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Child Survival Part II: At the Bangabaya Health Clinic
It's a Tuesday afternoon in late April, and I am at the Peripheral Health Unit (PHU) in Bangabaya, a small community in Kono District. The town is not much more than a clearing of mud brick buildings that emerges suddenly, a one hour drive off the main highway, out of the dense bush, but it is fortunate enough to have a PHU and a school building.
When I arrive, about 30 to 40 women--new and soon-to-be mothers--from the surrounding communities are sitting on rows of benches in the PHU's main room while traditional birth attendants (TBAs) in patterned skirts and head wraps sing and dance. Their songs contain messages about safe motherhood and encourage women to come to the PHU for antenatal care and delivery. The songs are the routine start to the pregnant women's support group that convenes monthly at the PHU to ensure that local women receive proper medical care and support during their pregnancies.
Sierra Leone has some of the highest rates of mortality and morbidity for new mothers and children under five in the world, in part because many women do not access medical care for themselves and their offspring during their pregnancies or after they give birth. Even fewer make it to a PHU for the delivery. According to the Maternal and Child Health (MCH) Aide in Bangabaya, only one or two women a month give birth in the facility, despite the high numbers who attend the pregnancy support groups. Women who do not give birth at PHUs are usually assisted by TBAs in their homes; unfortunately, the TBAs lack the drugs and equipment to deal with complications during delivery. If things go terribly wrong, it can be at best difficult and at worst impossible for the Koidu Hospital's ambulance to reach the women in their villages.
This day, I am at the Bangabaya PHU with Dorice Manasseh, IRC's Child Survival Coordinator, to learn about IRC's new pilot project to encourage women to deliver at the PHU. After an introduction by the MCH Aide, Dorice addresses the pregnant women directly, asking why they and other women in their communities do not come to the PHU to deliver. The most common response is the distance between their communities and the PHU. Dorice announces that the Bangabaya community, with support from IRC, is constructing a traditional mud brick house next to the PHU for pregnant women. When it is completed, women who are expecting to go into labor can stay at the house for a few days and then access the PHU for delivery.
In addition to increasing access to the PHU, IRC is working to provide high quality care at the PHU. IRC has posted a midwife to the Bangabaya PHU, redid the maternity ward (including providing lights powered by a solar panel) and is supplying basic drugs and supplies for emergency obstetric operations. The hope is that by easing access to the PHU and providing top-notch medical care, more women will come to the PHU to give birth and maternal and newborn death rates will drop.
As usual, however, there is one question on everyone's lips: will the community and the government be able to maintain these improvements after NGO support ends?
