Cold sweat broke out in the unlikeliest of places the moment the call came through – the girl had gone into labour as feared. Threatening to deliver in the community, Atchulo’s worst fears were just about to come true.
A dedicated young male Community Health Officer in the part of Ghana better known as “overseas” due to its geographic access issues or the lack thereof, Atchulo would later recount this as his most memorable and most professionally challenging experience in his few years of practice in the Pudua sub district of the Nanumba South district of Ghana’s Northern region. From the first signs of the bulging pregnancy in the girl, Atchulo had not failed to recognize its danger signs. Accordingly, he had outlined a plan and advised her to make adequate preparations to deliver in the District hospital. In labour in the community however, other considerations had held sway, or so it appeared.
On arrival at the girl’s father’s house, he heard how the laboring had been ongoing for hours. The girl was exhausted and sweating, not to mention baying in pain. Atchulo’s diagnosis didn’t change. Neither did his prescription; hospital delivery— which is where he came face to face with the afore mentioned considerations. The laboring girl’s father was however adamant; he would nary deviate from the soothsayer’s advice. As it turned out, a soothsayer had simultaneously been consulted throughout the duration of the girl’s pregnancy and more importantly, shortly after the onset of labour. In the girl’s community, such soothsayer consultations were commonplace for myriads of reasons; to determine the sex of the baby, to court spiritual favor and support during labour and last but by no means the least, to help decide where to deliver— the facility under the supervision of a skilled health worker or at home under the supervision of a family member, magazia or a community birth attendant. Though not the case in the girl’s instance, there were times when a home delivery was advised to help determine a laboring woman’s fidelity to her husband. A good woman would have easy and safe delivery as her reward whiles the unfaithful woman was expected to suffer greatly - her suffering only alleviated through confession inclusive of mentioning the offending concubine’s name!
To Atchulo’s horror, the soothsayer consulted by the girl’s father had recommended home delivery thus sharply contradicting him. His profuse sweating worsened. He pleaded and pleaded with the girl’s father to allow him to send the girl to the hospital. The elderly man refused, at which point, Atchulo became emotional and burst into tears. Faced with Atchulo’s relentlessness, the father finally relented, with a caveat. Prior to delivering the forewarning however, he insisted on marching Atchulo to the village chief’s house and with the former as witness, placed the following on record: “Young man, the life of my daughter is in your hands. You will be held fully responsible if anything untoward should happen to her when she goes to the hospital!”
As it turned out, some real negative perceptions about health facility delivery could not be ignored –among which was the belief that at the hospital, one was exposed somewhat to evil forces compared to the safety and comfort of home delivery. Others included many women taking pride in home delivery as a demonstration of their strength. Poor health staff attitude was also one of the factors.
The irony contained in the father’s caveat notwithstanding, Atchulo was grateful for this dark opportunity. With poor mobile telephone coverage as his next bottleneck, he climbed an anthill to improve signal reception to enable him summon an ambulance from the National Ambulance Service. When it arrived, he accompanied the woman first to Bimbilla and then to the Tamale Teaching Hospital where he bumped into Dr Gandau who had mentored him a few years earlier during his rotation.
“What brings you here my friend?” Dr Gandau asked. Atchulo narrated his emotionally tumultuous day, ending with “Doctor, I am really hot. The life of this girl is in my hands. If something bad happens to here, I cannot return to my village. Please help us.” Wasting no further time, Dr Gandau quickly assessed the girl, rushing her afterwards to theatre for an emergency caesarian operation with safe outcomes for mother and baby. The day the girl was discharged home safe and sound; Atchulo became an instant hero in the village!
Reflecting on the above at a gathering of health professionals and community leaders at a meeting convened to improve faulty referral processes accounting for the deaths of mothers and newborns, the following actionable change ideas were generated during a brainstorming session: to intensify community education on safe delivery, to consider offering domiciliary midwifery services where possible, to engage in consultations and negotiations with community opinion leaders long before a woman went into labour as part of contingency planning.
Finally, came the suggestion to reach out to soothsayers as key leverage points in the decision making processes in what some community leaders referred to as a “psychological strategy.” The strategy was defined as being respectful of soothsayer views and practices while encouraging skilled delivery. Perhaps two processes could be run in parallel: encouraging male decision makers to freely consult with the soothsayers for spiritual support etc. while removing themselves as bottlenecks to deliveries under the care of skilled midwives given the unlikelihood that the gods will at any time soon, take a position against safe motherhood.
Ghana has a gap between the over 90% of pregnant women who diligently access antenatal care and the 57% that eventually deliver in facilities under the care of skilled health professionals. Also significant is the current shortfall of over 5000 midwives nationally, with over 50% of the current number above 55 years. In the Nanumba South District where Atchulo works for example, the population of almost 80, 000 is served by only two midwives without a doctor in a system that is perhaps perfectly designed to secure the bad maternal and neonatal outcomes being currently recorded. National human resource systems redesign is urgent and imperative if significant changes are to happen by the 2015 millennium development goal timeline. In the meantime as we mull these weighty matters, the positive attitudes, dedication and commitment of the Atchulos of this country ought to be noticed, named and celebrated as some diligently apply themselves to brightening their respective corners in the quest to make a difference.
firstname.lastname@example.org 5th October, 2012