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Tag: attendants

  • Agitation for fuel attendants’ welfare ongoing, says NUPENG

    Agitation for fuel attendants’ welfare ongoing, says NUPENG

    The agitation for improved welfare package for over 300,000 petrol attendants in the country is ongoing, the Chairman, Southwest branch of the National Union of Petroleum and Natural Gas Workers (NUPENG), Mr. Tokunboh Korodo, has  said.

    He said the body is not resting on its oars in ensuring that fuel attendants get improved welfare package and live a good life, saying N18, 000 is being considered as the minimum salary for petrol attendants nationwide. He said the workers will be better for it if everything goes according to plans.

    He said inability of stakeholders to reach a compromise has slowed down discussions on the issue,  adding that efforts to get the dealers to understand the predicament of petrol attendants and further increase their salaries have proved difficult, but it is accomplishable.

    Korodo said: “Discussions are ongoing on the issue of increasing the emoluments of petrol attendants and others working at fuel retail outlets across the country. Several meetings have been held on the issue because we believe that the workers’ welfare must be improved.”

    The National Chairman, Petrol Tanker Drivers arm of NUPENG, Mr. Akanni Oladiti said efforts are being made to reposition the downstream sector of the oil and gas for growth. He said petrol tanker drivers are being trained to be more professional in their conduct, stressing that the training would be nationwide.

  • Controversy trails pay rise deal for 300,000 petrol attendants

    Talks on the planned enhanced remuneration for about 300,000 petrol attendants across the country  may have been stalled, The Nation has learnt. The talks were scheduled to begin last  month.

    There was an agreement to increase the salaries of petrol attendants  by last month, but the decision has been mirred by disagreement and stakeholders in the deal are back to the discussion table.

    The deal is being brokered by some interest groups within the downstream sector of the petroleum industry.

    The Independent Petroleum Marketers Association of Nigeria (IPMAN); Petrol Dealers Association of Nigeria (PEDAN); Petrol Station Workers Union (PSWU) and National Union of Petroleum and Natural Gas Workers (NUPENG) are yet to reach an agreement on the issue.

    Intrigues and power play, it was gathered, are hindering the implementation of the scheme, a development that suggests that the majority of the workers are still receiving  N8,000.

    Sources, who pleaded anonymity, said the controversy has mirred the  unions involved in the issue have failed to reach a consensus to ensure that the workers get a better deal.

    The sources at the meeting of the unions, which took place in Ilorin, Kwara State capital, said the workers could not get new salary package as planned for last month due to some problems in the scheme, which were yet to be resolved.

    The Major Marketers Association of Nigeria (MOMAN), a part of the talks, according to the sources, though absent, would not refuse to accede to the demand of the petrol station workers, adding that   MOMAN’s commitment was not in  doubt.

    “The Petrol Dealers Association of Nigeria (PEDAN), Petrol Station Workers Union (PSWU) and others are still working out modalities for the implementation of the enhanced welfare package. The Independent Marketers Association of Nigeria (IPMAN) is yet to show strong commitment to the issue. We do hope that all the concerned groups would come to terms on the issue soon. This will give the workers a new lease of life, given that most of them are not well paid,” the sources said.

    Efforts to get the IPMAN’s President, Chief Chinedu Okoronkwo to speak on the issue proved abortive, but the ex-officio, Petrol Station Workers Union, Mr. Samson Akintayo said modalities for the new salary scheme for the fuel attendants have been fashioned out by bodies, such as PSWU, which is the apex body for petrol attendants, Petrol Dealers Association of Nigeria (PEDAN), IPMAN and NUPENG.

    He said the assocaitions were involved in the Collective Bargaining Agreement (CBA), which drafted the conditions of service for the workers.

    He said the agreement would spell out the new salary structures of the attendants, their leave bonuses, hospital bills, and other packages, adding each of the 300,000 attendants  who work in over 30,000 filling stations in the six-geo political zones of the country would be given a copy of the agreement, as soon as the scheme takes off.

    He said the minimum salary for the attendants is N15,000, while the older and experienced ones would earn between N20,000 and N25,000  monthly under the new scheme.

  • The changing face of traditional birth attendants

    The changing face of traditional birth attendants

     In a bid to reduce maternal and child death in many developing countries, governments are partnering with Traditional Birth Attendants, TBAs on how to reduce risks of infection, mortality rate and generally improve their services. Medinat Kanabe takes a look at how well this partnership is working, taking Nigeria’s commercial capital, Lagos, as a case study.

