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Curbing Maternal Mortality in Refugee Camps

When Mary Nareka arrived at Kakuma Refugee Camp in March 2017 from South Sudan, health, education and clothing was not part of her worries anymore, despite her being pregnant. All she wanted was safety, not only for herself but for her entire family too. Mary Nareka, a 31-year-old mother of four, flew from South Sudan together with her family, after war broke in Chukudum where they used to live. During the conflict, their houses were torched, leaving them with no place to call home.

Upon their arrival in Kakuma, they were taken to Kalobeyei Settlement Scheme, in Village 3, whereby they were given space and tent for their shelter, and put on a monthly food programme for the refugees. The living conditions at the Settlement Scheme are just but for survival purposes. As a matter of fact, the family has been forced to grow a few vegetables behind their compound. This was after the doctor noticed that Mary’s body lacks calcium, and advised her to at least take vegetables that will provide her with calcium in the body, now that she’s expectant. However, Mary and her husband are excited and full of hope. This is the first time that Mary will deliver her baby at the hospital. “I delivered all my four kids at home back in South Sudan with the help of a traditional birth attendant. We were living on the mountains in the rural areas and the hospital was 24kms away. We tried so hard to ensure that I deliver our first born in the hospital but we could not make it. Whenever I went for my antenatal visits, I never came back home until the next day. This is because I used to spend all the day walking, and would arrive at the hospital late in the evening. This discouraged us so much, and that’s why I resorted to be giving birth at home,” Mary narrates.

Mary learnt about the hospitals at Kalobeyei Settlement Scheme through a Safe Motherhood Promotion Program conducted by Red Cross in Kalobeyei. “Here our hospital, Clinic 2 is very near and offers free services. Moreover, there’s an ambulance just in case the labour pain starts anytime. I feel so good that I will be able to deliver with the help of trained nurses, who understand what they are doing, and are able to help whenever there’s an emergency during delivery. Traditional birth attendants aren’t skilled,” Mary adds. But Mary is not alone; she represents many women in Kalobeyei, who have never had the experience of delivering from hospital, as realised by Christine Simiyu, a Sexual and Reproductive Health and HIV Coordinator at Red Cross Kenya in Kalobeyei. “Majority of our clients are South Sudanese. When we started this program in 2016 here in Kalobeyei, we realized that majority of the South Sudanese came with their traditional birth attendants because most of their deliveries used to happen at home. These traditional birth attendants used to deliver with their bear hands, without taking into consideration the many infections that come along with that,” Christine says.

Safe Motherhood Promotion Programme
Safe Motherhood Promotion is an advocacy program that was started globally, with the aim of reducing maternal mortality. In the refugee settings, the initiative aims at reducing maternal and new born morbidity and mortality, transmission of STIs including HIV, creating awareness on family planning methods as well as preventing and managing the consequences of sexual and gender based violence. It helps disadvantaged women, girls and children, who don’t get access to healthcare, because of the nature of emergencies. However, the initiative is not only about a woman but a family too. “We teach the community that when they notice a woman who is pregnant, they collectively know that there’s a reproductive health service needed there. We empower them in such a way that they can come to seek services on their own in health facilities,” Christine adds. Currently, Kalobeyei, a settlement scheme comprising of both the hosts and the refugees, has 31 Safe Motherhood Promotion volunteers, serving 3 villages made up of people from 8 East African countries.

The trained Safe Motherhood Promoters who comprises of the traditional birth attendants as well as refugees from countries represented in the Settlement Scheme act as health mentors in the community. They walk door to door on a daily basis, creating awareness about the services offered at the health facilities, teaching them about the importance of delivering at the hospital, attending the antenatal and postnatal visits as well as the importance of family planning. Not only do they teach the community but also provide first aid services just in case of an emergency, related to maternal health since they’ve been trained on that too. “The community has really improved. They know us nowadays and freely share with us their pregnancy condition. At times they call us at midnight whenever the condition is worse and we bring them to the facility,” says Mary, a Safe Motherhood Promoter. Although they have been able to win the trust of the people in the community, some communities are still rigid especially when it comes to the family planning topic. “When you visit the Somali community and start telling them about family planning, they chase you away. The person will just say, please you are wasting my time (sic), our culture does not accept that, so just go away,” one of the volunteer laments.

World Health Organisation 2014 report documents that major complications that account for almost 75% of all maternal deaths are severe bleeding and infections especially after birth, high blood pressure during pregnancy, complications from delivery and unsafe abortion.

In 2015, United Nations Population Fund (UNFPA) gave a report indicating that 185,000 maternal deaths occurred in 35 countries that were affected by humanitarian crisis or fragile conditions, which is 61% of the global estimate of maternal deaths. According to the World Health Organisation 2014 report, more than half of maternal deaths in developing countries occur in sub-Saharan Africa, especially in vulnerable and humanitarian settings. South Sudan is considered to be having some of the worst health outcome indicators globally. Additionally, the 2014 report shows that the maternal mortality ratio in South Sudan stood at 789 per 100,000 live births, whereas neonatal and under –five mortality rates were at 39.3 and 99.6 per 1000 live births respectively. The situation is blamed on the humanitarian crisis that has continued to be witnessed in South Sudan since 2013, due to conflict, that has seen millions of people fleeing their homes to neighbouring countries.

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