17 October 2013

Guest Post: Having a Baby in Kinshasa

This post is a challenge.  

You will see photos that might make your pity-sensors go wild.   Resist. 

Because these pictures represent success.  They prove that Western ideals of fancy equipment, pretty rooms, or even completely germ-free operating rooms aren't necessary for a baby to be born safely.  The seven clinics that you see below represent some of the most hopeful maternal and infant mortality rates around in a country well known as 'the worst place to be a mother.'

This is a guest post by Ruthie Schaad, who has been working with moms and babies in Kinshasa for years.  She is a fellow Labor & Delivery nurse (we get to call ourselves that forever, right?) and has a long and close working relationship with seven local maternity clinics in Kinshasa.  I could listen to her stories forever.  Here's a little glimpse into what it's like to be pregnant and give birth in urban Congo...

Even with the odds stacked against it, childbirth in Congo can be safe for both mother and child.

Although the biological process of birth is the same the world over, the experience of it varies widely. In Kinshasa, mothers look forward to welcoming their newborns just as mothers do the world over and children in Congolese society are by tradition, revered in families. Many women give birth in neighborhood health center maternities (clinics that specialize in mother-baby care) where the facilities are basic and often run down. 

The entrance to Liboke Center.

In spite of this and the lack of hi-tech equipment and supplies, these places can be vibrant with dedicated, competent, and trained staff that strive to assure safe care for mothers and babies.

Tshisuaka clinic delivery room midwife with a homemade plastic apron.

The Presbyterian Health Center Maternities of Kinshasa have been providing such care for the past twenty plus years. Each of the seven maternities are located in heavily populated, disadvantaged neighborhoods of Kinshasa, all facing extreme social and physical challenges in a city with inconsistent, if any, city services. This makes for a challenging work environment for health care workers, many of whom are as disadvantaged as the populations they serve.

The receptionist at Tshisuaka, Annie, nursing her new baby at work!

Expectant mothers come on specified days, usually Fridays, to maternities for their prenatal care or “kilo” (meaning kilograms of course but referring to “weighing in” or “check-up”).  There is a specified national standard for prenatal care. Individually, each woman sees a nurse or midwife for the usual checks and basic lab work is ordered and done on site. The mothers receive iron and folic acid pills, specified, periodic doses of Fansidar for malaria prevention, Mebendazol for intestinal parasites and Tetanus vaccinations during pregnancy.  In centers affiliated with a mother to child prevention of HIV/AIDS program, the mothers will have the choice of receiving voluntary testing and counseling and treatment at a referral center if this is necessary. An ultrasound is generally ordered although not all women can afford to pay for it.  At some point during the weekly checks a group discussion will be held by one of the midwives on a topic related to pregnancy and childbirth.

Not a prenatal class, but another group education opportunity:  Immunization Day at Tshimungu Clinic.

Women are taught, among other things, to prepare a birthing kit and what basic supplies to put in it  including an ample piece of used cloth that should be washed and ironed and will be precisely folded to be used as the first maternity sanitary napkin (little access materially or financially to disposable ones).

Nurses from Liboke Clinic with Safe Motherhood Kits.

The centers have  mosquito net distribution programs for expectant mothers administered through the health zones and the maternity wards have nets for each bed, something that was not always so. Prenatal visits improve outcomes for mothers and babies so are strongly encouraged as are well child clinic visits.

Mosquito protection and a full house at Boo Nsuba Clinic.

The simple and sparse labor and delivery rooms are usually next to each other or in the same room together, expectant mothers walking between the two. Women generally labor alone with no support person other than the nurses and midwives; significant other men, for a variety of practical, habitual and cultural reasons, are not welcome.

Delivery room at Boo Nsuba Clinic.

Delivery room at Centenaire Clinic

Once having given birth, the new mother is helped to dress and then walked to the nearby maternity ward which tends to be one main room. Meals are brought in by family members and new mothers are taught and expected to wash their own soiled clothing as an infection prevention mechanism. 

New mother washing clothes.

It is an accepted and expected natural norm that mothers will breastfeed their babies, even twins or triplets. Mothers and their babies stay in the ward for around three days, although some find themselves staying longer as family members put together enough money to pay the bill. 

Baby washing at Boo Nsuba Clinic

Yes, except in rare circumstances, mothers are not discharged until the bill is paid. Paying the maternity costs is probably one of the biggest stressors of giving birth for these women.  Depending upon the center, uncomplicated births cost between $10 and $45. A C- Section costs around $200.

A mother and her new baby - less than one hour old!

Six of the seven health centers and maternities have a doctor working on site or on call and if needed can perform emergency caesarean sections or other surgical interventions. If possible, the physician sees and examines expectant mothers on their first prenatal visit. Surgeries are done in sub-optimal conditions with minimal equipment and supplies but nevertheless save lives.

Operating room at Mayamba Health Center.

Transfers to a bigger, more equipped, hospital is the ideal but so often not possible in the middle of the night when it is not safe to go out on practically impassable secondary roads. There are few functioning ambulances that will venture to such places or that could even get to them and the use of them can be a bureaucratic headache. In addition, there are more costs involved in a transfer; a big deterrent for patients and their families that stall things into becoming life and death situations.

The centers have managed to keep providing services in spite of huge economic short falls. They strive to maintain fees at accessible rates in order to serve their needy populations.  Health care worker salaries are based upon center production, thus salary expectations are a constant roller coaster. Amazingly, given the odds, staff like their profession and are motivated by the ongoing desire to serve their patients, many driven by a Christian faith that is reflected in their daily life and work. It is noteworthy that in the city of Kinshasa, having one of the highest maternal mortality rates in the world, in 20 years of operation these maternities have had a total of only 5 maternal deaths in their facilities.








Text and photos by Ruthie Schaad.


6 comments:

  1. Amazing statistics there at the end. Thank you for sharing!

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  2. Ruthie, I just read this post for about the 10th time today. Wow! These centers are so impressive and I love, LOVE reading about sustainable, good things happening in Kinshasa.

    My biggest question, however, is what on earth is your trick for getting Congolese people to smile in photos!? It took me a while to realize that this is one reason this post struck me so.

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  3. This didn't make my "pity-sensors" go off at all! It was a wonderful look at how dedicated individuals can make a significant difference (those stats are awesome!). Plus, it makes my heart go mushy to see the devotion those mothers have for their children. Thanks for sharing!

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  4. Ruthie, I loved seeing the pictures and reading the story. I am still sad we didn't make it to one of the clinics to the the amazing work being done to care for the women of Congo. Next time!!

    Melissa

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  5. seeing the gloves airing on the rail obviously after being rinsed, ready to to be used again makes me realise the things we take for granted, thank you for this insight

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  6. great post! Although I haven't yet been sick (or pregnant), I always appreciate the dedication of health workers in this region of the world!

    Also, I love how fabulously dressed all the women are in the immunization clinic. Including the mother an hour after birth...

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