Life in the worst place to be pregnant

Zeituna Abdi spent two nights on the road travelling from Isiolo to Sericho. At eight months pregnant, the journey took a toll on her. She sought refuge in our car as the landrover she was travelling in was stuck in the mud [GARDY CHACHA/STANDARD]

The journey to Sericho on the border of Wajir and Isiolo counties began on a Tuesday. We were going to meet Halima Guyo and Halima Wako, two mothers who know the pain of losing a baby either before or after birth.

We travelled on dirt roads all the way – most of the time following imaginary routes as we attempted to pick the best stretches of earth.

We were driving in a Toyota Land Cruiser and hoped to cover roughly 300-kilometre journey from Isiolo town in a day. However, due to the bad road we had to spend the night at Gafarsa, about 160 kilometres from Isiolo, and continued with the rest of the journey the following morning.

We bumped into Zeituna Abdi on the second day. She was among a group of travellers in the middle of nowhere – we could as well call it a bush. The Land Rover they were travelling in was stuck in the mud.

She looked weary and exhausted. And this is why: She was eight months pregnant and had been travelling for the last three days.

“Last night was my second night on the road,” she said, asking for help into our car – which was already full of other passengers we had rescued on the way.

“I just need a little space. I don’t want to be here any longer,” Abdi said, appearing not to care much about her round belly. We all squeezed in and created space for her.

The past eight years have been epic for her. Her first pregnancy culminated in a protracted labour in the hands of a traditional birth attendant. The baby emerged but he was disabled.

She then lost her second and third pregnancies – both at six months.

“Losing two children was painful. I needed to know what was wrong but there was no doctor to conduct the diagnosis. The nearest clinic didn’t do much,” she said.

When she got pregnant a fourth time, she travelled to Isiolo Level 5 Hospital. It was the nearest place she could meet a specialist. She did not want to lose another baby.

“The roads are impassable; it is a treacherous journey. In fact, travelers have to arm well with resources just in case you have to spend several nights on the way. You can never be too sure about your arrival,” she said.

In Isiolo, Abdi had to be housed by a well-wisher for a month. She was too exhausted to travel back. But then, in Isiolo, specialists are hard to come by. So, she could appreciate an appointment nearly two weeks later.

“The doctor gave me an injection to prevent another miscarriage. He said the baby was doing well. I can’t rejoice just yet,” she said.

In this part of the world, laments Msallam Ahmed of the Kenya Red Cross Society (KRCS), death of unborn babies as well as expectant mothers is not a shocking phenomenon. “They die and are buried. It is part of life here,” he said.

Ahmed, an officer with Japan-funded KRCS, runs Integrated Health Outreach Project. He said lack of infrastructure is the main factor hampering maternal health in the area.

“There is no tarmacked road from Isiolo town moving interior towards Wajir and Mandera,” he said.

In Mandera, 3,795 women die for every 100,000 live births. The figures have made the county the world’s worst place to carry a pregnancy. The figures for Wajir, Marsabit, Isiolo and Garissa are 1683, 1127, 790 and 646, respectively.

This data by United Nations Population Fund indicates that the five counties – forming the larger North Eastern bloc – are doing badly as Kenya’s national average is 488. Some counties have as low as 85 deaths for every 100,000 live births.

It is approaching dusk when we arrive in Sericho. Halima Guyo still recalls the tragedy that almost claimed her life as it did that of her unborn child.

“Right from the start, pregnancy was difficult. But at five months, my health deteriorated. My blood pressure shot to 230 and the doctor advised that the pregnancy be terminated,” she says.

She was first taken to Sericho Dispensary, which only had a clinical officer. She was consequently referred to Modo Gashe, and then to Garbatulla, and eventually landing in Isiolo at IDH for specialised care.

“I was lucky. I was half dead when I arrived in Isiolo - any longer I wouldn’t have survived,” she recalls. Her womb was evacuated and she lived to tell the tale.

Guyo is happy now because four weeks ago, she gave birth to a healthy baby girl named Amziya Jokar. The baby is sort of a consolation for the pain she suffered.

Hers is a rare “fairy-tale” in this remote part of Kenya: many women in her community are not this lucky. Khadija Racha’s family hasn’t yet got over her death. The young woman died while on transit from a remote place called Eskot, via Garbatulla District Hospital (that couldn’t handle her case) to Maua where she had been referred, a distance of nearly154 kilometres.

Khadija had given birth to twins at home when her health took a turn for the worst. Weak and exhausted from a bumpy ride at the back of a KRCS Land Cruiser, she succumbed with nearly half of the journey to go.

“There is no mobile phone network in Eskot. There is no way to call for help in case of an emergency. The car just happened to be passing nearby and a well-wisher flagged it down for Khadija to be ferried to the hospital,” explains Denge Adan from Garbatulla.

Death – whether it is an unborn baby or an expectant woman – pervades North Eastern.

Makaye Foble from Malka Daka miscarried in May 2014. A similar tragedy befell Halima Abdulahi from Gafarsa in 2013. Halima Waqo from Sericho gave birth to triplets but lost one. Fatuma Abdi, a community health worker, had called Isiolo county government ambulance, which showed up after two weeks.

We ask Fatuma the frequency of gestational deaths in Sericho. “We can’t count,” is all she says.

Finland, according to World Bank data, records only three deaths for every 100,000 live births. Estonia has only two deaths. When she hears of these statistics, Guyo is lost for words, only choosing to ask: “Why can’t we be that safe?”