AFRO-NETS> Maternal Deaths Disproportionately High... (7)

["John W. Arube-Wani" <arube@chdc-muk.com>]

Maternal Deaths Disproportionately High... (7)
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Just in case the whole issue is forgotten, one more please!
 
I still don't understand why, in Uganda's case at least, we still 
retain such a huge number of untrained personnel (50%) to man our 
entire health units, and expect mothers not to prefer delivering 
at home, or attended by TBAs? Officially, the MOH seems to have 
maintained a rather shifting position regarding TBAs, yet it has 
not stepped up the training of midwives to manage deliveries in 
our peripheral health units.
 
I got to learn from Sweden that the early intervention of mid-
wives was/is responsible for much of the reduction in maternal 
deaths in that country, as well as the other Scandinavian coun-
tries like Finland. Note that it was not primarily because of 
doctors that the situation improved, so I was told (by midwives 
of course). I don't think we should try to maintain a doc-
tor/delivering mother ratio as a measure of deliveries by trained 
personnel, but rather that of midwife/delivering mother ratio.
 
Whilst I am essentially advocating for the stepping up of the 
training of midwives and nurses (both at enrolled and registered 
levels), to replace nursing aides, I would at the same time sug-
gest that the quality of training has got to be stepped up. Our 
midwives, and indeed all health care personnel must be trained to 
behave in a more client-friendly manner. In our days of nurse 
training (the '60s) the question of ethics and/ or etiquette was 
very much emphasised. These days it seems to rank low, and so the 
behaviour of some of our health workers (including midwives) as 
some studies have shown, leaves much to be desired. So how can 
you blame mothers who prefer to deliver elsewhere, like at the 
TBAs, who incidentally also use more 'appropriate' traditional 
positions for delivery, like squatting? Many of our delivering 
mothers would rather prefer this, to lying exposed on the back 
(lying supine - the Hospital method). Besides, there are many 
other related costs like transport, as well as other supplies and 
sundries, maternity clothing, etc., that the delivering mother is 
asked to bring in her package.
 
There are many more issues to be addressed, including the ques-
tion of supplies and equipment for the health units, but I 
thought it pertinent to look seriously into addressing the ques-
tion of 'appropriate staff' for our delivery services, before we 
could possibly think about what methodologies to use for measur-
ing maternal mortality, etc.
 
Regards
 
John W. Arube-Wani
Child Health and Development
Makerere University Medical School
P. O. Box 6717
Kampala, Uganda
Tel: +256-41-541-684/530-325
Fax: +256-41-531-677
mailto:arube@chdc-muk.com

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