In the maternity ward of Dolo Ado health center, Ethiopia, Doctors Without Borders/Médecins Sans Frontières (MSF) midwife Aisha Akello has an emotional discussion with a woman sitting on the hospital bed. Unlike the rest of the women in the modest ward, lying next to their newborn babies in their respective beds, Rabiya Osman, 23, is all by herself. She looks weary and pale. She seems a bit inattentive to what the midwife is saying—lost in deep thoughts of her own. Shyly, she looks into the midwife’s eyes and nods her head. Two days ago, Rabiya went into labor at home. She lives just two hundred meters away from the health center, but she had an obstructed labor that lasted hours and began to bleed excessively. The traditional birth attendant couldn’t help. Rabiya lost her baby and lost consciousness.
“When she was carried to the health center by some relatives she was on the verge of death,” said Akello. “She was bleeding excessively; her blood level was very low and she was unconscious. We managed to stop the bleeding, but she was already severely anemic, we needed to do a blood transfusion. Unfortunately, her family was against it. When she regained consciousness, we spent hours trying to convince her and her family, but all our efforts [to convince them to allow transfusion] were futile.”
Rabiya’s story is not unusual in Dolo Ado. “Many women are against major lifesaving procedures in the maternity ward, such as blood transfusions and Caesarean sections,” says Akello. “By the time they make up their minds to accept the procedures it is often very late, when either the baby is dead or the mother is in critical condition.”
In this region, a deep-rooted traditional belief that it is safer to give birth at home than in a health center causes many women to shy away from institutional delivery. Moreover, the fact that men, not women, have the right to make decisions on health matters further complicates the situation. Because of this, important health decisions often take a long time—time that could have been used to save the lives of the women and their children.
Akello has worked as a midwife for more than 13 years. For seven of these, she has worked with MSF in different countries including Uganda, Nigeria, South Sudan, Sudan, and most recently Ethiopia, where she started working in the south before joining the Dolo Ado project, in Ethiopia’s Somali region.
“We lose women to conditions like obstructed labor, pre-eclampsia and eclampsia antepartum, and postpartum bleeding—which we can handle, but just because they come too late our capacities are limited,” says Akello. “Had these mothers arrived in good time, we would have saved their lives and their children’s. I feel very sad to see women die from avoidable conditions just because of lack of awareness. It’s heart-breaking, and sometimes I stay up at night, just contemplating what has happened and pondering ways to find a solution to prevent these avoidable maternal deaths.”
In December 2014, MSF initiated a program that brings traditional birth attendants (TBAs) together to work as educators in its community health promotion. Eleven TBAs were identified and trained, and each was deployed to one of Dolo Ado’s 11 villages. Reports show that since they started conducting health promotion activities, deliveries in the health center shot up from an average of 18 to 20 a month to 50 to 70. For example, there were 54 deliveries in March, 70 deliveries in April, and 51 deliveries in May at the center. Community health workers accompany mothers to the center to help the team conduct health education on maternal and child health, and also help to bring mothers to the center for delivery and antenatal and postnatal care.
This is a step in the right direction, and one that Akello hopes will continue to increase the number of mothers that come to the health center for deliveries, antenatal and postnatal care, and to get immunization for their children.
Dolo Ado town is located in the Liben Zone of Ethiopia’s Somali Regional State. The town’s population is around 130,000 people. MSF has been working in Dolo Ado since 2009, providing primary and secondary health services at the Dolo Ado Health Center. MSF, in coordination with the Ethiopian government and UN High Commissioner for Refugees (UNHCR), provides medical and humanitarian support to Somali refugees in the Buramino and Hiloweyn camps.