Wardher is a town of approximately 15,000 people situated in a remote part of Ethiopia close to the Somalia border. An ongoing armed conflict continues to destabilize the area creating frequent insecurity for civilians as well as reducing the availability of health services and creating difficulties in accessing those that are available. Médecins Sans Frontières (MSF) is providing free healthcare including antenatal care in the town’s main hospital and through outreach to smaller towns in the area. Hundreds of patients are seen daily, often with respiratory infections including TB, skin conditions, malnutrition and wounds. One of MSF’s primary activities is also caring for pregnant women.
MSF teams are treating pregnant women providing ante-and postnatal care and working to ensure women have safe deliveries. On average twenty babies a month are born in the hospital. Women are often admitted to the hospital with pregnancy related complications, many women arriving at the hospital are underweight, weak and dehydrated not only due to the hard conditions of life but also due to multiple pregnancies with too little time in between each pregnancy.
In this isolated border area according to official government figures only 3.8 per cent of women receive antenatal care compared to 42.1 per cent nationally and only 2.6 per cent of deliveries are attended by a health professional compared to 12.4 per cent nationally. Most women deliver their babies at home or in the bush with the assistance of traditional birth attendants.
In the past women would only come to the Wardher hospital where MSF is working if they had experienced complications in labour. MSF’s team of midwives and nurses say this slowly is beginning to change as more women are coming to the hospital for antenatal examinations and check-ups.
I returned from Wardher a month ago where I spent time meeting MSF midwives, health workers and pregnant women. During the five days I spent in Wardher two babies died after delivery due to complications in pregnancy. One baby died because she was a breech birth. A breech birth occurs when a baby is positioned feet or bottom first, making delivery much more complicated.
Here are some of the stories of women I met:
The midwife: Iman
“In Somali culture women get married young and have many children. Sometimes babies do not survive to adulthood and so women have as many as ten babies in a short space of time. Women are then becoming weak; their bodies are unable to cope with being pregnant so soon after they have given birth and so many of the women who come to the hospital are anaemic and weak. Women and girls often do not have enough food to eat.
When women find out they are pregnant, they are of course very happy but also scared because they know giving birth is hard here. Pregnant women suffer from many health complications. Most of the women I meet suffer from urinary tract infections. Often their husbands have more than one wife and this also increases the chances of them picking up infections and becoming unwell. Most of the patients I see have low blood pressure and don’t practice family planning. They have many babies in a short space of time.
I enjoy working as a midwife, for me it’s important that I’m doing something to help my community. I meet women who walk sometimes for two hours to reach the Wardher hospital despite being heavily pregnant. Women travel from long distances to arrive at the hospital. Often they have suffered a miscarriage and come to see us for treatment.
I’ve noticed that more women are now coming to the hospital to deliver their babies. Before they would have their babies in the bush but now they feel confident of getting good medical care in the hospital. It takes years to change the behavior of people but I feel these changes are good and that women are relieved that they can come to deliver the babies here. MSF is part of our community now and as a midwife I feel proud to be part of the MSF.”’
The patients:
Badoo, 40, from Dolo Zone
“I gave birth seven days ago to a baby girl. I delivered my baby in the bush where I live as I have done with all my previous babies, I have ten children. A traditional birth attendant delivered my baby but soon after I became very sick. I had a very high fever and was shaking uncontrollably. I felt like all the energy was leaving my body. I had been cut very badly and became infected after the birth; I found it painful to pass urine and the pain made me want to be sick and I almost fainted. I told my family that I felt very unwell and I needed help.
My family put me on a donkey cart and it took two hours to get here. The road isn’t good but its sandy and so I was able to cope with the journey even though it was very hot and exhausting. I have been in the hospital two days and the staff check my blood pressure. They have given me medicine and have put me on an oxygen machine. The doctor says I look better now and I feel like I’m getting a little more energy in my body.
This is the first time I’ve become sick after delivering a baby. I don’t want more children. I am tired now. I feel like now I am here in the hospital I will be ok. I was in a lot of pain but every day that I’m here I feel a little bit better. I have to breathe with an oxygen mask on because I’m still weak. If I had stayed in the bush and not come to hospital I don’t know what would have happened to me.”
Amoon, 35, from Wardher
Amoon gave birth to a baby girl in Wardher hospital on December 3rd.2012.
“I have five children, two died shortly after birth and two are still alive. This is the first time I delivered my baby in hospital. I came here two days ago for the delivery. I found the birth difficult and painful but what was more painful was when the midwife had to pull the placenta out (manual removal of placenta). That was the worst pain. My babies, two of them have died shortly after birth. I know this baby is sick because I can see the midwife spending a lot of time with my baby. I hope she survives and I can take her home. If it is Allah’s will for her to survive she will and if not then I accept it.”
Amoon’s baby girl died in the hospital on December 4th 2012.
Asle , 39, ten children, visiting the hospital to see a patient
‘’Most women I know come to the hospital for deliveries as they feel more comfortable coming here. I had my children in the bush with the help of a traditional birthing attendant. They are good but they do not have the same information the midwives have and if the delivery isn’t easy and there are problems they are unable to do much to help keep the baby alive. I have lots of children; my husband likes a big family. I am happy that I won’t have more children now because I am tired of being pregnant and delivering babies.’’
“Many men here take four wives and keep on having children but are unable to provide for their wives or children. There isn’t a lot of work here and not much to do. It’s very hard for women. They suffer a lot and are not able to make decisions about who they want to marry and how many children they want. I see cases every day of very exhausted women; they are weak women, anaemic and come to the hospital for checkups when they are pregnant. They will never say they are unhappy about being pregnant but they look very tired and exhausted.’’
Rape and sexual violence
MSF’s midwives are also sometimes confronted with women who have been raped. At times this results in an unwanted pregnancy.
Between Jan 2009 and December 2012 fifteen women and young girls came forward seeking treatment for injuries sustained during rape.
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