An investigation by Nyasa Times reporter on circumstances surrounding death of the then 21-year old late Alesi Makwinja indicates a spotlight of health authority’s negligence but also a positive portrayal on child survival.
One morning, last year, in the typical rural community of Mangwere village, Traditional Authority Kuulunda in Salima District, one pregnant woman late Alesi Makwinja walked few metres to her nearest health centre – Lifuwu. She was admitted in the labour ward for delivery.
Upon monitoring her condition, the medical personnel examined her further and saw a need for the service of a government ambulance to transport the then pregnant woman who was patient from the health facility to a district hospital, a distance of 30kilometres.
A-60-year old grand granny, Celina Ashimu who was guardian to late Alesi says, “The nurse on duty upon seeing complications on the patient, she gave us referral and called for an ambulance around 10pm on that day but it never comes. We waited almost five hours and we were asked to find own transport because we understand the ambulance had no fuel at that time.
“We convinced a local transporter to pick us on loan which we have not repaid yet. He charged us MK15, 000 to transport the patient and we arrived at the referral hospital around 4am, the following day,” says Ashimu.
Delivery and maternal death
Few hours upon arrival at Salima District Hospital, a new born named, Favour Makhakhisoni was born with 2.6kilograms weight but the mother (Late Alesi) was weak due to prolong labour and heavily breeding which started previous night. She was later taken to theatre after medical personnel requested blood donation from relatives.
They got another referral Salima to Kamuzu Central Hospital in the capital Lilongwe, which is a distance of about 98.2kilometres where Alesi was pronounced dead.
“We were driven to Lilongwe by a government ambulance which never comes the previous day. We are very sad with the negligence that caused death of our relative. It is very unfortunate that the ambulance did not come at Lifuwu health centre due to fuel shortage but to our surprise the same ambulance had fuel to take us to Lilongwe the following day,” says a 43-year-old Cecilia Sanudi.
Sanudi said, “Late Alesi was walking by herself to the community health facility and when being transported to the district hospital. After delivering her baby; she was put on stretcher, oxygen and when travelling to Lilongwe she had a pint of blood on one hand and another drip of glucose on the other hand.
“Until today, we have not been told the actual cause of our relative’s death. We don’t know where to go and complain when such incidence happen. We are appealing to government to priotise provisional of ambulances on time to all pregnant women whenever a need arises.”
Centre for Human Rights and Rehabilitation (CHRR) an organisation which strives to achieve empower rural and urban communities on issues of citizen’s rights, roles and responsibilities says it is very unfortunate that people do not know where to go when such incidents occur.
CHRR, Advocacy Coordinator, Fletcher Simwaka says government should priotise availability of ambulances to all pregnant women if there is a need. He said; it is unfortunate that such incidents are happening whilst there is a campaign to change fatalism to hope; apathy to action; maternal survival from side-issues to political priority; and best guesses into hard facts.
“How can we reduce maternal deaths when communities affected and front-line health providers are not consulted, an in-depth investigation on this matter is necessary in order to improve care,” says Simwaka.
Evidence for Action (EA4 Malawi) a programme aimed to achieve the vision where every pregnancy is a safe experience for mother and baby; launched a public action campaign called, ‘MamaYe’ which allow the active participation of the Malawian public to reframe the issue positively and to empower the wider public to take responsibility and act for maternal and new-born survival.
Information sourced on ‘Mama Ye’ website says maternal death is a notifiable event in Malawi. Maternal death audits are regularly performed at the district level; however, a national commission on confidential enquiry into maternal deaths is not yet functional. Pilot projects in establishing community death reviews have been introduced by different stakeholders, but linking community/ district level efforts to national structures has not yet been attempted.
Maternal death reviews capture information on the number of maternal deaths and examine the factors that led to these deaths. Information gathered from them, if acted upon, can create the change needed to improve the quality of health services and help avert further deaths.
Establishing accountability systems within community, district and national levels will include developing and implementing accountability tools, a feedback loop to ensure that action is taken, based on evidence and findings. These accountability systems will be key methods for holding different stakeholders to account on issues of quality of care, financial resources, human rights and more.
Despite a sad maternal death incident there is a positive portrayal because the child survived. As a neonatal – Favour who is the eleventh person in the house grew through hardships. Members of his family are the aged; divorced and widows who are sisters of the diseased and some orphans who are cousins. His grand granny is in hard poverty as they get a single US$1 dollar in every three weeks.
As a neonatal – Favour who is the eleventh person in the house grew through hardships. His family members are the aged, divorced sisters of the deceased and some orphans who are cousins. His grand granny is in hard poverty as they get a single US$1 dollar in every three weeks.
“I make mats to get income but the process takes us three weeks to process one mat. I sell each mat at K800 and the money; is used to buy goat milk in order to substitute with breast milk. As a family, we had low harvest last year due to climate change but Favour is now a grown-up even in situation of the rooming hunger,” says Sanudi adding that, “a nurse who gave us referral at Lifuwu she also gave us some advice on how we can take good care of him and our secret has been just following the health care instructions.”
Favour’s cousin a 3-year-old Mizamulu Chimeka also grew without sacking her mother’s breast because the parent was diagnosed with HIV during his birth.
In 1988 the World Health Organisation (WHO) made a film based on lecture by obstetrician Professor Mahmound Fathallah tittled, “Why did Mrs X Die?” It is now almost 28years after releasing this film which is aimed at raising awareness of millions of mothers and babies dying each year from pregnancy and childbirth. But the capacity to do maternal death surveillance and response (MDSR) in Malawi is still limited yet reporting and reviewing every maternal death to guide action is vital to improve care.Follow and Subscribe Nyasa TV :