    Traditional Birth Attendants are pregnancy and child birth care providers that have been well-rooted in our society, well before the advent of modern medical practices. Going by their origin and orientation, they were not formally educated, as they get their knowledge through apprenticeship and oral teaching. Usually, they are seen in remote and other medically underserved areas, where their services are welcome, albeit despite the risks. It should be noted here that orthodox health practitioners are particularly against Traditional Birth Attendants, not necessarily because of competition or neo-colonialism as many want to claim, but according to former Director of Nursing Services in the Lagos State Ministry Of Health, Mrs. Olubumi A. Raheem, because of their weaknesses, which “lie in harmful traditional practices, which may have harmful effects for her clients; unhygienic practices and inexistence of the referral system.”

    Government however recognises their relevance nevertheless, especially in the remote areas where they are top choices and sometimes, the only available choice, hence the decision to train them in government hospitals and imbue them with the power of referral, such that they are able to refer patients who need special medical attention. They now also get certifications, licensure and registration.

    In a Lagos State Maternal and Child Mortality Reduction (MCRC) Program released last year, Nigeria is one of the 187 countries that signed the Millennium Declaration in 2000 with the aim of reducing the 8 identified goals/targets substantially by 2015.  Notably, reducing maternal mortality rates is one of the goals.

    However, the country, as at 2015 still has one of the highest maternal mortality rates in the world, which varies between 800 to 1,000 births based on the geographical location. In 2008, the figure, though slightly better than the national average of 650/100,000 live births (NDSHS 2008), was still unacceptably high.

    The figures also show that two decades after various Safe Motherhood initiatives since its launch in Nairobi in 1987, Nigeria has failed to make any remarkable impact on the maternal health indices.

    This may therefore be one of the reasons a state like Lagos is relaxing its noose on Traditional Birth Attendants, reputed to be one of the major factors responsible for the poor indices.

    Investigations also confirm that more Nigerians prefer the Traditional Birth Attendants to the orthodox health facilities. In 2013, 154,304 attended antenatal at the Primary health care (PHC) centres, while only 16,699 delivered. The same trend continued in 2014, where between January and August, 121,451 attended PHCs for antenatal, but only 13,000 delivered there.

    Coordinator of Reproductive Health, in the ministry, Taiwo Johnson also said that the state Ministry of Health reviewed maternal death records from secondary facilities in certain areas and uncovered the causes of maternal deaths to find solutions.

    “In March, we went to Ajeromi-Ifelodun because we noticed a high incidence of maternal deaths in cases referred to our facilities from quacks. Then, we came to Epe, where records showed that a number of maternal deaths can be traced to TBAs,” she stated.

    During the first convocation of the TBAs at the Lagos State College of Health Technology, wife of former Lagos State governor, Mrs. Abimbola Fashola said their training is in line with the vision of the state to reduce infant and child mortality.

    Chairman, Lagos State Traditional Medicine Board, (LSTMB), Dr. Bunmi Omoseyindemi who also spoke at the convocation explained that the TBAs have been classified as Community Based Health Workers (CBHW) by the National Primary Health Care Development Agency, NPHCDA. She added that it is in line with the World Health Assembly, WHA strategy on development of traditional medicine to improve health-care coverage.

    Indeed, for a state like Lagos, with over 21 million people, it is not surprising that its government has chosen the path of reason, as the facilities on ground are grossly inadequate to service the huge population. Besides, the economic situation and phobia for Caesarian section has also contributed in no small ways to the thronging of people to the TBAs.

    However, some states in Nigeria may still be living in denial, as they continue to outlaw and discourage patronage of TBAs in their domains.

    In a recent report, the News Agency of Nigeria, NAN, quoted Dr Ngozi Nwosu, the South East Coordinator of the National Primary Health Care Development Agency, NPHCDA to have said that the TBAs are major threat to maternal health in the region.

    She said the increased patronage of TBAs in communities have become worrisome; she also claimed that the proportion of women who receive ante-natal care in health centers is a lot more than those who are eventually delivered of their babies in those health facilities – a confirmation of the fact that women opt for the TBAs at the last minute.

    However some of the reasons some women opt for TBAs in the South-East may be a bit vane. Said Dr. Nwosu, “In parts of Anambra and Ebonyi states, the people believe that women who are delivered of babies in hospitals are not strong and this is part of the illiteracy problems we face. Pregnant women who patronise such places are prone to infections, as the TBAs lacked the requisite knowledge and facilities to take care of deliveries,” she said.

    For Mrs. Modupe Kolawole, her reason may however border on fear of the surgeon’s knife. Mrs. Kolawole registered with a private hospital where she underwent her antenatal. It was her first child, so she kept all her appointments until her last weeks when she was told that her baby was leg-breeched and would therefore be delivered through a Caesarian Section.

    After an argument with the doctors and nurses on duty, Mrs. Kolawole went home to her petty trading. She later told her story to a friend who introduced her to a TBA. She told the TBA that it was her first child and that the doctor has said the baby is breeched and will be delivered through a CS. As is often the case, the TBA assured her that all would be well, and that all she needed to do was to pay twice the regular fee.

