Archive for March, 2010

A woman’s first
clinical delivery

The pain was intense, coming at short intervals. She touched her stomach, remembering what the doctors had told her during her visits to Kathe Medical Care. Consolanta Kebikari was in her ninth month already, any sign of pain could mean contraction and that the baby was coming. That is what the midwife Helen Tukundane had told her when they were going through her birth plan, a blue booklet marked “Passport” given to expecting mothers attending antenatal care.
This felt like what ‘musawo’ Helen had said. In fact, it was what she had felt the eight other times when she was going in labour.
She had planned this one and wanted everything to be okay. She had even sold her last two chicken to raise enough money for a boda boda (bike) ride to ease movement to the medical centre when the baby came. Kathe Medical Centre where she was booked is 15 kilometres away from her home in the hills of Kibaale parish in Isingiro district. It is the nearest medical facility to her home.
Getting there from Mbarara takes a two hour’s drive on a ragged pothole filled Mbarara-Kabale High Way which is undergoing construction. The available means of transport to Kebikari’s house in the hills stops travellers at a sign post that says welcome to Ntungamo district.
Then villagers like Kebikari find their way into the hills often on foot because they cannot afford the boda boda fare. The road that snakes around the hills is ragged, steep and dusty.
If and when the baby comes at night, mothers have to walk down hill to the nearest government facility Itojo Hospital, 25 kilometres away.
So mothers like Kebikari often prefer to stay at home in the hills and deliver at their homes. This is sometimes with the help of neighbours, a traditional birth attendant if one can be afforded and yet sometimes alone.
Kebikari had her first child 12 years ago in her two roomed mud and wattle house roofed with papyrus.
“I didn’t have money to go to a hospital” she says. When the second one came she stayed in her house and still delivered, and so was the case with the third.
All three have now grown up but don’t go to school because she cannot afford sending them there. School means money for books, uniform, lunch, shoes, writing material and all the additional costs the teachers demand for.
On her next pregnancy she lost the baby during delivery at home. So she tried again and lost that one too. And yet again she lost another two. All neonatal deaths. But she kept trying and on the eighth, she delivered a boy at home in 2007.
She knew that the gods were on her side and so she decided to try for another child to make them five and replace the ones she had lost.
She conceived again. And yet she still had no plan of ensuring the child’s safety by going to a medical facility.
One day a chubby man, Kenneth Kayema called a village meeting at Kibaale trading centre. He was wearing a blue apron that said Healthy Baby.
Kayema told them the words mean “Omwaana wamagara amarungi” and went on to explain the benefits of delivering a healthy baby under the care of a skilled birth attendant.
Like Kebikari many women in western Uganda had never afforded the care of a skilled birth attendant, doctor, midwife, nurse, clinical officer. At the start of March 1, community health distributors were contracted by Marie Stopes International under the Out Put Based Project to visit districts of Mbarara, Kiruhura, Isingiro, Ibanda, Lyantonde to teach mothers about a new affordable option.
They would identify expectant mothers who would be assessed if they qualified to merit the cheap option, the Healthy Baby Voucher card, a pilot project in western Uganda.
That is how Kebikari learnt of the Healthy Baby project when Kayema was talking about the affordable healthy option for mothers and their unborn child. He called it the healthy baby voucher, to the villagers ‘kacardi ka baby’.
Kayema told Kebikari to buy the card for Shs 3000. It entitled her to four antenatal visits, a normal or caesarean delivery at a health facility and postnatal care.
“She had no money to buy a voucher so I went back several times,” Kayema says.
She asked the distributor to buy her two small chicken to pay for the card.
“She paid for the card in instalments. She first paid Shs 1000 then later finished with Shs 2000”
Her husband is mostly concerned about his leisure with friends in the evening.
It doesn’t take a genius to know that Kebikari is a peasant, the surroundings of her home paint a clear picture.
When we visited a happy woman emerged from inside her mud and wattle house with a big smile to welcome the visitors.

She recognised Kayema who was asking to see the baby. Consolanta Kebikari’s two roomed house stands by the roadside.
She says her husband owned the land around but sold it off piece by piece until they remained with the small piece where the house sits, a toilet right in front of the house and the compound. Drying under the sun are four mats stained with urine which her children use as mattresses.
The view from her compound is of beautiful big plantations of matooke, pineapples, potatoes, tomatoes. She is only a porter on these farms. To survive, the family hires land from other people where they plant and share proceeds with the owner of the land.
So when that expected date in April came, Kebikari jumped on to the boda boda and rushed to Kathe medical Centre. The midwife immediately checked her but she was not ready— all false alarm. She waited at the centre as she couldn’t afford to go back home only to return later.
When two days passed, the Clinical Officer and proprietor of the centre Kamugisha Asaph took her to Mbarara University of Science and Technology for a scan.
“They put me on the TV and I saw the baby inside,” Kebikari says with much joy of her first time to see a scan.
They returned to the centre after confirming that the baby was fine but just late. After four days she delivered a bouncing baby boy. She tells of how the nurses and midwives took care of her, showed her what to do, gave her free medicine, food.
A month and a half later the baby doesn’t have a name, she calls him Atuhaire (God gave us) as she waits for her husband to choose a name.
She runs into the house and returns with a beautiful healthy boy wrapped in tattered pieces of cloth. Mother and child are both healthy and fine. For now she wants to join family planning she heard about it during postnatal


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