Problem

In Nigerian rural communities, there are series of cultural factors contributing to high rate of maternal death. Most of these negative practices are due to ignorance and non-availability of better alternatives. They are deeply rooted in myths and legends which seem impossible to change. Resultantly, people are shy, or otherwise helpless in reversing these despite their knowledge of their negative impacts. Keeping age-long traditions bequeathed to them by their ancestors has hampered adherents of such faiths. Consequently, these keep growing on daily basis with no strict attention to halt them. Health professionals struggle with how to address the abounding harmful traditional health practices in Nigeria. The basic question of whether a practice is harmful or necessary is often hotly debated -- debates that sometimes rely on simplistic divisions between "Western" and local medical values. 75% of maternal death in Nigeria is due to direct causes like obstetric hemorrhage (abruptio placentae, placenta praevia, genital tract lacerations, and uterine atony), Eclampsia, Pregnancy-Induced hypertension, Sepsis, Obstructed labour, Malaria in pregnancy (which is associated with 10% maternal deaths in Nigeria) and complications from abortion. Most of these deaths are preventable with prompt, adequate and accessible medical interventions. The reasons can be broadly classified into FOUR categories: • Delay in Decision-Making: Decisions to seek care before and when complication develops, either due to religious reasons, distance, road conditions, fasting periods, festival / market days or poor provider attitude * Engaging in cultural harmful practices. • Delay in Reaching Facility: Distance to health facility, location of health facility, road conditions and cost of transportation. • Delay in Receiving Adequate and Appropriate Care: Due to operational difficulties, incompetence of available staff, and lack of finances. While I was doing my community posting as a nurse/midwife in a rural community, I visited a village to see some young (girls) women who their husband restricted from visiting the hospital. On that faithful day, I met this pregnant woman cracking palm kernel, we exchanged greeting and while talking she said to me that she does not want her expected date of delivery to reach. I asked her why she was so reluctant to say. After much conversation she started telling me about the various harmful practices that they are been forced on during pregnancy and delivery. Below are the listed practices. • Dry sex and vaginal drying: This entails the insertion of herbal leaves or powders, commercial products (for example, toothpaste, antiseptics, or soap), ground stones, or cloth into the vagina either on a regular basis or before sexual intercourse. It is a common belief in some parts of Eastern Nigeria that the insertion of herbs and objects into the vagina helps to beautify the baby. • Grinding of tobacco leaves for sexual hygiene, artistic reasons, prevention and treatment of sexually transmitted diseases and vaginal infections, itching, and discharge. She said that this happens mostly anytime the husband want to have sex with her, so that he will enjoy the sex very well as the tobacco makes the vagina Drinking of concoctions some days before the expected date of delivery to hasten deliveries • Smoking of hemp and weeds to produce heat at the uterus for quick expulsion of the fetus • Hitting the pelvic region with the bone of a particular animal to expand the pelvis for easy passage of fetus • Insertion of herbs and object into the vagina to beautify the baby • Placing of hot water bottles on the belly to make the baby strong after birth • Cooking with the placenta and drinking its water for a particular period to produce breast milk and lot more. I could not stand on my feet after she listed all this harmful practices. She said that her concern is that most of the women after doing this die after one year due to effect of the practice (bleeding etc). And they attribute it that the gods are angry with the women of their community. I could not do much at this time, but was only monitoring her. I became friendly with the husband and family members so that I can convince him to allow me do home ANC for the woman and also conduct the delivery for her. After all effort the man refused. After my midwifery I left that village only to come back for my result and heard that the woman died before her EDD. I cried like she was my sister and I could not do anything at that point After this I got the vision to registered a NON profit organization to support and put an end to the practices going on in this village. The name of the organization is TRAFFINA FOUNDATION FOR COMMUNITY HEALTH. I started working specifically on women’s health, I went to that village to do a sensitization programme titled “ NO WOMAN SHOULD DIE PREMATURELY” This programme brought light and breakthrough to the women of this community. We had a road walk and a football tournament titled “kicking of maternal death” this programme ended with a lecture on the effect of harmful cultural practices. Their husbands all came and could not stop crying that day on how ignorance has made them to lose their precious wives. This programme has been going on in other communities too. We are still on our research and also rendering and care. in a riverine community in the Niger-Delta I have also encountered that women forcefully sit and exert their weight on the fundus of the uterus of a woman in labour in other to relieve any obstruction and induction of postpartum haemorrhage to clear the uterus of impure blood. Sadly, women in the rural communities see conducting deliveries at home by themselves as a means of showing off their strength and womanhood thereby neglecting the care and support meant to be offered to them during pregnancy and after childbirth by specialized health care workers. My visit to the hausa ethnic group (Northern Nigeria), the predominant harmful practice after child birth is “Wankan Jego”. This is done immediately after delivery for 40 to 120 days, where the mother takes two scalding hot baths per day to keep out the “cold”, using a bundle of leaves to splash the hot water on her body. Following this, she remains in a well heat room with glowing fire underneath a mud bed. She takes kanwa (a special pap made from guinea corn or millet with potash and pepper so as to increase the quality and quantity of the breast milk. The complications of hypertension, burns injury, and Eclampsia are well known. Other post partum harmful practices include crude local symphysiotomy and “agurya” cut (removal of the hymen loop on 7-day-old females). Also among the Yoruba ethnic group (Western Nigeria), it is believed that diarrhoea is associated with the appearance of the anterior fontanelle and teething and that every child, as a mark of survival, must experience one or two episodes- diminishing the need to seek medical attention. In most places, it is a common practice to place hot water bottles on the mother’s belly to make the baby strong after birth; and cooking with the placenta and drinking its water for a particular period to produce breast milk and lots more. During part of my outreaches I met also a young girl of about 14 years old who just delivered practicing some harmful practices, she was placing cow dung on the umbilical stump of neonates to fall off; in that same community I met another that was conducting delivery on by herself using unsterilized equipments in cutting the placenta. “My tears are no more” . i am applying for this care challenge because there are underlying issues why are mothers are dying during pregnancy and childbirth, which Traffina Foundation has identified and is eradicating. We have done a lot and we need more support to continue. My passion for this is so deep. Let us all that are reading this come and support to stop maternal death. More needs to be done. There are a lot of women and young girls who during pregnancy don’t come to the hospital due to lack of money as well, not just culture. These groups of people are the people I go to look for in the rural communities with my team. My carrier has turned practically into core community nursing. My team and I don’t only look out for these groups alone. We regularly embark of free medical services with complete medical team. We stay for days and attend to there need and do a referral linkage to a nearby health center for those that are having critical cases. Right now we have two major projects: 1. Let’s save our mothers/ say no cultural harmful practices 2. Community free medical care. This program has cut across 10 states in Nigeria and the vision is to extend it across the 36 states of the federation in Nigeria. Let us save the lives of mothers who die every minute in the developing world especially for rural communities in Nigeria from the avoidable/treatable complications of childbirth and restore the hope of the mother and future of the unborn child in our health system also to restore more families from its devastating effect and to reduce the risk being faced by the surviving children. When one mother survives a lot survives with her, a mothers survival is the key to her baby’s life and welfare, a mothers survival means that her children receives adequate nutrition and immunization that will ensure survival during their tender years, a mothers survival ensures that all her children goes to school, and HIV/AID downfall and malaria eradication. Therefore saving the lives of mothers in reducing maternal death should be considered as the most central of MDGs, not the peripheral, not an afterthought, not on the margin, but right in the mainstream. It is regarded as the goal of goals a mega goal and a defining objective.

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I told my grandmother how you hleepd. She said, "bake them a cake!"

Egypt Egypt December 20, 2011




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