Coping with provision of maternal, newborn health care during COVID-19 lockdown in rural Uganda
By Dr Felix Kizito | All mothers and babies’ lives matter even in the toughest of the situations, as medical workers we ought to save lives and support bring life to earth. I have had the privilege to work on projects saving mothers and their newborn babies over time. Serving on the Community in which Mothers and Newborns Thrive (COMONETH) project with support from the UK charity Comic Relief has presented me with opportunity to witness first stand implementation of a community owned project with linkage to the facility promoting high coverage of preventive care improving the quality of client care given the project aim.
We meaningfully engage the community through the Village Health Teams (CHWs) while conducting refresher training through videos on maternal newborn health and support them apply these within communities they live in. There has been a substantial impact ever since the inception of the project in 2017. Mothers in community receive timely health education through VHTs and because of this project they have managed to attend all the required ANC visits but also make postnatal review visits. Before COMONETH, Luuka district in Eastern Uganda had the poorest MNH reviews and now it is among the best districts in Uganda along those lines.
Like the rest of the world, COMONETH project activities have been abstracted by the directives in responses against the COVID 19 pandemic. As a frontline “essential” health service provider I offer emergency obstetric and newborn care at Kiyunga Health Centre IV where I have witnessed immediate disempowerment in the maternal newborn care due to the COVID 19 pandemic. So many mothers have lost their lives due to the restrictions on movement and the frustration that comes with seeking permission to go see a health provider or deliver babies. Many mothers have now resorted to doing home deliveries, delivering with traditional birth attendants or small drug shops casting them into a great risk of death and paying copious amounts of money for very poor quality services.
Due to the support provided under the COMONETH project we have managed to carry out 150 C-sections and 2016 normal deliveries in Luuka. However, these efforts have been crippled by the COVID 19 outbreak. One of the major cases that robbed me off the comfort of my home was a young lady in her early 20s who had died due to inability to access emergency obstetric care, her situation was a bit complicated, first she was alone in the house so at the time of labour pains in the night she couldn’t access transport means to a facility so tried delivering herself hence rupturing her uterus which was as result of obstructed labour. This lady’s case was an eye opener and I made effort together with my colleagues to find my way from Kampala to Luuka to curb preventable deaths of this kind.
With all this urge to save lives, it was dismaying returning to Luuka and there was shortage of emergency drugs, PPEs like gloves, masks and anaesthetic drugs which with the help of the project we managed to purchase without which we would be useless. However, these efforts have not gone unrewarded. We have operated 16 mothers so far, whose stories may have been different if services were absent.
As Ugandans we are aware that all these directives are put in place to shield us from the deadly pandemic. However, before the outbreak, we had numerous health challenges especially concerning maternal and newborn health. As you read this, a mother is dying somewhere due to inability to access the health centre. The three-delay model will show us that more mothers will be dying because of delay 2 which is inability to access transport. Its takes less than 5 minutes a mother to bleed to death, now most mothers in the rural villages lack phones and sometimes they use the husband’s phone. Imagine situation where the husband was locked up in a far district and this lady goes into labour in the middle of the night, surely chances are high that she won’t survive.
Moreover, some health workers running the maternity wards, have not been able to access their facility due to lack of nearby housing facilities and inability to be transported using public means like boda boda to work areas hence cutting off the service to these mothers. Immunisation and antenatal services have been cut off in some facilities due to fear of crowding and lack of PPEs by the health workers.
Therefore, I appeal to the government and the different development actors to devise means extending these services to the community during this emergency period. Like having emergency response teams at the facilities, with special focus on pregnant mothers and newborns. If possible, the district should use VHTs to record all pregnant mothers in the villages who are near their due date and a delivery plan be well laid down in case of onset of labour. This can be done while observing the social distancing guidelines.
*Dr Kizito Felix is the medical officer and co-ordinator of the COMONETH Project.