    On the day of her delivery, she went to the TBA, who uses a room in her home to deliver women and the process started. When she was dilated to the last stage of delivery, one of the baby’s legs came out. The baby’s other leg however remained stretched inside the mother.

    The TBA immediately held the baby’s leg and forcefully pulled her out. The force caused the baby to tear from between her legs. She didn’t cry as she was weak and injured. It was then the mother realised she had made a mistake. Regretting her actions, she immediately took her baby to Ifako Ijaiye General Hospital, Lagos.

    The doctors and nurses on duty did their best to save the baby, but she gave up the ghost after some days.

    Without any gainsaying, one could say that it is for cases like this and several others that Lagos particularly opted to co-opt the TBAs, rather than leave them to their practice.

    LSTMB chairman, Dr Bunmi Omoseyindemi, who spoke to The Nation, said the TBAs in Lagos are guided by rules.

    First they must be registered by the board and trained by the board. After that, they are sent to general hospital for 6 weeks orientation, where they observe procedures and thereafter they can take deliveries.

    He acknowledged that many of the TBAs have been on their own for many years, and said “they just come to us to refine them.”

    Stating what they must have and how the place must look, he said they must have a delivery bed and the necessary delivery tools like scissors, and other things that are used in the hospital.

    “The environment must be clean and they must have at least two rooms – one for delivery and one for consulting.”

    Asked if it is allowed for them to convert a room in their homes into delivery room, he said no. “It is not allowed for TBAs to use homes where they live with their husbands and children as their delivery rooms; but it is the practice and we are trying to make sure it stops because of basic hygiene, space and privacy.”

    Asked to comment on which is better between TBAs and public health facilities, he said patients choose between delivering in the hospitals and going to TBAs; so he could not say categorically that one is better than the other. “The fact is that two of them complement each other. Many people prefer the TBAs because of their culture and because they have more empathy than the hospitals.

    “Another thing is that majority of the TBAs reside in the communities, so they know the person that is pregnant and understand where they are coming from. It is like a family doctor, they have more confidence in them and after delivery they can still help out with taking care of the baby.”

    On what happens when a TBA that is not registered is caught, he said the law states that the person is fined and can be jailed for at least two years.

    Asked what happens when a woman is in a critical condition, he explained that the normal thing for a TBA to do is to refer her to the nearest general hospital. “That is why we say that they should be trained in the general hospitals nearest to their local government.

    “This is so that they can have interactions with them, to prevent any delays when they go to them with such cases, and they must not allow a patient to stay long before they refer.

    “Patients that must be advised to go to the government hospitals include patients who have done CS before, because they have tendencies to have complications. They must also refer first-time pregnant women. If they don’t refer and the patient dies or becomes a case of emergency, they will be sanctioned.”

    He advised the TBAs to make sure they are registered with the Traditional Medicine Board. They should be ready to go for continuous study at the general hospitals and college of health technology and must take good care of the patient and encourage them to take their immunizations.”

    Several TBAs still not registered

    However, when this reporter visited TBAs in Badagry, a good number of them still operate unregistered, thereby running fowl of the new government rules.

    At Latabas House in Metoho Street, Badagry, a woman uses her room in a self-contain apartment, where she also lives with her family, as delivery room.

    The place is converted to a delivery room anytime she has a patient in labour.

    She claims that she has a lot of pregnant women, who come to her, when it is time for them to deliver, and that so far, no case of emergency has been recorded.

    At Cele Bus-stop, Ansar-ud-deen Road, also in Badagry, a TBA takes delivery in his compound. As the landlord of the property, a ‘face me-I face you,’ he has a number of tenants. He also has a building to himself where he lives with his family and takes delivery for pregnant customers. Although his elder children live outside the building, the compound itself does not look suitable for a clinic.

    Rumour has it that apart from taking deliveries, he also does abortions in the building.

    For Mr. Adenigba Henry of Humanity Family Foundation for Peace and Development (HUFFPED), in the past there were great improper operating procedures noticed before their interventions with the TBAs.

    “Such practices included unclean environment, inadequate staff, inadequate equipment, space and lack of skill for referral. But things have improved, as capacity building of different areas of operations are being introduced by the government and the Community Service Officers, CSO. Some were very primitive but have improved over a period of time. Some were ignorant of what their Terms of Reference (TOR) should be and the limitation of their activities, as some try to go beyond their permissible activates; but some adhere strictly to the ethnics of the job.”

    He noted that the government has put in place strong monitoring and evaluation activities to ensure standardization.

    Speaking on the TBAs he has worked with, Mr. Adenigba who claimed he has been working with TBAs for the past 10 years said they have worked with over four hundred TBAs on several funded projects.

