Maternal and Newborn Health: Breaking barriers in rural Uganda

Here’s the account of how the training he received through the Royal College of Obstetricians and Gynaecologists (RCOCG) and the Kitovu Health Care Complex partnership – funded by THET – has changed the way he works and the experience of so many mothers in rural Uganda.

The sun was just beginning to rise over the eastern shore of Lake Victoria when our trip began. Destination: Mannya, a small village situated about 160km from Kampala. It takes us more than four hours to finally get there, through endless plantations of corn, coffee, tobacco, and forests shining emerald, mint and lime green, such as I had never seen before in Africa. It is clear to see how generously the Katonga River irrigates these lands.

On the way to Mannya we pass through a number of small villages: simple huts made of straw and wood, a well here and there, and many young women and children at the edge of the road, staring at us with curiosity, sometimes waving at our car. The last 9km are the worst: it rained only a couple of days ago and the road – more like a mudslide – is almost impassable. It gives us a taste of the kind of difficulties that people from the nearby villages have to face when seeking care at the Health Centre we are on our way to visit.

The buildings of St. Bernards do not look as I was expecting: the health centre is composed of about ten ordered small houses with sandy beige and scarlet walls, so similar to the colour of the land here. Elegant gardens and hedges surround the buildings. At the entrance, waiting for us is a very tall man, at first glance I estimate 6.5 feet probably. He has steady hands that he opens in a hug-like gesture to welcome us, and a calm smile. His name is Vincent, director of the centre and our guide for today.

Vincent, a clinician from Kampala, has been working in this rural area for four years now. His first words are filled with the sense of pride he has in showing us around and it becomes obvious how dedicated he is to his work. We start our visit. Vincent introduces us to his colleagues, mainly nurses and midwives, whilst explaining the activities of the centre and why offering maternal and child care services is so crucial in such an isolated area of the country.

When I first arrived here, one of the main challenges was to convince pregnant women to even visit the centre! There are so many barriers involved. Fertility rate is high in the region.[1] When a mother delivers her first, second and even third child at home with no complications, she thinks that she doesn’t need any kind of support. Sometimes they would like to come here, but don’t have any means of transport and travelling would be either too long or too expensive for them. Sometimes they are just ashamed of their poor clothes. We have been working closely with the community to help these mothers to understand why it is important to seek care during pregnancy and after giving birth.

The situation that Vincent describes seems to be very common in other areas of the country as well. As Theo, Clinical Officer at the Kitovu Health Care Complex, who accompanies us during our visit, explains:

The fact is that today in Uganda only 42% of mothers are attended by skilled health workers. The cause is what we call here ‘the three delays’: one for socio-economic reasons; a second one for geographical barriers, and finally because once the mothers have finally decided to seek treatment they might not find a skilled health worker or a health worker at all!

The training that Vincent received through the RCOG-Kitovu partnership addressed this problem, by underlining the importance of building a relationship based on reciprocal trust with the patients.

Mostly people were scared of coming to the centre. The training taught me how to speak to patients in the right way. And at the same time I could teach colleagues here how important it is to treat patients respectfully. Things are slowly changing.

I can see what Vincent is describing first hand. Today it’s Wednesday, and the maternal clinic is open for consultation. The waiting room is filled with young women: some of them are heavily pregnant, others holding their babies in their arms. The health centre welcomes 20 to 30 women every week. On average, 21 children are born here every month. Apart from regular checks, new patients are also tested for HIV/AIDS, in a small lab adjacent to the clinic. The rainy season is at the door: a particularly tough period for the health workers at St Bernards, because of the increased number of patients with severe malaria.

The patients look with insistence at the Nikon camera that I am holding. One woman, wearing a bright orange shirt, asks me to come closer to take a picture of her baby in her arms. Vincent explains that she had twins and I can hear a baby crying. It’s the other twin being examined next door. Other patients seems less happy to see me taking pictures. I feel like I am intruding, so I move swiftly out of the waiting room to another area of the clinic.

It is a very small room with a simple bed in the middle and two windows. In a corner some surgical tools – mainly scissors from what I can see – a box of latex gloves, disinfectant bottles, some drugs. There is no machine or any sophisticated equipment. I am surprised to learn that this is the operating theatre. Vincent seems to notice the surprise in my eyes and rushes to explain that only minor procedures take place here, such as suturing, circumcisions, and of course child deliveries.

“Even though we do not do any major interventions here, the real problem is the lack of operation lights… sometimes if a delivery happens at night we can barely see what we are doing! It can be dangerous for the mother and the baby” Vincent explains.

Inevitably I find myself thinking of the things we take for granted back home and how the lack of those very things can make the difference between life and death here. Vincent invites me to join him in his office where he uses his last minutes with me to tell me about the training he received through the health partnership and the way it changed his practice.

“The most important thing I learnt is the use of the partograph, to monitor the labour, and to refer the mother in case of complications. I trained in a regional referral hospital where using this tool is not common practice. But during the training at Kitovu Health Center Complex I realised you can’t ensure the patient’s safety without one. So I came back here and enforced its use. Knowing that something is wrong with the mother or the baby in time is crucial, especially here when it takes time to organise transport and to reach the closest hospital.”

It is almost time to leave, the road back to Kampala is long, but I have one last question for Vincent: “What is the thing you are most proud of?”

With no hesitation, he replies: “That after the training I was chosen to share the skills acquired with others. It was very exciting to train senior midwives who, in spite of their experience, were keen to learn new things. The partnership leads said they were looking for people who had performed well and showed enthusiasm during the training, I can’t believe they picked me!”

I can Vincent.