TO LOSE A MOTHER…

It is a really tough year for the medical fraternity who have lost four young female doctors in the past four months. What makes it even more painful is that they were all young mothers, two of whom died of direct pregnancy-related complications.

The saddest thing about maternal mortality is that it is largely preventable but unfortunately, we have all not done enough to prevent it. When young women who spend their days trying to stop mothers from losing life, die of the same monsters they are busy trying to slay, it is a sad irony.

Pregnancy is not a disease. It is a natural physiologic state. Approximately 10% of pregnancies will complicate but the vast majority are expected be normal. It is terribly unfair when a mother, whose only desire is to have a baby, ends up in the intensive care unit for weeks on end or spends the rest of her life in a vegetative state because of eclampsia.

As a country, we may have made some strides in preventing maternal mortality but with the resources this country can afford, we should be so much farther. Celebrating a maternal mortality ratio of 362 per 100,000 live births is nothing to write home about in a trillion shilling economy. Maternal mortality and child mortality ratios are regarded as a yardstick for the state of healthcare in a country. Being ranked 30^th worst country worldwide in maternal mortality is nothing to be proud of. It puts us only 29 positions behind South Sudan and 27 behind Somalia yet we haven’t been in a two-decade war.

It is a good thing to see effort and resources being channelled into the fight against maternal mortality but why is all the effort seen in Kenya not bearing adequate fruit? It then raises the question of how coordinated are these efforts? Are they the best investment money can buy? Do we think through our interventions? How many of these investments actually impact on outcomes? We must guard strongly against doing highly popular interventions that do not result in reduction in the loss of life.

Mary* is a 26 year old patient who walked into our maternity unit a few years ago, healthy, happy and excited to meet her first born daughter. She had a positive attitude and a sunny disposition. She laboured like a champ and delivered a beautiful healthy baby girl. But in a space of five minutes, our celebration turned into a nightmare. The baby was whisked away to the new-born unit as we started a monumental fight to save Mary. Suffice it to say, the glaring lack of resources saw us lose this woman. She held my wrist with a strength surprising for a woman on the brink of death, looked me in the eye and said to me, “Thank you for putting all this effort doc, at least I’ll die knowing I wasn’t neglected.” Despite pumping three units of blood into her simultaneously while trying to get her into the operating room, she died without ceremony.

I saw a grown man shed a tear for Mary. He was the laboratory technician who was in the blood transfusion unit. He would prepare the blood and rush it to the ward personally, if only eliminating the delay of someone having to come to the lab for it would help save the life. Mary died as he was bringing a fresh batch of three units for her. He looked like he had been punched in the stomach when we drew a bed sheet over Mary’s face. I will never forget that look. All our collective pain and will would not keep Mary alive long enough to get her on an operating table.

We were denied a fighting chance because we had only one operating room functioning at the time, and there was a patient already in surgery. We were grateful that blood, the rare life-saving commodity, was available for transfusion. Despite great team response, we sorely lacked in numbers. We did not have all the necessary equipment and we did not have an intensive care unit.

These are the requirements needed by the 10% mothers whose pregnancies will complicate. We may invest in ambulances but isn’t it better to just provide resources needed to save life at the point of contact with the mother? We may buy fancy equipment for the hospitals, but without the requisite skilled personnel to operate the equipment, the patient will still die; it is called starving amidst plenty.

For as long as we continue investing in training schools for nurses and midwives, who are our first line of defence in fighting maternal mortality, and once we graduate these precious skills, refuse to invest in employing and retaining them in our health facilities, we are wasting resources! When we train highly skilled doctors and refuse to equip facilities and ensure consumable products are availed to them to enable them to save a mother’s life, as a country, we continue to participate in murdering our mothers.

We missed our Millenium Development Goals by a disenfanchisingly wide margin when we talk of maternal health. We can sugar-coat it all we want by saying we are on track, but the truth is, we are failing terribly and must stop the downward spiral we are caught up in. Let us take collective responsibility for this epidemic that is leaving a devastating trail of pain behind. Our orphans will judge us harshly for it.

Lest we forget the thousands of women who may survive but with heart-breaking morbidities that make them prefer death. Women whose livelihoods have been destroyed and whose families have been impoverished by the costs of taking care of them. Women whose statistics we don’t know because we have not bothered to interrogate them. They live among us yet we ignore their plight.

When a doctor dies of pregnancy complications, forget who she was as a professional. We just lost a mother and a baby is either dead or is orphaned!