The calabash is a treasured gourd that can serve as a decoration, a favorite kitchen tool or even as a musical instrument.
In Sierra Leone the broken calabash has a second meaning. When whispered in safe company, it means another mother has died in childbirth. The whispers are used because somehow perinatal mortality is perceived as the mother’s fault and brings shame to the family. So the secrecy continues.
Doris K. (not her real name) was a 36 year old mother of three. As the child of a local judge (paramount chief) she was well known and respected. Doris received pre-natal care and was scheduled for a cesarean section in the next county because of a breech presentation.
But three days of postpartum hemorrhage led to fever and fatal sepsis, despite three hospital visits. Without ultra sound, blood bank and aggressive antibiotics/supportive care, there was not much of a chance for her survival. The shame is not hers or her family’s, but that of a fragmented, dysfunctional health care delivery system.
This is not the only calabash that has broken. Sierra Leone statistics show a lifetime 1 in 17 chance of a mother dying in childbirth. In 2015, there were 3,1002 perinatal maternal deaths. On a percent of newborn delivery basis, Sierra Leone ranks the highest in Africa for percentage of mothers dying in childbirth3.
The government and religious organizations are trying to fill the gap left from the 10 year civil war and Ebola epidemic. The Ebola epidemic caused the general public to distrust medical providers— people treated for Ebola usually died. Trust continues to be an issue for all medical providers4.
Outlawing home deliveries in 2010 seems to have made it more difficult to record reliable statistics on perinatal mortality.
In 2018 MOH will be focused on several priorities, with improving maternal mortality at the top of the list.
Mission of Hope will help improve the 3 steps to receiving great perinatal care:
1. Mother decides to seek care
2. Mother can get to the hospital
3. The hospital can deliver the needed care.
This year, we will start a perinatal outreach program, using the portable ultrasound at some of the neighboring 110 villages.
Transportation will improve with the addition of the repaired second ambulance and a new 12 passenger Land Cruiser. The hospital will be upgraded with the addition of a blood bank, severe post partum hemorrhage protocol, ultra sound training and financial support to a nurse anesthetist and a physician.
These projects will be sustained financially by revenue generated from a clean water packaging operation. Also we will partner with the Sierra Leone UMC and the Paramount Chief to identify other possible sustainability projects for 2019 implementation.
Come join us to work on these and other projects. Help us to improve perinatal care and prevent more broken calabashes.
By Sam Spicer, MD, MMM
Sources:
1. www.unfpa.org/news/breaking-silence-about-maternal-death-sierra-leone
2. https://data.worldbank.org/indicator/SH.MMR.DTHS cited Jan 2018
3. https://data.worldbank.org/indicator/SH.MMR.DTHS
4. http://b.3cdn.net droftheworld/54befeb29ddee73fa1_s4m62058i.pdf