In South Sudan women shun hospitals despite childbirth risks

Posted November 6, 2011 by Ugandan Diaspora News Team in Featured ~ 3,181 views


By Jocelyn Edwards, Special to the Star ~ Lushi Rashid throws her arm up in the air, stretches out on the yellow sheets and ululates in pain.

“Jiijiijiiijiii,” she cries as the contractions grow stronger, emitting the high-pitched trilling noise that South Sudanese women make to show emotion.

Sitting on a stool at Rashid’s bedside, midwife Regabia Ahmad shushes her. “It’s not good to shout,” she says gently. “If you shout there is pain; if you don’t shout there is pain. So you keep quiet.”

Though she lives near the country’s best public hospital in Juba, South Sudan’s largest city, the 29-year-old Rashid has decided to have her baby at home with a midwife.

“At the hospital, everyone is trying to do something to make the baby come when it is not yet ready,” she says. “At home. . . there are not so many people.”

Ahmad, 42, takes off her watch, washes her hands and puts on plastic gloves. The baby will be born in about an hour, at 5:30 this afternoon, she predicts.

Ahmad has been delivering babies for more than 20 years, through the country’s civil war and afterward. She was trained by the state health ministry and works at a local health clinic. Rashid is one of the lucky 10 per cent of women in the country who will see a qualified birth attendant.

With fewer than 100 trained midwives for a population of more than 8 million, South Sudan has the highest maternal mortality rate in the world. For every 100,000 live births in the country, 2,054 women die, according to statistics from the United Nations Development Program (UNDP). It’s a situation the health minister of the East African nation has called “our greatest nightmare.” A woman in South Sudan has a one-in-seven chance of dying in childbirth over the course of her lifetime.

The world’s newest country — it gained independence in July after more than 20 years of civil war — South Sudan is chronically underdeveloped. Even among African nations, where the maternal mortality rates tend to be highest, it stands out. In neighbouring Uganda, for example, only 435 women die for every 100,000 births, says the UNDP. (In Canada, the number is 12, according to Unicef’s 2008 figures.)

Here, “most of the population doesn’t have a health unit and if they do, there’s no health provider and no drugs,” says Dr. Abadallah Mergani, head of obstetrics at Juba Teaching Hospital, the nation’s largest.

On a busy weekday morning, Mergani rushes between making rounds, operating the ultrasound machine and administering the ward. He’s one of only a handful of obstetricians in the country.

The majority of women who die in childbirth here suffer from haemorrhaging and sepsis, treatable problems in the developed world. The absence of qualified medical personnel, along with the lack of health facilities and transportation difficulties — the nation has only 50 kilometres of paved road — can render otherwise minor complications fatal.

And a lack of medical supplies means doctors are sometimes unable to help even those women who do make it to the hospital. “Some even die while we are looking for blood,” says Mergani. The hospital has no blood bank.

Since the end of the civil war in 2005, there have been efforts to reduce the maternal mortality rate, but the country has a long way to go. “In some areas you are starting from the ground up,” says Gillian Garnett, a midwifery specialist with the United Nations Population Agency.

The agency has a recruitment program for midwives but has found it difficult to attract people since midwifery is traditionally considered a low-status profession in South Sudan.

And there are other cultural factors at play. Even where hospitals are accessible, women often choose not to go to them.

It can be seen as a sign of weakness to give birth in the hospital. “Women feel that they have to show strength,” says Garnett. “In the hospital, they feel like you are pampered.”

Furthermore, “it’s the culture that a lady should deliver at home with her family around her, her mother, her grandfather, her sisters,” says Mergani.

Accordingly, standing over Lushi Rashid in her bedroom are her aunt and sister.

Her 3-year-old son has been shooed outside by the midwife, but he peers in the window. A neighbour pops her head over the fence to check on the progress of the birth.

Rashid’s mother enters the bedroom and sprinkles water over her daughter’s abdomen. It’s a blessing for the good health of mother and child. There’s no need for her daughter to go to a hospital, Marcelina Dudu believes.

“Before, during the war there were no (hospitals). I had three sets of twins without fear at home. Even Lushi was born at home. They were all born at home,” she says.

The contractions become closer together and Rashid ululates louder and more frequently.

Ahmad reaches under the sheet covering Rashid’s knees and, almost before the others in the room know what’s happening, pulls a baby boy out from between the mother’s legs. After a second, he emits a strong, healthy cry.

The midwife wraps the baby in a purple blanket and consults her watch. Just as she predicted, it’s just a few minutes before 5:30.

Mama Dudu pulls out her mobile phone and calls friends and relatives.

Despite the pain of the ordeal, and the fact that she has four other children, Rashid says she wants to have more. “I want to take some time and then I want a girl because I have all boys,” she says.

Her husband, Amin Rashid, arrives home about an hour later. He’s been at work; men rarely attend their children’s births in South Sudan.

He knows of women who have died in childbirth but he approves of his wife’s decision to deliver at home. “The hospitals in Juba are poor. All the (government) ministers here, when their wives have one or two months remaining, they go to Nairobi or Kampala (to deliver).”

Collecting her medical supplies, Ahmad prepares to leave. She doesn’t know it yet, but when she arrives home she will be called to attend another birth that will keep her out until the early hours. Given the small number of midwives in the nation, she’s always on call.

Ahmad gets paid for her work as a midwife by the government. But despite long hours and a culture in which government workers often ask for a little something extra from those for whom they perform services, she doesn’t charge the families.

She sees her work as a kind of vocation. “If you give me something, I will take it; if you do not give me anything, I do not ask. This is the work God gave me to do.”

About the Author

Ugandan Diaspora News Team

Ugandan Diaspora News Online is an independent, non political news portal primarily aimed at serving Ugandans who work and reside outside Uganda. Our aim is to be a one stop shop for everything Ugandan and the celebration of our Ugandan heritage.


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