    “For instance, on FHI360/LSACA project, we are working with over 80 TBAs in four local governments – Lagos Island, Agege, Shomolu and Badagry; and we have worked with over 300 TBAs since inception of the project three years ago in these four Local governments.”

    On what risks a child and mother are exposed to if attended to in TBAs, he said, there is no risk for a child and mother that attended registered TBA that follow ethics of the job, but for the TBAs that are not registered, there are lots of risks, which include the child being infected with HIV if the mother is HIV positive and is unawares of her HIV status; dirty environment, dirty water, infection and even death.

    Asked to confirm if indeed many women register at TBAs, he said: “Yes, both educated and uneducated. Some attend because of their traditional beliefs and nobody can discourage them. Some attend because of the attitude of healthcare providers and some attends because of funds as the TBA bills are very moderate and affordable.”

    He called on the Lagos State government to reduce the registration fee to encourage unregistered TBAs to register because many women go there without knowing whether a TBA is registered or not.

    “Lagos State government is supporting the TBAs very well, especially in capacity building in term of regular training for registered TBAs, organizations also work with government in area of testing and counseling for pregnant women during their clinic days. The government also finds time to hold meetings with registered TBAs.  But there are many TBAs that are yet to be registered. I think government did not realise on time how many women patronise the TBAs. They were looking down on them before. But now both are collaborating to save the lives of mother and child; collaborations between TBAs and orthodox facilities are becoming very strong now.”

    He called on TBAs to embrace change. “They should forget about what is obtainable during the ages of their grand-parents, which have become tradition and imbibe new and standard ways of doing things that will be in conformity with the government and universal tenets.”

    Another expert, an Associate Professor, College of Medicine and Consultant in Primary Health Care, Lagos State Teaching Hospital, LASUTH, Mrs. Olayinka Abosede who spoke with The Nation seemed to agree with Mr. Adenigba.

    Mrs. Abosede, who started working with TBAs since 1983, said many more of the TBAs are trained now on conventional method. “We train them on how to prevent infections, especially with HIV/AIDS challenges. Most of them are registered now. We train them at the Institute of Child Health and Primary Care and I also interact with a lot of them.”

    She also agreed that a lot of the ones that have been trained are performing much better than they were doing some years back, adding that studies have shown that in the North, where there are no midwives, the community health workers working with the TBAs have reduced the rate of maternal mortality. “As a matter of fact they refer mothers to the primary health clinic and they are utilizing these clinics more than before. Although there is still room for a lot of improvements, with training, they are doing more than before.”

    She explained that a lot of women register with TBAs, saying if 100 mothers attend antenatal clinic in the government hospital, when it comes to delivery you find out that 60 per cent of them deliver with the TBAs.

    She called on the government to work with TBAs as they graduate, “For instance, from College of Technology, they are attached to a Primary Health Care centre within their wards, so that the midwife can supervise what they are doing.”

    She also called on the TBAs to relate more with their primary health facilities that are well equipped and take their deliveries there, noting that it can happen in Nigeria just as it has happened in Ghana.

    “Primary Health Care centers are also beginning to have anti-shock garments, which the TBAs normally do not have; so if a woman is bleeding, she can be taken to the nearest Primary Health Care centre to access good more adequate health care.”

    On TBAs who convert a room in their homes into their delivery rooms and keep them untidy, she said this is why if they have a link with the primary health facility, “it will be better for them, because the nurses and midwife at the primary health facilities will be able to inspect and see where they are taking those deliveries, and help them to improve the facilities. The practices must change because they will be supervised.

    “Before, they were functioning on their own without the intervention of the primary health facilities, but now, if they really want to function in our communities, they must be attached to a primary health facility. And those that are working there are now responsible for checking on what standards they are maintaining wherever they are taking those deliveries. That is in addition to their ward health committee members, because those being delivered in those untidy facilities are mothers and therefore there must be a check on what the TBAs are doing.

    “I will advice them to make sure they are trained, registered and must go according to the national standing order that have been set for them. They should not go beyond the limitation of the standing order and as soon as they find that there is any problem, they must refer. They must be close to and link with the primary health facility within their ward.”

     

     

  • The fears that force us to patronise traditional birth attendants

    The fears that force us to patronise traditional birth attendants

    The worshiping community of St. Lawrence Catholic Church along LASU Expressway, a suburb of Lagos State, was thrown into mourning recently when Bukola, a pregnant member of the church, suddenly passed away. She had gone to church and taken active part in the celebration a day before she passed away. Her pregnancy was said to be seven-month when she died.

    The members of the church were dazed by the incident and kept wondering what could have led to her death. They kept asking one question after the other but got no response. Their expectation of seeing Bukola with her baby after putting to bed and dancing to the altar with her family to appreciate God for adding to their number was dashed. She died.

