Nurture the Nurturer

I am seated at the consultation room of one of the busiest health centres at Kilifi district  cheerfully attending to pregnant women who have come for ANC (Antenatal Clinic). There are slightly over 10 of them in the waiting bay. So far, I have seen 5 of them, and am happy with the number that has attended the clinic today. I am a nurse and this is what we love doing. There is no greater joy than the one of seeing a happy mother holding her healthy newborn baby. I clearly understand the pivotal role of effective ANC. Just next door is a queue of about 30 women with their children waiting at the Child welfare Clinic (CWC) room for immunisation and growth monitoring of the children. A few metres away is a young man with a large register book on the table, surrounded by about 20 people waiting to be served.

Sister Chaka, nurses in Kilifi are called sisters, walks in. She is visibly happy as she greets the woman I am attending to then turns her attention to me for the report: Mwanawali Mwadzuma is 29 years of age. She is 5 months pregnant, her blood level (HB) results are out and reading 5.0g/dl. This is her eighth pregnancy; she lost the last 2 babies at around 28 weeks of pregnancy, and was admitted once in the hospital because of severe anaemia .She has delivered all her babies at home. Her current weight is 46kg, blood pressure is relatively low, no bacteria, sugar or protein in urine. She neither has syphilis nor HIV/AIDS. Sister Chaka chuckles and lovingly pats Mwadzuma’s back as she says ‘Mwadzuma, am glad you came.’ She goes on to explain how most pregnant women in this region do not attend ANC. They prefer to deliver their children at home with the help of traditional birth attendants (TBA). She states that ‘The women do not understand the importance of medical checkups during pregnancy, actually, they do not appreciate the importance of taking precaution against diseases, to them, hospitals are for the sick!’

Maternal mortality is the worst nightmare in any clinicians mind. Research has shown that with effective antenatal clinic visits, 99% of all the risks that lead to death of a pregnant woman are prevented. If she delivers at a health facility under the supervision of qualified health professional the risk is reduced further by over 0.8%. Maternal deaths are therefore almost completely preventable through simple cost effective approaches that are incorporated in effective ANC visits. It is unbearably painful when women die of poorly monitored pregnancy that would instead have brought pure joy and bliss. Majority of the pregnant women who seek ANC services are referred by community health workers (CHWs), who consistently encourage them to attend these clinics and follow them up for revisits. ‘These women need constant reminders and follow up for them to come for the clinics, a role that the CHWs are playing excellently.’ The CHW identifies the pregnant women, sends a short message text (sms) with a mobile phone to the health facility for registration and refers the woman to the health facility for ANC.

The clinician sees the client, and schedules the appointment date for review. Just before the appointment day, the computerised system at the health facility sends a text message asking the CHW to go and remind that particular woman to attend her antenatal clinic appointment. This tool has not only increased the number of women attending ANC but more importantly has led to increased number of revisits for ANC that the women make per pregnancy.

Women are natural carers; they are more concerned about the welfare of everyone else in the family and in the society than of their own. They have a multitude of tasks that they perform and thus need to be constantly reminded to attend their clinics. It is a great gesture to them that we are genuinely concerned about their health and that their health is of paramount importance. This woman who has constantly been followed will most likely come to the health facility to delivery her baby. And as mother walks out of the health facility all smiles, the joy reflected on her face as she holds her healthy baby in her arms, is what keeps the Sisters zealous in their work.

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