By Sophie Ndungu
Maternity Nurse, Malindi District Hospital
Teaching More ‘Safety in Pregnancy & Childbirth’ Program Director
My patient is 32 years old and has had three deliveries with no living baby. Her first delivery was at home and was a vaginal delivery where the baby was born dead. Her second delivery was a c-section where she ruptured her uterus and bladder and the baby was born dead. Eventually she was discharged from the hospital to go home. At home, she noticed she was leaking urine but not much. She had no idea this could be repaired because she thought it was normal. Her third delivery was also a c-section. Once she arrived at the Malindi Dictrict Hospital, where I work as a nurse, we immediately took her to the operating theatre with a diagnosis of one previous c-section and a ruptured uterus. The third baby was already dead, the uterus and bladder were re ruptured. The uterus and bladder were repaired in the hospital.
While in the hospital, we noticed her fistula (ultimately a hole between the vagina and bladder, which causes an uncontrollable and constant drip of urine from the vagina) and how she was always in a mess of urine. Nobody wanted to be near her because of the bad odor. One day when I was working on the night shift, I went to her bed and we talked a lot. After listening to her story, I found out that during all of her pregnancies she had abdominal massage as early as 3 months into the pregnancy and continuing every day up to 9 months. When she went to have a massage, she was told to not eat anything so that the TBA can easily locate and turn the baby. The massage is done using coconut oil, paraffin, and warm water. When the baby is difficult to “turn” using hands, the massage is done using the heel of the foot.”
After all of these massages, my patient has no living baby. Her fistula is beyond repair, and she will leak urine for the rest of her life. Her husband was killed in tribal clashes and her house was burned down. I feel something has to be done by going into the villages where the TBAs are. I feel that after several visits and talks with them, we can change this world. I hope to see more babies born alive rather than dead.”
A NOTE ON ‘ABDOMINAL MASSAGE’
by Danielle Kellem, Teaching More Executive Director
“Abdominal or Maternal Massage” is one of the many problems that plague the tribal women of Kenya. Because of the complete absence of education of the TBAs or “ village midwives” these dangerous and superstitious practices continue. “Massage” obviously causes a multitude of problems including infant death, maternal death due to hemorrhage, ruptured uterus, ruptured bladder, cracked bones, etc. Fistulas are among the long list of problems as well. Women with a constant uncontrollable urine leak soon become shunned and ostracized by the tribe because of the odor. There is no education about how to prevent it or that it can be repaired.
The TBA’s that we have trained have been overjoyed and eager to learn. They have begged us to come back and teach more. They crave the knowledge. They want to be taught.
It may seem a little extreme or idyllic that by teaching them and talking with them “we can change the world” but really, to these women, that’s exactly what it is.