    Loveth, a woman who had married for 10 years without any child, suffered a similar fate when she eventually got pregnant. When she became pregnant after several years of childlessness, the husband was highly elated and wasted no time in getting all the necessary things the hospital asked them to buy in preparation for the baby’s arrival. Towards the period of her delivery, their house wore a new look as they did not want the baby to come into the house the way it was. Because her stomach was extremely protruded, people in her neighbourhood had started calling her mother of twins.

    Unlike Bukola, who did not get to the point of going into labour before she died, Loveth went into labour but did not come out alive, neither did her baby. The joy that came after 10 years of painstaking waiting ended up bringing calamity and trauma to the husband, who could not comprehend what went wrong. He asked the doctors series of questions but their answers were incapable of bringing the wife and baby back to life. The incident brought an end to the life of another woman in the course of giving birth.

    Clement Ade saw the wife put to bed last month but shortly after the news of the birth reached him, the cold hands of death snatched the wife away. The baby survived but the mother ceased to exist from that moment.

    Such worrisome stories are endless in the country. They are instances of maternal mortality cases which Dr. Rotimi Adesanya, a child and public health physician, described as alarming in the country. According to him, “We contribute 13 percent of the world’s maternal mortality rate. It is not just acceptable because we are just after India and Bangladesh. It is still very alarming and we are not yet there.”

    Apparently scared by the incidents, checks showed that the number of pregnant women trooping to spiritual homes and traditional birth attendants has been on the rise.

    Dr Bunmi Omosehindemi, Chairman, Lagos State Traditional Medicine Board explained the reason for this. He said: “Many people are opting for traditional birth attendants because it has to do with the culture of the people and also inadequate medical facilities we have in the nation. We have a poor human resource for health. In Nigeria, we have only 30 doctors to 100, 000 patients. We have about 100 nurses to about 100, 000 patients and about two lab scientists to 100, 000 patients. Based on these facts, people have to look for various ways of taking care of themselves.

    “If you look at the records, only about 30 percent of women who attend ante natal go to hospital to give birth. It also has to do with the attitude of the health workers towards the patients. The factors responsible for this are so many. In some cases, it could be financial reasons, attitude problems and the belief systems of the people that are patronising the traditional birth attendants.

    “A human being is a product of his experience, belief system and his religion. Based on these, the women believe that they get better attention from traditional birth attendants and one thing you should know is that traditional birth attendants are part of the people’s culture.”

    A traditional birth attendant, who gave her name as Alhaja, opines that the reason is beyond that. She said: “Many pregnant women are now coming to us because they are convinced that doing things the natural way is better. During the days of our fathers, did we have these frightening stories of women dying when pregnant or giving birth? All these are happening because civilisation and foreign religions have rubbished the powers we inherited from our fathers.

    “The moment a child is not coming out with his head, doctors will book you for operations immediately. This is what our fathers would only use herbs to reverse within a space of time.  We do all these and save women from going through the knives. Some pregnancy challenges are better handled traditionally because there are words that we speak that alter some nasty problems.  Doctors don’t believe in this. The moment the drugs cannot handle a situation, the next thing is operation. Many women are scared of this, so they prefer to come to us.

    “We also don’t charge much. Our fees are inconsequential compared to what hospitals charge. We render humanitarian services.”

    Abiola Alice, Executive Director of God’s Love Natural Health Clinic and Maternity Home, a faith-based centre, attributed the increasing patronage to the quality of attention they give to pregnant women, adding: “Many pregnant women that have come to me have always complained about the harsh treatment they get in public hospitals. Nurses in public hospitals don’t pamper them the way we do. Besides, there are some that have spiritual problems which could make it difficult for them to be delivered. We do organise prayers for them every Monday and in the course of doing that, some of them will begin to confess different things. Some will say that they will die if they are delivered of the baby in their womb. After praying, they always overcome the problem and end up giving birth successfully.”

    Aside from prayers, she hinted that she has undergone series of training organised by Lagos State Traditional Medicine Board to enhance her skills in child delivery.

    She said: “The training has really built my capacity in caring for pregnant women. Before now, when a baby is sitting down in the womb or coming with leg or hand, we would pray and God will take control.  Now, we have a medicine called Adjust sold to us at the centre. When we use it for such women, the baby will turn and come the right way.

    “If the baby does not adjust after using it, we would refer the patient. I have used it for four people and have never had any disappointment. We also have never recorded any death since we began operations. It is a call from God and we answered it.”

    A pregnant woman, who patronises traditional birth homes, said: “I have had all my children in this place. I prefer traditional birth attendants because they use natural treatment. Here, you don’t have fears of undergoing operations because they have what it takes to correct situations that medical doctors would be quick to use operations to tackle. I don’t think anybody will go through operations and remain the same.

