Tuesday, June 9, 2009

Life's Risky Start in Zambia

The more time I spend in this country, the more I realize how truly fortunate I am to be a woman in the US – and for once, this statement is purely based on access to health care  – all other observations and ranting aside.  I will probably never view pregnancy and childbirth quite the same either.  In the US, pregnant women ‘glow’ or so I hear people say – they go to the doctor for regular checkups, and pack a bag to prepare for the delivery, well before the due date.  In most of the rural areas I have visited, it is very surprising to see any woman above the age of 17 without a protruding stomach and another child strapped on her back.  No one asks these women how far along they are in the pregnancy or if it is a girl or boy.  If these women pack a bag, they are packing soap, clean cloths, and an umbilical clamp because these things are not provided by the health facility.  However, most women have no need to pack a bag… it is estimated that 75% of women in the rural communities don’t actually make it to a health facility ….their children come into this world as they lay on a dirt floor, perhaps with someone to help if they are lucky.

With misoprostol, these women are at least given a fighting chance.  Maternal mortality is somewhere between 591 and 729 deaths per 100,000 live births.  Post-partum hemorrhaging (PPH) is the leading cause of maternal death.  Among the benefits of misoprostol is that it can be orally self-administered immediately after the birth of the baby and prevent PPH.  For women delivering at home, misoprostol can be life saving.   

During my last site visit in Petauke, it was the antenatal clinic (ANC) day for two of the health facilities.   One day a week is designated for antenatal education sessions and individual counseling for pregnant women.  Nearly thirty women were waiting to meet with Sister Hilda, the only trained provider, and I was told this was a light day.  On average she will counsel 50 women a week.  Now, thanks to the efforts of Venture Strategies, misoprostol education is included in the antenatal education sessions. After their individual appointments and screening, women are given the option of taking misoprostol home with them.  An overwhelming number agree to do so, tucking the packet of three tablets into the corner of their chitenge (traditional skirt) as they head back to their homes.

After spending some time with the women, questioning them on what they learned during the ANC, I left the maternal ward of the facility and gave Sister Hilda a hug, thanking her for her incredible commitment to the women and the community.  As I rounded the corner, I passed by another line of general treatment patients.  Men, women and children were all crowded on to the porch of the front of the clinic, trying to avoid the beating sun.   Sister Hilda has an assistant to help with the screening, but eventually she would need to treat all of these patients as well.

I left the site visit feeling frustrated and sad, even though it was evident that the project was going well.  I believe in the importance of the work at hand, but in reality, it is just a drop in the bucket, given the incredible amount of need in these communities.  I started feeling a bit more optimistic by the third clinic visit.  It was a very impressive facility, with a new addition built in 2007…this indicates progress, right? I glanced up at the ceiling of the new building and noticed the asbestos…            

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