Out of every 100,000 live births in a year, 362 mothers die giving birth. And out of every 1,000 live births, 39 newborn babies die. Only 58 per cent of women make the recommended four or more antenatal care visits.* “The major causes of the deaths of these babies are hypothermia that causes pneumonia, diarrhoea, neonatal sepsis and malaria,” says Lucy Kaigutha, 32.
Lucy founded Toto Care Box in July last year, to give away carton boxes to mothers in the slums who’ve just given birth. The box and its contents mitigate the risks that contribute to infant mortality. “It comes with 18 essential items that protect the baby in its first 28 days,” she continues. “The box is also a crib for the baby to sleep in for up to three months. Mothers are taught how to use the box correctly during ANCs, and this is an incentive for mums to finish their four ANCs and give birth at a health facility.”
So what’s in the box? “We have a water-proof mattress, a set of baby clothes and a blanket; cotton wool and an antiseptic cream for cord care; Sunlight soap for promoting hand-washing and hygiene; Aquaguard for disinfecting drinking water, and a mosquito net to drape over the box when the baby is sleeping inside.”
Lucy studied public health and international development for her undergraduate and Master’s degrees, graduating from the University of Sheffield, U.K, in January 2012. She spent the next two years selling insurance and furniture online before returning home in September 2014. Lucy was confident she would get get a well-paying job, but all she got was internship, frustration and volunteer work.
“I’d been to West Pokot in 2011 with my school for a two-week international field class and saw this mother in Marachi village – mid 40s, four children and a newborn, absolute poverty – and you could tell she’d not had lunch that day. I wished I could do more for her.” In 2015 Lucy stumbled upon an article on the BBC website about Finnish babies sleeping in cardboard boxes. It was a 75-year-old tradition. Finnish boxes have 111 items. Finland has the lowest infant and maternal mortality in the world. “I thought, Why not come up with a similar box but for mothers and newborn babies in poor and marginalised communities?” Lucy says.
WITH A LITTLE HELP FROM HER FRIENDS
Lucy set up the organisation as a social enterprise and pulled in four of her friends: Dr Jacqueline Gachihi (a pharmacist who now handles PR and marketing), Helen Kariuki (public health graduate, manages finance) and Dr Angela Kavila-Kwinga (another pharmacist, oversees operations).
They spent the next six months building the concept through focus groups with new mums and consultations with midwives, paediatricians and the Ministry of Health. They gave away their first kitted box in December. It was warmly received. They’ve since given away 82 since. Their focus for now is mums in Mukuru Kayaba slums.
The box itself plus all its contents cost Sh3,000. Lucy and her team have financed them from their own pockets and through crowd funding. “We’ve raised Sh300,000 so far,” says Dr Kavila-Kwinga. Chuckling, she adds, “Do you think you can write our M-changa Paybill number in the story? It’s 891300, account number is ‘totocarebox’.”
In the past year, the team has also realised that they cannot isolate the immediate needs of the newborn from that of its mother. Dr Kavila-Kwinga adds, “At the follow-ups, you find mothers with issues like alcohol and substance addiction, gender-based violence... We cannot say we will look after the baby for 28 days and ignore the condition of the mother. Our plan is to partner with people offering counselling, long-term family planning solutions, proper breastfeeding… so that we are can offer these mums a robust package.”
The next day, Lucy and I go to Mukuru Kayaba slums to deliver 12 boxes to Lengo Medical Clinic, and make home visits to follow up on mums. It’s a gray morning. I meet up with Lucy at her place in South B so we can walk to the clinic. Lucy has kitted the boxes and stacked them at her front door; she’s waiting for the mkokoteni guy to collect them. She and I chat as we walk. “I make these follow up visits every two weeks. I can because Mukuru is in my backyard. When we scale up, we’ll figure out how to do it different.”
We arrive at the clinic 30 minutes later. It’s a slender four-storey concrete structure opened last October. Mums-to-be make their ANC visits and deliver here, all free of charge. Eight mums were discharged that morning.
We meet one of them and her newborn. Irene Adhiambo is 35 with four kids; her new daughter is two weeks old. Irene says she likes the box because her baby can sleep safely inside it, away from her playful siblings, while she goes on with her house chores. “At night, the many mosquitoes won’t bite her. I also really like the cord cream and I appreciate this warm baby blanket.”