    “We have heard cases of people that they forgot one instrument or the other in their stomach after operations and those that died after they were sedated before operations. I believe that herbs are better. I have the ones that I drink and have a liquid that I rub on my body. It works perfectly for me.”

    Findings also revealed that many churches, especially the pentecostal ones, now organise special prayer sessions for pregnant women. The sessions observed were often attended by a large number of pregnant women with the ministers dishing out thunderous prayer points aimed at destroying all the forces that may be working against the safe delivery of the women.

    One of the attendees told The Nation that she opted for spiritual help when her doctor repeatedly told her that she didn’t have enough fluid in her sack. She said: “Every time I went to the hospital, the doctor will ask me to do a scan. After doing the scan, he would check it and say that the fluid wasn’t enough. It was becoming very scary for me, especially when they asked me to go and register for operation.

    “When I told my mother about it, she brought me here for prayers. I agreed because when doctors told my cousin she would not be able to give birth by herself, my mother brought her here and she was delivered safely. I refuse to be sacrificed on the altar of medical experiment.”

    A cleric, who identified himself as Elijah, said such prayer sessions were important for the pregnant because “There are many evil forces that are out to terminate the life of either the woman or the child and at times, both of them. These are beyond what sciences or medicine can handle. The bible made us to understand that we wrestle not against flesh and blood but against principalities in high places. Medical practitioners cannot fight these forces using thermometer. They are battles that can only be fought spiritually.”

    Causes of maternal mortality Medical doctors

    Explaining the factors responsible for rising cases of maternal mortality, however, Dr Eze Godwin, a medical practitioner said: “When a pregnant woman dies much earlier than the time she is supposed to go into labour, like the case of Bukola, it is possible that such woman had an underlining ailment that led to her death after all, she was not in labour.

    “In the advanced society, people will surely ask for a postmortem to know what actually happened. The death may be as a result of the pregnancy and it might not. There might be about 70 to 80 percent chances that the pregnancy might be the cause but the remaining 20 percent may not be. Some women become sick right from the time they become pregnant. That sickness does not leave them until they put to bed. Those kinds of people are supposed to be monitored. If they don’t follow that routine, they may die.

    “Some people’s placenta will not come out after delivery. At times, when the placenta comes out, the uterus will fail to contract. If it doesn’t come out, the woman would bleed and once somebody is losing blood continuously and it gets to a point where she doesn’t have any again, the person may die.”

    On his part, Dr Rotimi Adesanya, began by explaining what maternal mortality is. He said it is the number of female death per a thousand live birth in a country that arises from pregnancy-related condition in a year. That, he said, includes somebody that dies six weeks after putting to bed.

    The Maternal Mortality Ratio (MMR) in the country, according to him, is presently 600 per 100, 000. “This means that out of every 100, 000 women that go into pregnancy, 600 will die. If you want to break it down, out of 1,000 pregnant women, six will die from child birth and it is that bad. In developed countries like UK and US, they have less than one person out of 1,000. Out of 100, 000 that we have 600 cases, they have just 10.”

    He classified the causes into medical and non-medical, saying: “One of the non-medical causes (maternal mortality) is ignorance. A lot of our people are not educated. When you tell them that these are precautions you need to take, they will ignore you because a good number of them believe more in their culture and tradition that have been handed over to them. Some people believe till date that there are some health issues you don’t take to hospitals.

    “The other thing is poverty. At times in public hospital, you will find a man and his wife coming to the hospital with just N100. In Nigeria of today, what can N100 do? When most of them have complications and are asked to do surgery, they cannot afford it. The least you can pay for surgery even in public hospital is N50, 000. An average man on the road, especially in the rural areas, don’t have N50, 000 to cough out for such.

    “The cultural aspect, as I earlier stated, is also a serious factor. Some cultures don’t believe in going to hospital to seek medical help.  I have a client, who told me that a mallam who works for him, took delivery of his six children because he forbids his wife going to hospital. He said the wife never went to the hospital each time she was pregnant. It is all borne out of the religious and cultural practices that forbid their wives to be seen by another man.”

    He noted that people in rural areas are more involved in the problem of maternal mortality because they don’t have good roads, ambulance services and the required expertise there. “When they even get to these hospitals, the attitude of the health workers will discourage some of them and cause them to go elsewhere,” he stated.

    The medical factors, according to him, what is called Pregnancy Induced Hypertension (PIH).

    “Some women’s blood pressure used to go up when they are pregnant. This used to kill a lot of women. In short, there is what we call pre-eclampsia. Here, the BP will be high, you will see protein in their urine and the kidney is affected. After pre-eclamsia, you have what you call eclamsia. When this occurs, the woman will start convulsing because the BP is so high and has affected the brain, the liver and so many organs in the body. When such women are convulsing, a lot of them die and lose their baby.

