It’s 9am, a beautiful Thursday morning on Mfangano island. Inside the maternity ward at Sena Level 4 Hospital, we find Esther Odira sleeping on one of three beds. She is exhausted from a dramatic night that began with a call at around 10pm.
“I am a community health volunteer (CHV). I got a call from a colleague from a nearby village that there was a young woman in labour and she needed urgent attention,” she says.
She picked up her leso, hailed a boda boda operator, and off she went – to pick up the expectant mother and ferry her to be attended to at a health facility.
On their way to the hospital, she held onto 21-year-old Viola Atieno, keenly following the progress of her labour.
They made it to Sena and were promptly booked in by the night-shift midwife. At about 3am, Atieno gave birth to a healthy baby boy.
At daybreak, Odira was still by Atieno’s side: keeping her company while she advised her on motherhood.
To be a resident of Mfangano Island comes with risks. One such threat, for a woman of reproductive age, is the possibility that she might not get access to a healthcare worker to attend to her during pregnancy and childbirth.
A study by researchers from Maseno University (Kenya) and the University of Minnesota (USA) found that the most significant contributors to delays in accessing emergency care on the island were: facility closed or staff unavailable – accounting for 46.4 per cent.
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Titled ‘Monitoring Maternal Emergency Navigation and Triage on Mfangano’, the study also found that the majority of patients in need of emergency care arrived at a health facility after 1.1 hours.
The study, which was conducted between January 2019 and February 2020, also draws into question the health-seeking behaviour of the islanders. On average, the researchers found, it took 12.9 hours for anyone to recognise that a patient was in need of emergency healthcare services.
As a CHV, Odira’s primary function is to urge – sometimes even cajole – expectant mothers to seek hospital care. “This is the training I received close to 10 years back when I decided to become a CHV,” she says. “There are many factors that would make one handle an emergency at home but we advise against it.”
All her life she has been a resident of Mfangano. In her days of childbearing, women generally gave birth at home.
“Families that could afford to go to hospital had to get on a boat to Sindo (mainland); a journey lasting at least one hour and 30 minutes,” she says.
In those days, pregnancy-related deaths were commonplace.
“I am a woman. I know what it feels like to be in labour. I know the risk of dying during childbirth. This is why when I was called to attend to this young woman, I did not waste a minute. I knew she needed to be attended to in a hospital setting,” Odira says.
With her son beside her, Atieno could not hide her happiness at being a mother. She too believes hospital birth is safer, and is grateful to Odira for rushing to her aid.
Odira’s quick reaction to Atieno’s plight is especially profound because for someone her age – with grey hair to show for it – it takes a higher level of commitment to leave the comforts of a warm bed to venture into the rural night to ‘work’.
Homabay County Government pays CHVs a monthly stipend of Sh2,000. The amount is minuscule even by Mfangano Island standards.
“We are happy that the county appreciates what we do with the little they give us. But for me, I do this because I think it is my time to give back to my community dutifully,” she says.
A grandmother of 20, Odira is a farmer. Every week, she makes one or two trips around the village to enrol pregnant women for ante-natal clinics (ANC).
The CHVs are equipped with pregnancy test kits, which help them identify pregnancies in the villages and influence the women to visit the hospital for clinics.
Dr Dan Okoro, the Kenya Country advisor on sexual and reproductive health to United Nations Population Fund (UNFPA), says ANCs are critical to protecting the lives of an expectant mother and her baby.
He says: “Through the ANCs, a lot is monitored: the state of health of the woman and the foetus, detection of illnesses such as eclampsia (high blood pressure in pregnancy) – which is deadly, access to supplements such as folic acid and iron that protects the foetus, conducting imaging to detect any abnormalities on the foetus, and general monitoring of the pregnancy.”
The organisation has trained midwives and CHVs in Homabay County; deepening their skills – and collaboration spirit – to attend to pregnant women and save lives.
Mfangano Island is the largest of four islands that are part of Suba North. The others are: Ringiti, Remba and Takawiri. Together they form an administrative block with nine public health facilities, five clinical officers and one resident doctor: attending to a population of 30,943.
The midwives (with the help of CHVs) are often the first and last line of medical care in Mfangano for most of the time.
Just before midday, having rested a bit, and confident that Atieno is no longer in need of her services, Odira takes off, walking back home; almost unaware of the commendable sacrifices she made to protect the lives of a mother and her baby.
Would she do it again? “As long as I am alive and able to move around, I will continue doing it,” she says.