Tuesday, August 1, 2017

An Insight Into Maternal Health in Sandema

You would have to be living under a cow if the community spirit of Sandema evaded you! Along with the refreshingly amiable and constant greetings on the street made by strangers and friends alike, most initiatives, whether they're religious or medically inclined in nature, begin and end with the community in mind. 

Speaking to a nurse at the Sandema District Hospital, I was told of the 'Durbars', organised by the local Chief. He holds considerable sway within the community, and is therefore able to gather locals together. During such meetings the healthcare staff can intervene and educate the public on the importance of antenatal care and personal hygiene. Speaking of healthcare staff... 


This is Nafeesa, 
A practicing Midwife at the Presbyterian Clinic.

A practicing Midwife at the Presbyterian Clinic in the subtly wonderful village of Sandema. Nafeesa tells me she has always found fulfillment in seeing the emergence of new life. Having been a midwife for three years now, with experience in the nearby village of Boko, she speaks with passion about some of the challenges she has faced that are unique to Sandema.

“The main issue is being unable to deal with emergencies due to a random lack of supplies. Despite the established system of National Health Insurance, when the insurance companies do not give out funding in due time, it casts the hospital into a crisis. I hate having to turn to a financially constrained patient who has somehow already managed to pay for insurance and ask them to buy medicine from the pharmacy – medicine we should have in stock. The drugstores in Sandema are rendered somewhat useless in that many here cannot afford to purchase from them.”
Nafeesa mentioned an example of often lacking in resources for the treatment of pregnancy induced hypertension. This was disheartening to hear, of course;  but it got worse.

“The poverty is directly linked to the mental health of the mothers' during and after pregnancy. I’ve seen cases where women deeply resent their whole 9 months, when the pressures of feeding and clothing severely dampen any joy the pregnancy would have bought to the mother, when heavily pregnant women have climbed trees to cut branches to sell just to be able to afford to continue carrying the child.”

Research into the 2008 Free Maternal Health plan currently in place in Ghana reveals that many hospitals face challenges in providing confidentiality and privacy during delivery. Further, women are pressured into buying antibiotics, having scans, and buying dressings and bed spreads early on – the up-front cost of such necessities often discourages pregnant women who cannot afford them.

I asked Nafeesa if there was one thing she could pull out of the air to add to the clinic, what would it be? Her response was immediate.
“I have always wanted to run a nutrition centre. A place where we could assess children and look for signs of malnourishment; a place where essential foods like maize, beans, ground nuts and eggs could be provided for them, free of charge.”

UNICEF claims that 1/3 of all child deaths in Ghana are due to undernourishment. Further that 57% of children under five years of age are anemic. I later learnt of a NGO which had in the past established five nutrition centres in the district, but due to a lack of support from the government, upon the departure of the NGO, the centres collapsed. Quite a neat example of sustainable development.

The barriers facing maternal health include difficulties in the up-scaling of services especially at district levels – the dazzling variety of languages in Ghana makes it harder for healthcare workers from different areas to engage with mothers. There are other limitations; from the non-medical costs of transportation not being covered; to ones that are amalgamations of limited education and poor health-seeking behaviours. There is also a dire need for a better regulatory framework to provide a refreshment of knowledge and skills for staff members. Another health worker I interviewed spoke of how inexperienced women are largely unaware of the protocols in the hospital environment and view them as a means of punishment rather than attempts to help their work. 

“Many women are simply repelled by the idea of undergoing a physical examination.”
But this is no grand unveiling. Such hesitation is not uncommon in conservative societies. Sensitizations to the public, made by volunteers and nurses, can help reduce and fade away such fears.

It is encouraging to know that most maternal deaths are preventable (with the majority being due to Post-Partum Haemorrhage). It is also good to know that the maternal mortality ratio in Ghana has decreased over the past 20 years, especially following the opening of 2 training schools in Tamale for aspiring  midwives. But in these statements, we mustn’t forget how such snapshots assess the country as a whole, and so the truth for regions like the Upper East gets lost somewhat in the haze of assumed overall progress.

Written by Sabeera Dar (Team L.I.F.E. UK volunteer)


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