    “When a woman has eclamsia, a doctor will quickly bring the baby out even; if the baby is a day old, the doctor would have to bring him out once the mother has convulsed.  If you have that in the rural areas, who will help them? Such women would just die like that. Another cause of maternal mortality is post partum haemoharrage. After delivery, some women would just be bleeding for just no reason. The doctor will try all his best and would still not be able to control the blood. Such women may be referred to a gynecologist.

    “Some of such women’s womb may be totally or partially removed by a gynecologist. But most times, the whole womb will be removed. If this is not done, she may bleed to death. When this is done, such a woman may not give birth again.”

    Infections, he added, also lead to maternal mortality. Malaria during pregnancy is part of this. Some women also break their water before delivery. When this happens, it is better for the woman to quickly go to hospital to be given antibiotics to prevent infections because the sac is what is covering the woman from infection. Once the water breaks, the place is open and anything can come in.

    He expatiated: “Some people believe that when you go to hospital, they will tell you that they want to do surgery. We doctors are also part of the problem because if you have to do surgery in western world, a psychologist will have to counsel you for almost an hour to assure you that there is no problem. But here in Nigeria, especially in the public hospital, doctors don’t even have the time because of the number of patients they have. Once the women are rushed there, they will just say madam, you are doing surgery and it is an emergency.

    “In that situation, the woman doesn’t even have the time to think. A lot of women run away from hospital because of this belief that if you go to the hospital, they will ‘cut you’ (do surgery). Many of them now resort to going to traditional birth attendants because of this.

    “Some will tell you that people die in the hospital and would prefer to go to traditional birth attendants. Traditional birth attendants have a role to play and even some governments have absorbed them, but the truth is that in Nigeria, people go beyond their limit.”

    ‘Our worries about traditional birth attendants’

    13, 14, 15 LABOUR 28-2-15.Though he appreciates the role of traditional birth attendants in the society, Dr. Adesanya has some reservations about their activities. “They are supposed to be handling people that have been having babies before. We call them low risk. But some of them still dabble into handling people that had CS before and people who want to give birth for the first time and that is always a difficult delivery. They are not supposed to go into all that but they still do.

    “Now, thank God for scanning machine. Traditional birth attendants also accept scan but they don’t even have training in scanning. In medicine, if a woman giving birth for the first time has the baby coming out with the leg, she has to go through surgery because it would be very difficult and you may lose the baby or the baby may be deformed. But they still dabble into it. They will say they will turn it round and all that. Such things are not scientifically proven. Some practices like the use of incantation when delivering a woman of a baby is unscientific but they do it and our people still go there. Part of the drugs they give them are concoctions. It is unhygienic. Besides, they don’t do HIV test; they use the same instrument for patients.”

    However, Dr Omosehindemi frowned at any attempt to describe activities of traditional birth attendants as unscientific. “That is the belief of any doctor that tells you that. He is talking from an ignorant point of view. If you have no knowledge about how something is done, it is better you keep quiet about it. It is only an ignorant and arrogant person that condemns what he does not know.

    “If you as a medical doctor have disagreement with anything in traditional medicine practice, put it into scientific discussion and let us debate it. I am a medical doctor too. I don’t believe they are the cause of maternal mortality,” he said.

    “We in Lagos State are training traditional birth attendants. We give them six weeks training at the traditional medicine board. After, they go for another training at the general hospital close to them and give them another round of training at our College of Health Technology so that they can be part of our community. Pregnancy is not a disease. People do deliver without assistance. It is only when people have health challenges that it becomes a problem,” he added.

    Possible solution

    Proferring solution to the menace, Dr Adesanya said: “Female education is important because they are the ones that are concerned. Studies have shown that female education helps to put the women in the right track. The second is that people need to plan their family so that a woman that was just delivered two months ago will not be going through the stress of pregnancy again. The problem in this part of the world is that many women don’t accept family planning because of cultural beliefs. I am a certified family planning provider by USAID but in spite of all the efforts the body has put into family planning, our women don’t want to do it. They have wrong beliefs that it will cause cancer or that it will change their menstrual cycle. Some women even believe in getting pregnant and aborting it. That has a higher risk than using family planning.

    “The government also needs to equip our hospitals and ensure there is at least one gynecologist in every rural area. They also need to fix our roads so that when pregnant women go into labour late in the night, they can have good roads to go to hospital in no time. They should also provide unhindered access to health facility. Nigeria has an alarming rate of maternal mortality.”

  • ‘Training traditional birth attendants can reduce infant, maternal death’

    ‘Training traditional birth attendants can reduce infant, maternal death’

    Wife of Lagos State Governor, Dame Abimbola Fashola has said training traditional birth attendants (TBAs) is in line with the vision of the state to reduce infant and maternal mortality during childbirth.

