Women deliver without health workers at Edingeni clinic

When Bubile Banda, 19, started experiencing persistent stomach pains at Edingeni Health Centre in Mzimba, she knew that her time to deliver had come.

Sorrow gripped her. Not because of the pain she was going through. But she was not sure if she would deliver successfully without the assistance of trained birth attendants.

“At around 8am [on January 21 2015], we called for the health worker to attend to me during delivery. But to my anguish, no medical personnel was in sight,” she says, speaking from her hospital bed at the maternity ward.

In an open defiance against government’s ban on unskilled birth attendants, Banda literally turned to one of them, Lilly Nyirenda, to deliver her in the hour of need.

But she might not be wrong, entirely.

Her case seems to be an entrenched culture at the hospital which has elevated Nyirenda, a guardian, to the level of that promised saviour for most of the expectant women.

“The medical person came hours after I had delivered. The only job he did was to register the new delivery. If it was not for our chairperson [Nyirenda], I don’t know what would have become of me,” explains Banda.

Nyirenda, 51, was elected chairperson by her fellow guardians to act as a link with the medical personnel.

During her three-week stay at the clinic, guarding her expectant daughter Diana Kayuni, Nyirenda claims to have assisted eight women to deliver.

“My duty is to act as a link with the midwives when we have emergency cases. But out of eight maternity cases we had for three weeks, none of them have been attended to by the health workers. They came after the women had delivered,” she claims.

Women have lost confidence in the health care system at the clinic.

TinayanuKasalu, a guardian, says they are patronising Edingeni Health Centre for two reasons: To benefit from birth certificates the hospital issues and to be close to a hospital in case of emergencies.

“Otherwise we don’t see how a hospital is any better from traditional birth attendants,” she says, adding: “We are deliberating on abandoning this hospital for Embangweni [Mission Hospital] where women are attended to properly. But the challenge is that it’s very far.”

Edingeni hospital in charge Douglas Matemba pushes blame on the women.

He says some of these women were referred to Mzimba District Hospital, but did not want to go and opted to deliver on their own.

“As you might be aware, we have challenges with transport in referring cases to Mzimba District Hospital. So, most of these women fail to meet costs of transport.

“For example, we referred Banda to Mzimba because we were suspecting that she might have a stillbirth. But she didn’t go. At night when she was due for labour, they didn’t even phone us. It was in the morning that we discovered that she had given birth at our hospital,” he says.

Matemba says some women are afraid to go to Mzimba because of their foreign nationality, thereby resorting to self-delivery while at the clinic.

“This hospital serves a population of 50 000. Of these, three-quarters are Zambians,” he says.

Edingeni Health Centre committee says it is aware of these malpractices.

“The problem is that we have one nurse. We need more nurses here. We have written reports to the district health office several times on the issue, but the answer has been that they will send us nurses,” says Binna Sakala, treasurer.

Spokesperson for Mzimba District Hospital Raymond Kawaye says the district’s health office (DHO) is not aware of such cases.

He says the DHO will investigate and institute appropriate measures to discipline all concerned health workers.

“This is news to us. The only case similar to that was at Jenda Health Centre, but it was a misunderstanding. As for Edingeni, we have not received anything like that. But we can’t just rule out because it’s something that has to do with one’s attitude. It’s now up to us to investigate the matter.

“If it happens to be true, we will definitely institute disciplinary measures to the concerned health workers because we don’t condone such practices,” he says.

Medical Council of Malawi registrar and chief executive officer Abel Kawonga says regulations do not allow that women should deliver without the attendance of skilled health workers.

“A hospital should not be a danger for its users. It is supposed to help people in time of need and not become a death trap,” he says.

Kaonga says the council will deploy staff to the health centre to investigate the matter.

“If we find that the hospital has few health workers then we will close a section lacking staff. But we will also engage the ministry and nurses’ council on the matter,” he says.