By Augustine Aminu
Labaran Ihiabe, a resident of Emewe-Opada, in Dekina Local Government Area of Kogi State, lost his wife Aiyishatu during childbirth many years ago and the experience was not a good one and till today, he is yet to recover from the rude shock.
He said his wife suddenly went into labour and was complaining of pains around her lower waist and because the hospital was far from Emewe-Opada, it took the intervention of some women in the community to help her deliver the baby, but soon after that, she started complaining of stomach pains.
“She told me she was bleeding. I called one of the women who was there during the childbirth and she confirmed to me that my wife needs urgent medical attention. We started making arrangements for a car that will convey us to the hospital. For us to get to nearest hospital at Ochadamu, it will take up to 30 minutes because the road is bad, and most times if it is a market day, most vehicles are not usually available till evening when traders are returning from the market”, he added.
He recalled that it took him almost 1 to 2 hours to get a vehicle to convey his wife and at that point she was already losing too much blood. “We couldn’t get any First Aid and while on our way to the hospital, she gave up the ghost. That was how I lost my wife. If we had medical assistance on time, my wife would not have died”, he explained.
Notably, Ihiabe’s harrowing experience is however symptomatic of the high maternal mortality ratio in Nigeria, particularly in rural communities where healthcare facilities are very few and far between. It is estimated that out of over 30,000 Primary Healthcare Centres (PHCs) across the 774 Local Government Areas (LGAs) in Nigeria, very few have what it takes to cater for the health needs of its citizens.
Consequently, this trend has inadvertently worsened the maternal mortality burden of the country. Statistics by Maternal Figures, a database of maternal health interventions implemented in Nigeria in the last 30 years, indicate that more than 50,000 women die during childbirth in Nigeria every year.
The situation in Emewe-Opada community became so scary and worrisome. At a point most families suffered similar fate to the extent that out of every 10 childbirths, at least 6 or 7 women lost their lives. This ugly trend persisted until people in the community collectively resolved to take the bull by the horn and change the narrative for the common good.
Speaking in an exclusive interview, Mrs. Ojonugwa Joseph, a 28-year-old mother of 4 children who lives in the community with her family said in the past, marriage was scary to young women in the village because of the rate of mortality during childbirth.
She also noted that most pregnant women in the community travel and stay with some relatives in the city to get medical attention during their pregnancy, only to come back once they have their babies.
“It became a thing to worry about because you could see a girl of marriageable age but has refused to get married for the fear of death during childbirth. The story is not the same today as the community can boast of, at least a medical facility with medical personnel who attend to us, except for complications and most times it’s very few.
“I had all my children in the village facility. We were well attended to, and the health workers encourage women to attend antenatal. During this period, we are taught about food combinations, the kind of work to do and the ones we should avoid”, she further disclosed.
Mrs Joseph said physical exercises are done regularly by pregnant women in the hospital any time they visit the hospital for checks, adding that they are also given medications regularly except when it’s not available.
“We wait till it is available then we will be called upon to come and take them. The health workers here are very much on ground but we still need the government to come to our aid by providing more medical personnel and drugs. The distance to Holy Memorial Hospital, Ochadamu is far and because of the bad road, it is still a challenge especially when there is an emergency in the village”, she stressed.
A front view of the community clinic
Narrating how it all started, the community leader (Igago) of Emewe -Opada, Mr. James Idih said the case of maternal mortality was high in the community as so many women and children had died in the past due to lack of modern medical facilities in the community. Adding that the only hospital at that time, that the whole community go to for treatment is the one at Ochadamu, a neighbouring town.
The 57-year old leader noted that most women who have died during childbirth were not supposed to have died, noting that it was a big problem for the community because once a woman is pregnant, everyone becomes apprehensive until she gives birth.
“As a community, we discovered that if we continue like that, we will wake up one day without women in the community. We came together and allocated a piece of land that should be used as a hospital. Every family in the community contributed money which was used to mobilize the youths to clear the land and transport some of the elders of the community who paid visits to Dekina, the local government headquarters to see and discuss with the chairman how health workers can be sent to the community”, he disclosed.
He said during that period, the community started financing some of their children who were seeking admission to go to School of Health at Idah, adding that was this is was to enable them come back to the community to assist in handling health-related issues.
“Even when we had gotten the land, it took some of us to start calling some of our children in the cities to also send financial or material contribution for the project of the hospital before we got assistance from the local government.
