Men’s input has seen maternal health improve in Narok County

Jackson Lekutit (right) admires his newborn son as his wife Jane and other children look on Ongata Nado in Narok. PHOTO | VERAH OKEYO

What you need to know:

  • The local community is very traditional, with the man’s word basically law, so it began with barazas to educate them about the importance of family planning and the need to encourage their wives to go for antenatal check-ups.
  • Gradually they began accepting modern medicine instead of traditional birth attendants. This has seen a decline in childbirth-related deaths.
  • The women do not know about contraceptives, and even when they do, the man makes all the decisions, so it is pointless asking them to plan their families when even their identity cards are kept by their husbands.

When Agnes Jabit of Olopirik village in Narok suffered obstructed labour in 1982, the traditional midwives who had come to help her kept her at home for three days, scolding her to “stop being lazy and just give birth”. As a result, she developed fistula and was forced to wear nappies, which she could ill afford. The condition also crushed her self-esteem.

Sadly, there are at least six women in Olpirik village with similar stories, some as recent as 2013.

While Narok County does not record as high a number of maternal deaths as other regions in the country — 191 in every 100,000 according to 2013 data from the Ministry of Health (although  Christian Aid placed it at 435) — cultural practices tend to override science and modern medicine.  As a result, women in dire need of basic health services rarely seek them.

Esterine Nenee, Narok County’s health executive, told DN2 that few women in the region attend antenatal clinics.

“They have to get permission from their husbands, and if the man is not bothered, they do not come,” she said.

This makes it difficult to help them when they eventually seek professional help at a health facility, she said, adding, “When you ask them when they had their last period, they turn and look at their husbands.”

But apart from this retrogressive culture, it is clear that the area suffered serious government neglect for a long time.

And although the county government is working to avail  health services to within a radius of five kilometres to most people, some people still have to seek such services 68 kilometres away.

BORROWED KINDNESS

John Leposo, a nurse at Ongata Nado Dispensary in north Narok, knows what these inadequacies mean. He was given only Sh15,000 by the county government to buy medical supplies for three months, yet he serves a very large  area.

When DN2 visited the dispensary recently, he had run out of 5 ml syringes and had  had to beg for some from a private facility in Narok Town, which could only spare him smaller ones.

 “When I want to inject 5 ml of a drug, I use three syringes because I can only draw two, then another two and finally, 1 ml,” he explained.

The dispensary also lacks gauze, cotton wool and gloves.

Nevertheless, he has recorded 31 successful deliveries in the small, two-room facility since  December 2014.

Leposo is too embarrassed to seek any more help from the hospital that usually bails him out.

“I sound so needy, I feel like I am abusing their kindness yet I am the one working for the government,” he said.

Whenever he refers patients with complications to the facility in Ntulele, 30 kilometres away, he feels apprehensive because it could be the last journey the patient makes.

The roads are impassable, even in all-weather vehicles.

He would love to resign and work elsewhere but said he has never gathered the courage to do so.

“There are times I have returned from a day off, only to be told that a mother came to the clinic and delivered outside the door without any assistance,” he said.

Wiry Asige, a the co-ordinator of a maternal health programme run by the Anglican Church of Kenya in the expansive Narok County, empathises with Leposo. 

He says the money his church receives from Christian Aid, a European non-governmental organisation, to run the maternal health programmes in Narok, is not enough, but acknowledges that it has helped many women.

The church also has 11 ambulances for taking expectant women to the hospital.

An expectant woman is helped by a man and a traditional birth attendant to board the 'ambulance' Motherpack to deliver at Olokurto Hospital in Narok County. PHOTO | VERAH OKEYO

REPULSIVE IDEA

In addition to the headache of poor infrastructure and inadequate medical supplies, there is also the issue of traditional birth attendants (TBAs), elderly women with no formal or medical education, but in whom the local women put great trust. Indeed, such is their faith in TBAs that only 26 per cent of the women attend the recommended four antenatal clinic visits.

According to the National Aids Control Council data of 2012, there were about 1,256 HIV-positive pregnant women in Narok County in 2011, 85 per cent of whom did not deliver in a health facility.

County Reproductive Health Director Nenee takes a pragmatic approach to the issue of TBAs: “The government was nowhere in sight when the women were groaning in labour, the TBAs have been there doing all they can to make the woman comfortable,” she said.

But well aware of the risks involved in TBA-assisted deliveries, Nenee decided to exploit their grip on the local women to attain her goal in reducing maternal mortality. So she came up with an unexpected proposal

“I told the county director of health we had to work with the TBAs,” she recalls.

They were appalled by the idea, repulsed even, but she convinced them.

“I told them that it would take 100 years to eradicate the trust these women have in TBAs because they are the only people they have seen go out of their way to see them deliver safely, not nurses in white dust coats and gloves,”  she explained.

So, with funds from the church, Nenee sealed a deal with the TBAs in 2013.

“For every mother the TBAs accompanied to the clinic for antenatal care and delivery, they were paid Sh500,” Nenee explained. In addition, they developed a curriculum for training TBAs  on how to  examine the mothers and newborns to make sure that they were feeding well, effectively making the TBAs  the ministry’s link with patients.