    According to her, training of this cadre of healthcare professionals in modern and essential skills in child delivery will support the government to achieve its goals.

    Mrs Fasholoa spoke at the First Convocation of TBAs at the Lagos State College of Health Technology.

    She said TBAs play important roles in the communities, stressing that they should be valued because of the services they render.

    Nigeria, she said, is among countries with the highest rate of infant and maternal mortality, adding that this should not be.

    Mrs Fashola said: “One of the obvious reasons for high infant and maternal death ratio (IMDR) is that expectant mothers in the communities prefer the services of TBAs who do not have formal knowledge on the modern and essential skills in child deliveries and other precautions.”

    The training of the TBAs, she noted, would help to reduce infant and maternal death significantly, and even to “zero level” because the exercise will be done more regularly and across the country.

    She enjoined the beneficiaries to put to use the skills acquired during the training to ensure qualitative delivery.

    Special Adviser to Governor Fashola on Public Health, Dr Yewande Adeshina advised the TBAs to operate within the capacity of their job.

    She said the hospital remains the best place for delivery, adding that TBAs can be helpful by referring critical cases to health facilities where expectant mothers can deliver unharmed.

    Dr Adeshina warned them to know their limit because unnecessary delay can cause preventable deaths of mother and child.

    Chairman, Lagos State Traditional Medicine Board (LSTMB), Dr Bunmi Omoseyindemi said the TBAs were trained through collaboration between the college and the board.

    The TBAs, he said, have been classified as Community Based Health Workers (CBHW) by the National Primary Health Care Development Agency (NPHCDA), stressing that their training was a strategy to improve healthcare coverage in the communities.

    “This is in line with the World Health Assembly (WHA) strategy on development of traditional medicine to improve health care coverage. This made the World Health Assembly pass some resolutions to recognise the importance of traditional medicine to provision of essential health care, especially to populations with limited access to healthcare system.

    “Traditional medicine was recognised as one of the resources of primary healthcare (PHC) services that could contribute to improve health outcomes, including the Millennium Development Goals (MDGs),” he said.

    Omoseyindemi said the TBAs are involved in assisting in the birth of newborn in developing countries but they are largely self-taught or informally trained.

    “They provide additional services, practical help and education as well as counselling to women. Although they cannot substitute for skilled providers, they can contribute to the survival of mothers and newborns by facilitating access to needed information, clinical services and support,” he said.

    He said their role usually reflects the culture and social structure of the communities, adding: “In some communities, a TBA may be a full-time worker who can be called upon and who expects to be paid in cash or in kind.

    Omoseyindemi said 110 TBAs graduated from the college after successful completion of their programmes.

  • Birth attendants re-trained

    A non-governmental Organisation, (NGO), the Brown Button Foundation and Yinka Mafe Foundation has held training for traditional birth attendants in Shagamu, Ogun State. It distributed medical kits.

    The NGO also organised free medical diagnosis and treatment to indigenes of the state, which coincided with the launch and presentation of the new Lawata Health Centre, Shagamu.

    The birth attendants were trained on how they can help the doctors who are often busy with their schedules.

    The Brown Button Foundation, led by its founder/CEO, Adepeju Jaiyeoba, a professional lawyer brought different medical doctors, who took turns to sensitise the traditionalists, who listened with keen interest.

    Their population filled the entire town hall. They were encouraged to pay attention to the teaching so as to avoid death resulting from over bleeding or infection.

    The birth attendants were urged to be hygienic by washing their hands and avoid infections, as personal hygiene in the delivery process is also essential for saving lives.

    They were encouraged by the medical instructors to sentitise pregnant women under their care on the need to eat foods rich in iron so that they can be adequately fortified for safe delivery.

     

     

     

     

     

    associated with child birth. Also, labour should not delay beyond 11-12 hours before they are referred to a paediatrician or hospitals.

    Also in the day, birth delivery kits were distributed. In it were white aprons, hand gloves and cloths to aid hygienic delivery. There was also a demonstration of how the kits were used.

    Mrs Jaiyeoba in an interview said the training was necessary because many mothers die at childbirth every year.

    “The situation is alarming. More than 36,000 women in Nigeria die yearly from childbirth. The report from maternity and child care report of 2012 shows that Nigeria is clearly off track in meeting Millennium Development Goals 4 and 5 (MDG) which has to do with child and maternal mortality. Everywoman is at potential potential risk.

    “The choice of shagamu was borne when we visited the community and saw that there were more than 15 traditional birth attendants without a hospital. The hospital we met there was just a room and parlour. Thus, in collaboration with the ministry, we have expanded and rebuilt the Latawa maternity centre.”

    Hon Mafe equally empowered women and youth by presenting them with tricycles, canopies, hairdryers and clippers, standing fans, generator sets, gallons of oil, engine blenders and motorbikes.