“During this period, some of the students who graduated from the School of Health have started helping out with health issues, especially childbirth. The mortality was reduced by 40 percent and today the community is enjoying the sacrifices we made 8 years ago”, he added.
Mr. Idih stressed that with the exception of serious complications, pregnant women in Emewe-Opada now can breathe well knowing that they will have their babies and they will also be alive to see their children grow.
“We are still in dire need of help from the government in terms of drugs and other modern medical equipment to also make our health center standard”, he further stated.
Community women solidarity and support
Under the current dispensation, women from the community have been very supportive in terms of assisting and encouraging their fellow women to seek medical attention at the hospital, especially during pregnancy.
One of women leaders in Emewe-Opada, Mrs. Lydia Abdul said since the community elders and opinion leaders decided to come together to speak with one voice by ensuring that the community now have a hospital, which has been very helpful in reducing maternal mortality drastically, the women are also playing their part to improve the situation.
“What the women did in their little way was to always help every one in labour by coming around to help take her to the hospital. In some cases, the women even contribute money to pay the bills for pregnant women.
“Sometimes, our relatives in the cities help by sending medicines, home. We usually appeal to them to help us supply medicines especially for women and children. Once it is finished we make calls again. Our roads are bad and we are still hopeful that the government will come to our aid to aid easy movement.
“We have a hospital now though not a perfect one, through the efforts of our men who rose to the occasion. We have a doctor now who helps in taking care of some of the medical needs of pregnant women in the community”, she added.
The 68-year-old women leader also pointed out that sometimes the nurses that come around to help the doctor, come from outside the community because the village is not conducive for them to stay, adding that they are not around most times.
“Another challenge is that since the hospital is not equipped, some families who can afford big hospitals take their relatives ahead of their due dates to cities to give birth to their babies, while others stay back to give birth here”, she further stated.
She further said that members of the community have also resolved that once a woman is in labour, any available vehicle within the town at that moment will be used to convey the woman to the hospital in the case of an emergency.
These community-driven efforts are in sync with the findings in an article published in the July 2020 edition of the International Journal of Tropical Disease and Health. The article which reviewed the effectiveness of community interventions in improving maternal health outcomes in the West African sub-region, revealed that such interventions resulted in the reduction on maternal mortality in Ethiopia and Nigeria, which declined by 64 percent and 43.5 percent respectively.
Health experts also agree that the inherent possibilities in community-based intervention makes it an attractive option that can be replicated, particularly in difficult-to-reach rural areas.
A Consultant Public Health Physician, Dr. Augustine Ajogwu noted that community intervention is needed to empower women, ensure early identification of pregnancy problem and seek help.
Dr. Ajogwu, a staff of the Department of Public Health, Federal Capital Territory Administration (FCTA) Abuja, said Community participation is also key to sustainability of the intervention.
Speaking in a chat, the medical doctor working with the Emewe -Opada Community Hospital, Dr. Ogohi Yusuf, said one of the major challenges is the lack of medical facilities.
Dr. Yusuf, who has been posted back to serve in the community for the third time since he gained employment with the Kogi State Health Board, noted that the first time he came to Emewe-Opada, there was not even a place called the hospital.
“This was the situation I met on ground. I was using the sitting room of the first house I stayed in, as the clinic. At that time, most people go to Holy Memorial Hospital, Ochadamu for medical needs while some people still depend on the traditional midwives.
“The mortality rate at the time I came was very high but after I met with the community leaders and some stakeholders in the community, the people were able to provide the land where we have the cottage hospital today.
He also noted that finance is another major issue in the community. Adding that most times the pregnant women don’t even have money to buy some pregnancy care drugs that are prescribed for them.
“We give them the drugs on credit most times, hoping to pay later and in most cases, we forgo some of the money such persons owe us. And once the drugs are finished from the dispensary, we have to wait until the government provides again, which usually takes time.
Manpower is also another problem in health care delivery here because most people posted here don’t stay or work their way out to go to more developed places. So, most times, the work here is beyond one person”, he stressed.
Call to action
Dr. Yusuf said the government has done well by identifying that these communities need medical attention and posting medical personnel there to work. He however, pointed out that this is not enough for the people because without the required medical facilities they can’t do anything.
“We call on the government to make the rural clinics more attractive by providing the required instruments and remuneration that will enable medical doctors stay and serve the people”, he declared.
This story is produced with support from Nigeria Health Watch