By
Joan Erakit
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The eight islands
that comprise Turtle Islands, Sierra Leone, are remote and practically
untouched by modern civilisation. Credit: Joan Erakit/IPS
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MATTRU JONG, Sierra Leone - Emmanuel is a male midwife.
At the age of 26, he lives and works on
one of eight islands off the southwest peninsular of Sierra Leone, an hour by
speedboat from Mattru Jong, the capital of Bonthe District.
On a particularly hot Wednesday
morning, IPS joins Marie Stopes, United Nations
Population Fund (UNFPA) and Sierra Leone’s Ministry of Health to go
and visit a population on one of the Turtle Islands that is practically
untouched by modern civilisation.
Marie Stopes is a British-based
non-profit that provides family planning and reproductive health services to
over 30 countries around the world. They work as a back-up support system to
the government, filling in the gaps in hard-to-reach areas that the government
is still working to resource.
On the mainland of Mattru Jong there is
a small market, situated on the river Jong which flows into the Atlantic ocean,
and crowded with various kiosks boasting fish, vegetables and live chickens
tied at their feet in straw baskets.
To reach the islands, one has to travel
by boat. But all the islands don’t have landing docks and the boats sometimes
stop in knee-deep water. Passengers — and midwives visiting the islands to
provide reproductive health and family planning services — have to hoist their
belongings and supplies above water, to make their way to the villages.
“Their [midwives] challenge is that
they don’t have a boat. If you want to do this effectively, you need a good
boat,” Safiatu Foday, a regional family planning coordinator for UNFPA in
Sierra Leone, explained to IPS.
For island communities that have very
little access to the mainland, basic health information is difficult to come
by, therefore the risks — especially those pertaining to pregnancy, become
inevitable.
With a population of over six million,
where women of childbearing age are between the ages of 15 and 49, this West
African country has refocused its health initiatives, working tirelessly to
strengthen the capacity and training of skilled midwives — an exceptional tool
in reducing maternal and infant mortality.
It Takes a Village
The village is inhabited by about a few
hundred people — most of them large families, many of whom have just started
utilising the peripheral health unit (PHU) that is onsite.
Emmanuel, one of the first men to
undertake the position of midwife in this area, is the person “in-charge,”
facilitating prenatal visits, deliveries, antenatal care, attending to
illnesses and referring patients to a hospital when needed.
“There are people who since their
birth, have never left the island,” Fadoy said.
Some of the women say they have
delivered 13 or 14 children prior to the work of Marie Stopes in their village.
Others recount having no time to “rest”
or take care of their other children while being pregnant almost every year.
There are common reasons as to why
women become pregnant so consistently.
One woman shares that there is a fear
of being “abandoned” by one’s husband. The women say if they do not engage in
sexual intercourse during the marriage, their husbands will look elsewhere.
Therefore women feel they have no choice but to keep getting pregnant.
There is also the question of approval;
many women must obtain permission from their husbands to start using
contraceptives.
“We used to get pregnant all the time
and our husbands would abandon us, so we had to fight for ourselves to survive.
Since Marie Stopes came to the island and we now have access to contraceptives,
we are able to take care of ourselves,” Yeanga, 33 tells IPS, adding, “It has
created an impact in my life, one, because I now know about spacing births.”
Yeanga is the mother of five children
with the oldest aged 25, and the youngest only three years old.
Before going on family planning, Yeanga
admits to having difficulties with her husband, which were only heightened when
he found out that contraceptives would help her not to get pregnant.
“Even when I wanted to join family
planning, my husband was not agreeing, but I talked to him about it and we
finally agreed to allow me to start family planning.”
In order to fully meet the demand of
women who are in search of family planning and reproductive health services,
the government has come up with an interesting strategy: recruit and train
traditional birth attendants (TBA’s) to provide quality health care services in
the villages.
Because they are from the village, they
are both respected and valued, thus their insight, advice and knowledge are
taken very seriously.
“Before midwives came to the island,
there were just TBA’s doing deliveries in this area – and there were a lot of
problems with these births,” Isatu Jalloh, 28, a nurse working in the village,
told IPS.
Without skilled birth attendants, many
of the women on the island suffered complications like preeclampsia, fistula
and even death.
Though Sierra Leone has one of the
highest maternal and infant mortality rates, 140 infant deaths per 1,000 live
births, and 857 maternal deaths per 100,000 live births, Jalloh believes that
the maternal death rate on the island has reduced due to the advocacy of
midwives who travel to the island to promote family planning and reproductive
health.
The ability to choose when to have
children has allowed women on the island to pursue small economic ventures.
They are able to produce an income to not only take care of themselves, but
also their children.
The Future is Bright?
As the last few hundred days of the
United Nations Millennium Development Goals (MDGs) come to a close, Sierra
Leone stands at an interesting cross section: that of incremental success and
challenges to come.
Demand for reproductive health and
family planning services is high, the commodities are being supplied through
partnerships with UNFPA and Marie Stopes, midwives are being dispatched to
different districts, yet obstacles remain.
Most trained midwives deployed to
health centres far from their homes don’t want to stay in those areas due to
harsh working conditions and unfamiliarity with their surroundings.
And with the outbreak of Ebola, most
midwives have been immediately evacuated, leaving patients, many of them
pregnant women, without proper care.
Sierra Leone faces an opportunity to
scale-up its reproductive health and family planning services by continuing its
ability for form essential partnerships, most effectively illustrated in the
one with civil society and advocacy group, Health
Coalition for All.
“Our focus is on health and
health-related issues. The key areas are advocacy and monitory, we work to
ensure that services are available, accessible, affordable and that they reach
the beneficiary,” Al Hassane B. Kamara, a programme manager for the coalition,
shared with IPS.
Based in Makeni, in Northern Province,
the Health Coalition for All has played an essential role in ensuring that
women have access to healthcare, especially during pregnancy.
By addressing the issues such as lack
of trained staff, delivery of commodities and most importantly, the high user
fees during clinic visits, the coalition takes a proactive stand to ensure that
women do not end up in unqualified hands.
“They pay very high fees to see a
qualified doctor, especially for cesarean operations. As a result they
have no options but to work with the TBA or a “quack doctor.”
With programmes such as the Free Health
Care Initiative (FHCI) that allows pregnant mothers, lactating mothers and
children under the age of five to access services for free, Sierra Leone
continues to put its focus on reproductive health.
Edited by: Nalisha Adams
The writer can be contacted
through Twitter on: @Erakit
Source: http://www.ipsnews.net
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