When Emily Namarwa, 28, started experiencing labour pains, Perez Khaukha, 42, her husband, of Buweswa village in Bulumera parish, Bwikonge sub-county in Bulambuli district encouraged her to push the baby.
This was Mrs Namarwa’s sixth child and Mr. Khaukha was convinced that since the five children before were delivered at home without the help of a qualified medical personnel Ms Namarwa would successfully give birth. The labour pains intensified as her husband kept telling her to push. When she could not push any more, she lay on ground silent and started bleeding.
Although everyone was busy preparing what to eat on Christmas Day, Mr. Khaukha rushed for his old bicycle and together with the LCIII chairman Mr. Paul Kimamati wedged Ms Namarwa who was half dead on a bicycle and took her to Muyembe health centre IV, the only district referral in Bulambuli, just about 11 kilometres away to seek medical attention.
They pushed on furiously for three kilometres through the bushy village paths of Buweswa village, to the muddy and almost abandoned road for about 4 kilometres. But at Bnambutye health centre, there was no medical worker, no medicine and they had to move on towards Muyembe health centre IV.
On reaching the main road, Mr. Khaukha’s relief quickly turned to despair when the young mother collapsed and died.
Mr. Khaukha’s traumatic experience is not unusual in rural districts of Uganda, where the healthcare system is inaccessible despite the billions of shillings of mostly donor money flowing in every year.
Visits to a few health centres in Bulambuli district reveals a chronic shortage of beds, drugs and medical personnel, confirming a recent verdict by the Anti-Corruption Coalition of Uganda that “service delivery and general care is almost not there”.
The LCIII chairman of Bwikonge Mr. Paul Kimamati says that this is the sixth mother to die this year in the rural inaccessible villages of lower Bulambuli were health services are unavailable because of a lack of medical workers.
“This death takes it to five maternal deaths which makes the death rate high in under eight months in one sub-county. This lady died because of bleeding and lack of maternity care because of a lack of health units here,” said Mr. Kimamati.
He said that although it was clear she had raised blood pressure a warning sign that she could have the potentially fatal condition pre-eclampsia, the husband insisted that she delivered at home under his care because there was no midwife around or health centre.
The District Health Officer Dr. Mpalya Mwiru Gidale said five direct complications account for more than 70% of maternal deaths: haemorrhage (25%), infection (15%), unsafe abortion (13%), eclampsia (very high blood pressure leading to seizures – 12%), and obstructed labour (8%). While these are the main causes of maternal death, unavailable, inaccessible or poor quality care is fundamentally responsible.
“I know over 72% of the people in Bulambuli deliver at home without the help of qualified medical workers just because the health centres are far, inaccessible and without medical workers but this particular woman should not have died because of bleeding, we are saddened but now that we have got a District Service Commission, we are going to recruit staff to move through the villages to sensitise pregnant women,” said Dr. Gidale.
“It was an avoidable death because even at Muyembe referral hospital, we would have referred her to Mbale because we don’t have staff, even medicine to help complicated cases,” added Dr. Gidale.
The LCV chairman Mr. Simon Wananzofu revealed that inadequate quality and number of health workers, poor roads, inadequate power supply and high illiteracy levels are some of the major causes of maternal death in in Bulambuli district.
“Uganda is one of the countries with the highest maternal and child mortality rates in the world and these mainly occur in rural inaccessible areas but Government is slow in curbing maternal death, efforts are needed to reduce maternal mortality rates. The district has a population of about 192,000 people but the entire district has one doctor who is most of the time in administration, about four clinical officers and a 23 enrolled nurses and midwives at some of the health centres in the district,” said Mr. Wananzofu.
He added that district has one health centre IV, four health centre IIIs, 8 health centre IIs without qualified medical workers and two private health centres one owned by the community while the other is owned by UPDF.
The government admits that the situation is dire. Lack of adequate resources is still limiting hospitals to provide the services expected. In many instances, basic emergency infrastructure, supplies and specialised equipment are inadequate, reads the latest annual health sector performance report.
The Government has proposed interventions in emergency obstetric care, which addresses causes of maternal death. These are bleeding, sepsis, unsafe abortion, hypertensive disorders and obstructed labour.
According to the annual health sector performance report 2011, an estimated number of 6,000 women die annually while under-five mortality rate stands at 137 out of 1,000 births.
