was finally ceding to grief. My tears came when Will voiced his fear that his four-year-old daughter, Poppy, will not remember her mum.
It’s just a radio show, but it had kept fans glued for the previous two weeks during Nic’s terrifyingly rapid death from sepsis — acute blood poisoning — after scratching herself on a rusty nail.
I am a casual Archers listener, but this was gripping, heartbreaking radio that instantly sent me back to a very different setting at Kiomboi Hospital in Tanzania.
I was there in June 2015 as part of a WaterAid team collecting stories and photographs for what would become the “Deliver Life” appeal to put water and toilets in hospitals and communities to help protect mothers and babies.
We spoke to many expectant and new mothers during our week at the large referral hospital where we would attempt to carry out this work. In Tanzania, fewer than one in three health facilities has even a basic source of clean water. One of the first women we met was Zaituni, who had just given birth to her fifth child, Mariam, after arriving, in labour, on the back of a motorcycle taxi.
It had been a difficult birth and Zaituni had lost a lot of blood, but mother and baby were now doing OK. Like the other mothers on the ward, Zaituni had washed herself in water brought from a dirty pond near the hospital because that was the only water available. She told us how she felt better once she was cleaned up and felt her strength returning, even though she knew that the water was not clean and she didn’t like drinking it.
A few hours later, we said our goodbyes, leaving her sitting under a tree outside the hospital waiting to return home by bus. Then three days later we heard that Zaituni was back, now dangerously ill with sepsis. Daniel, the midwife who had cared for her and her new baby after birth, was now fighting to keep her alive.
Sepsis is caused by an out-of-control infection spreading rapidly through the body and triggering an auto-immune response to fight it. The latter can shut down organs and, if not treated, will lead to death. Nic Grundy’s case started with a scratch that was not immediately cleaned; it is likely that Zaituni’s was linked to the dirty water she washed with after giving birth and that her body was already weakened through blood loss.
Kiomboi did not have running water at the time, but as it is a relatively large hospital, it did have some antibiotics and an IV drip to deliver them. But the unconscious Zaituni desperately needed a blood transfusion and there was no blood bank available. Her mother and sister were begging to donate their blood, but the risk of them carrying and transmitting Hepatitis B was too great. The hospital’s matron called other hospitals in the region to see if they had facilities to test blood for the disease. Alas, she had no luck.

Women wait to collect water outside the maternal waiting house at Kiomboi Hospital, Iramba, Tanzania. (Photo:  WaterAid, Eliza Powell)

Women wait to collect water outside the maternal waiting house at Kiomboi Hospital, Iramba, Tanzania. (Photo: WaterAid, Eliza Powell)

Then came a moment when one of the WaterAid team realized she could help. Showing her inoculation records to the matron, she explained that she would not have Hepatitis B as she had been immunized against it. After some luck with matching blood types and a subsequent quick donation, Zaituni got the blood she so desperately needed.
At WaterAid, I spend my working life writing about the consequences of not having clean water. The purpose of my job is to do my part to reach our goal of a world in which all people everywhere have clean water whenever they need it.
Earlier in the visit, I had sat with Daniel as he went through the hospital records that showed how many babies and mothers succumbed to sepsis at Kiomboi. I talked to him about how difficult that was for him as a midwife whose role was to bring new life into the world.
In that moment, in that hot, dusty hospital, knowing that a young mother was fighting for her life, I felt a rage I had not previously felt in my work. It was rage that Zaituni was facing death just because she happened to be giving birth in a country where hospitals often don’t have clean water. It was a rage that Mariam might never know her mother. It was a rage that more than 150 years after the link between unhygienic conditions and maternal mortality was discovered, this hospital, along with countless others, still did not have working taps.
We returned home to the U.K. the following day, knowing that the young mother was improving, but not yet out of the woods.
Then a couple of days later, Daniel got in touch to say that Zaituni had returned home to her family.
And things have changed at Kiomboi Hospital. Now, at whatever time of day a woman gives birth, she will never have to wash in pond water. This is progress. But we can’t let our rage ebb until there is clean water for every mother and baby in every hospital, everywhere, always.
WaterAid Canada is currently proud to be participating in the Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality, a partnership struck with three other Canadian organizations — Amref Health Africa, Christian Children’s Fund of Canada and the Centre for Global Child Health at the Hospital for Sick Children (SickKids.) With the support of $25 million from the government of Canada, this four-year project (2016 to 2020) aims to directly reach 1.7 million women, children and men across 20 districts in Ethiopia, Kenya, Malawi and Tanzania.

Fiona Callister is the global head of media for WaterAid UK.

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Fiona Callister is the global head of media for WaterAid UK.

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