Mother-baby death in Mparo, our national priorities

Dear Tingasiga:A  healthy 30-year-old woman was admitted to Mparo Health Centre in Rukiga District on Monday, June 6, to deliver her second child. Artificial induction of labour was started that night. However, when the healthcare team noticed that something had gone wrong the following day, they took her to the operating room (theatre) for an emergency caesarean section. They discovered that her uterus had ruptured, and the baby girl was dead.  FYI:Grief as mother bleeds to death during labour The doctor and his team removed the woman’s uterus to try and stop the bleeding. They requested blood to be brought from Kabaare, 16 kilometres away via a steep mountain road. Kabaare sent blood to Mparo, and the transfusion was started. Unfortunately, that intervention was too late to save her. She was pronounced dead at 6.02 pm on Tuesday June 7.  Her name was Diana Musaasizi, daughter of Margaret and Medadi Kamiiri. She was a homemaker. Her husband, Xavier Musaasizi wa Byarugaba bya Ndyabawe, is a 32-year-old computer instructor at Kabale-Bukinda Core Primary Teachers College. Their first child, a 6-year-old girl, is in primary one at a boarding school.  ALSO READ: The mother who bled to death IIIDiana and her husband, very much in love and sharing dreams and plans, were looking forward to the birth of their second child. Diana was confident that her second delivery would be as straightforward as her first. Her pregnancy had been appropriately monitored, including four normal ultrasound examinations in Kabaare.  When Musaasizi drove his wife and her sister to Mparo Health Centre, Diana was in cheerful spirits. On her way to the health centre, she bought her husband some presents. The couple expected to be back home with their newborn baby within a few days. Diana and her baby were buried on Thursday June 9 at their home in Kashumuuruzi, Kashambya, Rukiga District. As they were lowered into their grave, the conversation in the land was about super-luxurious cars for politicians and Anglican bishops.  A more tragic illustration of the consequences of our skewed national priorities would be hard to craft. ALSO READ: Haemorrhage leading cause of maternal mortality, says new report I spoke with Musaasizi three days after the funeral. The intensity of his grief was deep. Many questions were coursing through his mind. I fully agreed with him that their choice to deliver the baby at Mparo Health Centre was very appropriate, given that she had no identified risk factors and a health centre IV was designated to manage normal deliveries.  Mparo Health Centre IV has two doctors, well trained nurses and midwives, an anaesthetic officer, and other support staff. However, staff recruitment and retention has historically been a challenge there for three main reasons.  First, staff housing is very inadequate. Second, many professionals with school-age children prefer to send them to schools in urban areas. Third, the absence of an all weather (tarmacked) road makes access during the rainy season very difficult and treacherous. In short, Mparo, like the rest of Rukiga District, is a hard-to-reach area.  Patient care facilities are also inadequate. Speaking to TV West over the weekend, an Mparo nurse highlighted some of the challenges. Pregnant women sleeping on the floor; inadequate physical space; lack of a constant electric power supply, making it impossible to safely store blood on site; and lack of essential machines for monitoring and supporting patients during and after surgery.  Investigations into what happened to Diana and her baby are continuing. The final report should help to identify opportunities for improvement and prevention of recurrences. This assumes, of course, that there will be adequate funding for the needed infrastructure and operational improvements. Mparo Health Centre receives base annual funding of Shs32 million ($8,610) for its operating costs. It receives an additional results-based financing (RBF) of approximately Sh.48 million (about $13,000) per year. So, the main hospital in Rukiga District survives on an annual operating budget of Shs80 million (less than $22,000.)   An obvious machine that Mparo needs urgently is an obstetric ultrasound unit. We hope that, with the help of friends and well-wishers, a lap-top type ultrasound unit will be delivered to Mparo Health Centre in the next few months. A good quality machine costs between $20,000 and $30,000. This is a lot of money, but it is doable if we give with the enthusiasm that never fails us when we fundraise for weddings, funerals, and other gifts for individuals. The modalities for fundraising for this machine will be communicated shortly.  Another urgently needed piece of equipment is a functioning solar power battery to resuscitate a dysfunctional system that has been in place for nearly a decade. Hopefully the authorities in Mparo will share the specifications and cost with us so that we know what to fundraise for.Upon listening to the nurse’s plea on TV West, Ms Robinah Biteyi in Kampala, immediately called Phionah Abaho Bruce, the Uganda Program Coordinator for We Care Solar, an organization that “promotes safe motherhood by providing health workers with reliable lighting, mobile communication, and medical devices using solar electricity.”   ALSO KNOW:Why maternal deaths are still high Phionah, whose organisation previously donated two “solar suitcases” to Mparo Health Centre, has offered to follow up with the authorities in Mparo. The attitude and spirit displayed by Robinah Biteyi and Phionah Abaho reflects the patriotism and Christian spirit of caring people who understand the priorities.  The good news is that a new maternity building is under construction at Mparo. Shs300 million ($80,000), which was allocated by the Ministry of Health, has already been spent on it. Another Shs300 million ($80,000) is needed to complete the work.   There is part of me that feels that all this should be the government’s responsibility, with the rest of us supplementing the efforts of the minders of the national treasury. However, my friend Alice Mujunga, a Ugandan working in Nairobi, sobered me up with a note that: “The problem with us Ugandans is that we assume that the priorities of our leaders are similar to ours and that we put them in those positions to serve our interests.” I must say there are three elected leaders that have, so far, impressed me by their devotion to duty, their humility and their clarity and focus on our collective interests. ALSO READ: Prince or prisoner, the pain of death is the same The NRM’s Robert Mbabazi Kakwerere, the LCV chairperson of Rukiga, Caroline Kamusiime Muhwezi, the NRM Woman MP for Rukiga, and Roland Ndyomugyenyi, the Independent MP for Rukiga, are three leaders whom my friend Mujunga would be very pleased to work with. With their leadership, I am optimistic that we can improve the services at Mparo and other health facilities in our home district. Mulera is a medical doctor.[email protected]