Naraman Lakutet, a 57-year-old TBA, is thrilled about the partnership, and not just because of the economic benefit; she underwent a three-day training on how to examine an expectant woman and how to tell that she  should help the woman get to the hospital even if her estimated time of delivery had not reached.

FEMININE MATTERS

She said the training opened her eyes to the threat of the “disease”— meaning HIV— of which she was now very conscious.

“I was afraid of getting HIV, but I could not sit here and watch women so I am glad I can take them to the hospital where they will not bleed too much”, she said.

Naraman takes pride in the fact that some of the children she has helped deliver are in Standard Six, and some have even been named after her.

Another issue the county government has to deal with is slow uptake of contraceptives.

Ministry of Health data indicate that contraceptive use in Narok County had stagnated at 21 per cent for a long time.

Nenee has an explanation for this: “The women do not know about contraceptives, and even when they do, the man makes all the decisions, so it is pointless asking them to plan their families when even their identity cards are kept by their husbands.”

With her male colleagues, Nenee and the church introduced what effectively  revolutionised gender relations in the region: they started holding barazas where men were taught about “feminine affairs” such as the need for family planning and why they should help with household chores when their wives deliver.

The results were remarkable: contraception intake in Narok shot up from 21 per cent to a 47 in just three months.

But even when the men were willing to help, they were inefficient at the job.

“When a woman delivers, her husband comes to the hospital with a flask with milk, but no cup, spoon or a basin,” Nenee said.

To solve the problem, the church provided a mother pack, which contains a basin, towels, cotton wool, sanitary towels, spoon, cups and soap.

The packs  has also had a positive effect: at Olokurto, a level 3 hospital,  nurse in charge ,Rodgers Matara reported an increase from two to 15 deliveries in a month.

 

Nurse Rodgers Matara showing some of the items contained in the mother pack. The packs were introduced after it was realised that men who came to see their wives who had delivered did not bring any of the items a mother with a newborn needs. PHOTO | VERAH OKEYO

 

ENGAGING MEN

How involving men has helped

NAROK COUNTY’S approach to maternal health brings to the fore the importance of involving men. As seen in the area, the fiercely patriarchal Maasai man is gradually changing into a gentler man, who is sensitive to a woman’s health needs.

He’s no longer reluctant to get involved in “feminine” matters, so he’s persuading his wife to embrace contraception, as well as accompanying her regularly for her antenatal check-ups.

In Oyarata, in south Narok, John Ngurumwa’s sister-in-law lost her twins in 2000 due to obstructed labour, a fairly common occurrence  in a region with a poor road network and few health facilities.

During an informal meeting, he was taught about the importance of antenatal check-ups.

“It was sad for me, she suffered a lot… as a man, you have to put on a brave face, but when I remember her, I would not want any woman to go through that”, he told DN2.

Not far from Ngurumwa’s homestead, another man says that he wakes up in the wee hours of the morning to carry water for his wife, who is in her last trimester.

While, he would not confess to his peers that he cooks, he says  he is glad to do it because, “I was told at the hospital that a woman faces certain risks if she overworks and walks long distances in that condition.”

Since the men got  involved, the number of successful deliveries in a health facility with a qualified health worker has also increased.

Nenee Esterine, the county’s health director is elated. “If only we had realised earlier that men held the key to success in curbing these deaths,” she said, adding, “A women can come to the hospital complaining that she is sick, only for her husband to announce that he thinks she is pregnant.”

OUTSIDE LOOKIN IN

Reports from the Ministry of Health  last year indicate that only 30 per cent of the county’s 850,000 people have access to the most basic maternal health services, and due to other factors such as deplorable road networks and ignorance, only 17 per cent use these services.

Jackson Lekutit, a father of four in Ongata Nado, said his wife, Jane, had just had a baby and as soon as she recovered, he would take her to the clinic so that they can plan their family.

Lekutit is one of the men who have been part of the programme rolled out by the county government in partnership with NGOs to teach men about the need for family planning and other issues related to maternal health.

Lekutit, who says that he participated fully in  helping his wife’s  during her last pregnancy, told DN2: “I saw another woman deliver without pain and when she left the hospital, she was not bleeding… Jane suffered through her other pregnancies so I wanted her to have a different experience this time round.”

Medical anthropologist Prof Omar Egesa, a lecturer at  Moi University’s Department of Anthropology, says involving  men  in maternal health is “the most effective method” in resource-limited areas such as Narok.

 “Most of the much-needed medical interventions have failed because outsiders come and impose their ideas on people whose lifestyles they know nothing about,” he noted.

“In Maasailand the man is a respected authority and a woman believes what her husband says because it is only from the man that they have  a steady source of counsel,” he explained.

Nenee said that the government had also failed before because “even the examples given to men were too foreign”.

She said: “You do not come talking of mansions, cars…ask the man if he can prevent the goats from giving birth during the dry season using that hand-made skin apron, whether he could do that to the woman too.”

The county government has developed a curriculum for men’s barazas. 

The men’s involvement so impressed Christian Aid that it donated a tuk tuk ambulance to the local community, which the men fuel in turn, to take expectant women to the hospital.