Mothers in distress

Women in rural Butha-Buthe struggle to survive childbirth

By Tsitsi Matope

Butha-Buthe is a district in great need of baby-delivery services in the rural clinics.

All clinics in the district’s rural areas do not provide such services and mothers have to travel to Butha-Buthe town when in need. However, this is not always the case and a significant number of mothers end up delivering at home.

The Butha-Buthe District Hospital, Seboche — a Roman Catholic facility — and St Pauls’ Clinic, are the only health-centres that provide baby-delivery services.

As a result, the bulk of rural mothers would rather travel to the clinics just for antenatal or pre-birth care and then deliver at home.

The modes of transport are horses, donkeys and in worse situations, heavily-pregnant mothers are carried on makeshift wooden-beds. And just like in other mountainous districts, some mothers in Butha-Buthe walk long distances. The struggle to access comprehensive maternal health services in many rural parts of Lesotho is also blamed for the high pregnancy-related deaths in a country where mortality is 1 155 per 100 000 live births according to the 2009 Demographic Health Survey.

In Butha-Buthe, sick pregnant mothers living on the plateaus are often carried on wooden beds, down to the main rugged gravel roads before they are made to ride horses or walk to the clinic if they can.

There are three clinics situated in the hardest-to-reach areas, which are Motete, Rampai and Boiketsiso.

During this investigation, all were inaccessible because of the heavy rains experienced.

However, Linakeng Clinic, although not classified as hardest-to-reach, is inaccessible by any other type of transport other than a four-wheel-drive vehicle, a donkey, horse or on foot. The clinic serves six villages of about 7 000 people.

Damaseka and Ramabeleng are part of the villages that also rely on Linakeng for health services.

The clinic is located about 15 kilometres away by gravel road and it is much further for those living on the plateaus and mountains.

Damaseka village chief, Kopano Mothuntsane, said his village was willing to contribute money and construct a small clinic that can provide healthcare services that include delivering babies.

“Most mothers in this area are depressed each time they are pregnant. This is because both the Linakeng Clinic and Butha-Buthe hospital are too far,” he said.

Butha-Buthe Hospital is about 25km away from Damaseka village.

“We are trying to convince the government that we are willing to help with the construction of a small clinic here if they can provide nurses. We have since collected stones and grass to show our commitment to contribute towards the construction. We are desperate,” Chief Mothuntsane said.

Although traditional birth-attendants or midwives are no longer as active as they used to be in the area, Mothuntsane said it would be foolish for the communities to just allow the traditional caregivers to fold their arms when someone should be helping mothers deliver at home.

“Many mothers here only manage one or two clinic visits at Linakeng Clinic but expecting them to all make it to town when in labour and in many cases at night, is insensitive and unrealistic. The traditional birth attendants are helping us in emergent cases. It’s not safe to have a heavily-pregnant woman walk or ride on a horseback that far on such a poor road.”

Some women in Damaseka village said because of the hardship associated with accessing services and risks involved, they would rather not have many children. And many children in Damaseka, can mean between five and 12.

However, the truth of the matter is, deciding how many children they can have, is not absolutely up to the mothers.

“I was very afraid when I had my second child. During one of my few visits to Butha-Buthe hospital, I saw a woman die after delivering a baby. The woman was bleeding and she had come from a far away village. It made me realise how vulnerable we are here. I would like my second child to be the last but that is also up to my husband,” 30-year-old ‘Masenathe Mothuntsane said.

Her second child is only eight-months-old.

‘Masepeame Ramabeleng, a 96-year-old woman living with her family on Ha-Tlehi Mountain, said it was strange how pregnant mothers still struggled to access services in the area.

“I delivered seven children at home during my time and there was no clinic. Although we relied on herbs to be strong, some mothers died due to pregnancy-related ailments. I have also helped my daughter-in-law deliver all her 12 children at home because the clinic is just too far,” Ramabeleng said.

However, Butha-Buthe Hospital, where the bulk of the mothers who manage to travel to town deliver, has its own challenges.

In an interview, the hospital’s senior nursing officer, ‘Majulia Seutloali, said considering the limited maternal healthcare services in the rural areas, it was important to consider training and utilising traditional birth attendants.

“Most rural pregnant mothers are too far from the health centres here in town. I think instead of banning traditional birth attendants from helping pregnant mothers deliver at home, we should train them to help in emergent cases – while at the same time, still encourage the mothers to make an effort to come and deliver at the hospital,” Seutloali said.

However, the reality is that, Butha-Buthe Hospital also lacks the capacity to save the lives of all the pregnant mothers who might suffer various complications.

Last year, five mothers died at the hospital from pregnancy-related complications.

Seutloali said it was possible that more mothers die at home after they have been discharged from the hospital, which has no follow-up systems.

“Sometimes, we later hear that a certain mother who had just delivered here, died at home and was already buried. We have no way of following-up on the mothers and the families also don’t report when that happens,” Seutloali said.

The hospital has no obstetrician to enhance the care given to mothers during pregnancy and after they deliver. “We also don’t have a gynaecologist to help deal with infections that can occur before and after delivery. We do come across infection-cases, which we sometimes suspect to have resulted from criminal abortions,” Seutloali said.

But that is not all.

In some cases, the hospital has no blood to save mothers who would have suffered heavy bleeding before and after delivery.

On average, the hospital assists 200 mothers deliver per month and Seutloali said this was too high considering the shortage of midwives and the incapacity to accommodate all mothers.

The maternity ward can only accommodate 20 mothers and as a result, two pregnant mothers can share one single bed.

Although the hospital has 24 midwife nurses, only four are assigned to the maternity ward in the afternoon and another four in the evening, while the other 16 work in the other wards.

“This does not mean that at any given time, we have four midwives in the maternity ward because some can be off-duty and the pressure to serve all the mothers can suddenly become high.”

She attributed the high number of pregnant mothers who register to give birth at the hospital to the low- fee charged compared to other health centres.

“We are charging M30 for normal baby-delivery and M150 for a caesarean section,” she said.

But this is not, in any way, a guarantee that all the mothers would walk out all smiles with their babies in their arms.

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