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DRC: MSF facing obstacles in providing maternal care
A woman crying in pain arrives at the very modest mud-brick health centre. Suddenly, Carolina Jiménez and her MSF colleague, Dr Fidel Kiza, hurry out of the tiny office to attend to the mother in labour.
“This child had a miraculous escape. A few more minutes and there would have been no one to resuscitate him,” explains Carolina Jiménez, medical coordinator of the Médecins Sans Frontières/Doctors without Borders (MSF) mission in Minova, near Lake Kivu in eastern Democratic Republic of Congo (DRC).
Little Zawadi has just been born but is not breathing. His mother has already given birth to five children, including at least one C-section. It was a high-risk pregnancy and the mother arrived too late.
“The head of the baby was almost out and he was about to suffocate,” says the doctor a few minutes later. Despite the dangerous birth, both mother and child are fine. Now, everybody smiles.
This episode is commonplace across the country, yet the outcome is not always as good as this one. According to the World Health Organisation, 21,000 women died last year in DRC due to complications during pregnancy and childbirth.
That is one every 25 minutes.
The three delays
“The three delays in maternal health identified in the 1990s apply perfectly to Congo,” says Patricia Lledó, MSF gynaecologist and expert in reproductive health.
“The first one refers to the delay in making a decision because women fail to see that there is something wrong in their pregnancy. The second delay affects their arrival to the health centre. And the third delay is in receiving proper, timely care at health centre level because of the lack of human or material resources,” she explains.
One of the main results of these shortfalls is that health facilities are difficult to reach. According to UN figures for 2004, DRC barely had one doctor per every 10,000 inhabitants, most of whom are based in big cities.
The lack of health infrastructure means that mothers who deliver at a health centre have to walk for hours to the nearest medical facility.
Manishimue, 20, had to walk for four hours from Chambombo to the health centre in Shanjé to give birth to her second child. Now, she is lying on a bed in this small maternity centre located in Minova.
“They sometimes arrive from as far away as Bunyakiri, an eight-hour walk,” says Jackson, a member of the awareness-raising team in this remote and not easily accessible area."
High costs and difficult journeys
“They sometimes have a closer health centre, but they know that in the MSF-supported centres they will receive quality care for free,” Jackson adds. The 1,000 francs (roughly one dollar) it costs for a consultation can be a problem in one of the poorest countries in the world, where the annual income per capita is barely $400.
The lack of resources means that many patients cannot afford the required drugs. That creates room for irregular drugs that usually do not comply with security and quality controls.
Braving the transport difficulties, high-risk patients are referred to Numbi, where there is a better prepared health centre, and cases requiring surgery or transfusions are transferred to Minova – a more than two-hour motorcycle ride along a mountain road quite risky for any passenger, but even more so for a pregnant woman.
Mothers trapped by tradition
But while the problems posed by lack of access is not easy to solve, the delay caused by traditions that are deeply rooted in local communities are even harder to address.
“In the towns, you can see a little progress but most of the population live in rural areas and are stuck in a backwardness stemming from poverty and illiteracy,” says Dr Dina Dunya, a member of the MSF national staff in Minova.
Beliefs that a mother who does not give birth at home is a weak person still very much prevail. There are also many traditional healers in a region where diseases are thought to be witchcraft.
“Often delivery care simply consists of telling women to squat by a tree and push,” adds Benjamin, an MSF health promotion coordinator in the area.
Cultural factors make Congolese women so dependent on their families that sometimes they cannot leave. “In Congo, women lack decision-making power with regards to their health, they need permission from their husbands even to go and see a doctor,” explains Dunya, an expert in sexual and reproductive health.
‘It was a miracle’
Barbara, 25, was born in Hauts Plateaux, and came to Minova when she was pregnant with her fifth child to attend the antenatal clinics.
She decided to leave the health centre against advice to look after her children. When her labour pains started, her neighbours took her to hospital, but the situation was extremely serious.
“Her uterus was ruptured, probably due to a previous C-section scar, and the child was partially out. It was a high-risk situation,” recalls Carolina Jiménez.
The hospital teams in Minova managed to extract the baby, but the mother almost bled to death. Three surgical interventions and blood transfusions were needed to stop the bleeding.
“It was a miracle, she barely managed to survive,” Jiménez explains. Today, Barbara is slowly recovering at the hospital in Goma, the biggest city in the area. She can hardly hold small Rahema, yet she wants to go home to “look after her family”.
MSF increasing awareness of important services
Despite the enormous difficulties, the efforts made by the authorities and the humanitarian organisations in DRC have succeeded in increasing awareness among young mothers of the need to go to the health centres before and during childbirth to avoid having to hope for a miracle.
Safi is at the maternity unit in Numbi after delivering her fifth child. “I have delivered all my children in health centres. Before, having your children at home without any medical care whatsoever was seen as something perfectly normal.
"However, more and more young women realise that here we and our babies are properly looked after. This is what we have to do.”