Don't get pregnant here: Fears, chaos of pregnancy for Homa Bay islands women

During a cool mid-morning in Mbita, Homa Bay County, we set off for Remba Island located on the border between Kenya and Uganda.

There are about 10 of us here and we must sail at least 100 kilometres in a dilapidated wooden motor boat that grunts and grumbles its way through Lake Victoria’s waters. 

It is an intolerable journey that we have to endure today. Here, two pregnant women are wedged between bags of cement as they lean on crates of soda and beer. One woman is tightly holding her three-year-old son, but a buffer of sacks of kales gives them stability.

Between us and the women are six goats and three huge bulls that scare us that their weight could sink the boat any moment. 

Underneath them are several 20-litre cans of petrol and household goods like cooking oil, loaves of bread, baggage and cartons of milk.

You can tell from the residents’ poise that this is a voyage they are used to but the fazed, edgy faces of the expectant mothers mean otherwise – it is a treacherous journey.

From Mbita, only two boats travel to the island on any given day —  one leaves at around 9am and the other one at around 11am.

For the passengers, the only guarantee to safety is a life jacket that everyone had to wear, but a device that clearly wouldn’t be an option for a pregnant woman in labour.

We pass through the islands of Takawiri, Sena and Ringiti, dropping supplies and passengers, as we pick others, and by the time we reach Remba, it is 1pm and everybody is exhausted.

While the trip could take up to four hours even after making different stops, the actual length of the journey depends on the tides, and whether the conditions are fair enough to sail. When it rains or becomes stormy, it takes longer.

On this end, there is only one boat that leaves the island to Mbita, at around 4am. As usual, the journey is not direct and just like when coming from the mainland, the boat has to make several stops dropping and picking goods and passengers.

The trip costs between Sh450 and Sh600 and the only other option for pregnant women to reach maternity wards in the mainland is to hire a small boat, fuel it and sail directly.

Hiring a boat costs between Sh4,500 and Sh6,000, depending on point of origin from the island.

The price is almost unbearable for a majority of locals here, who mainly depend on fishing for their livelihoods. The boats are usually quite small in size, which means they are unlikely to withstand strong tides at night.

In Remba, Atieno welcomes us inside her metallic shanty. She is cuddling her little baby boy to sleep. This is her first child and she is more than thankful that during delivery everything went on normal, and she does not take it for granted.

Like a number of other pregnant women within the island, she was forced to shift from her home almost a month to her due date to move closer to hospital.

Atieno had to rent a house on the mainland, a few kilometres from Mbita Sub-County Hospital, where she had booked to deliver.

To avoid any mishaps, prior to this, Atieno had to strictly attend her prenatal clinics at Remba Dispensary within the island and sometimes at the ill-equipped Sena Health Centre in Mfangano Island.

“I had to religiously follow my prenatal clinic appointments every month and check for everything, from weight and height to blood pressure, but most importantly, follow up on my due date,” she told Healthy Nation.

At her rented single room in Mbita, she had to get a sleeping mattress, some furniture and utensils to enliven the room throughout her stay.

Her husband is a fisherman and he would visit her thrice a week because apart from the expenses to travel to the mainland, the boats aren’t usually available.

So on one early January morning, Atieno checked herself in to the labour ward at Mbita Sub-County Hospital. 

“At this time my husband hadn’t arrived from the island, so I called and informed him, but he couldn’t have done anything because at that point the boats to the mainland aren’t usually available.”

Atieno is only one of a few pregnant women from the island who can afford to pay for an extra room in the mainland when approaching their due date.

Those who can’t remain with three options — make arrangements and move in with relatives living nearby a hospital in Sindo or Mbita in preparation for birth, go to Sena health centre in Mfangano Island, or just remain in the island and hope that when labour time comes, they will have a normal delivery void of any child birth complications.

In case you aren’t so lucky, then maternal death is almost inevitable.

Remba is part of the greater Mfangano Island administratively and it is within this densely populated tiny island where only one clinic offers treatment for more than the 4,000 residents who are a combination of citizens from Kenya, Uganda, Tanzania, Democratic Republic of Congo and Somalia.

According to one official in the island who requested anonymity, besides being ill-equipped to handle most medical procedures, the dispensary lacks enough drugs.

“For pregnant women, the facility only offers prenatal and postnatal services, but when it comes to laboratory tests, the women have to travel to the Sena health centre because the dispensary doesn’t have this unit.”

On the other hand, it can only handle normal births without complications. In case of complications, a safe delivery is nearly not guaranteed.

Robinson Okeyo, a former programme manager of Ekialo Kiona, a community-based organisation in Mfangano Island, says due to the fact that obstetric emergency complains at Remba Dispensary cannot be handled, most cases have to be referred to the Sena health centre or hospitals in the mainland.

“There is no ambulance, organic health response or a maternity organ. A pregnant woman in this part of the world has to be keen with her delivery,” he adds.

Dixon Oriaro, a resident of the island, says there have been cases of pregnant women in labour dying and/or losing babies due to the torturous journey through the lake to the mainland.

He remembers some few years back when a pregnant woman died while being rushed to hospital in Mbita, in the middle of the night, in a boat.

“She started experiencing labour pains at around 11pm that night and due to the fact that no boat services to the mainland are offered at this time, she had to wait for the next boat available the next morning to get transport to the mainland. Unfortunately, she didn’t make it.” 

According to Dr Gordon Okomo, Director of Health, Homa Bay County, a facility like Remba Dispensary is not equipped well to take care of complications and emergencies like when a mother needs blood transfusion.

“It faces challenges like task shifting and sharing, for instance rapid tests for malaria and HIV, as well as the insufficient health personnel,” he explains.

It is not just a problem for Remba Island. It is an issue affecting pregnant women across all islands of Lake Victoria.

Rueben Otieno, a resident of Mauda in Mfangano Island, remembers a fateful night in 2018 when his wife Mary Atieno was expecting their first child.

“At around 8pm, she began experiencing labour pains and I rushed her to Ugina Health Centre within the island because this is where she had attended her antenatal clinics,” he recalls.

However, there was no means of transport, but luckily, a few hours later, they managed to get a boat.

“We left the island at around 9pm but then in the middle of the lake, we ran out of fuel. We tried to make calls for help but couldn’t get any. We had to spend the night stuck in the dark, in the middle of the lake, with my pregnant wife in labour,” he recounts.

By the time they reached the hospital the next day at around 5am, it was too late and the baby had died. Luckily for Reuben, his wife survived.

It is an even more doleful story for Calvin Okoth, who is mourning his young wife, Letizia Achieng. At just 22 years of age, Letizia’s dream of holding her first child came to an abrupt end on the Friday morning of March 25. At that time, Letizia was living with her brother-in-law and her husband’s cousin Bernard Ogango in Sena Beach in Mfangano Island. Her husband, a primary school teacher, was away in college. The previous day, Bernard says, while he was visiting a friend at Kitawi beach on the other side of Sena, he was called by neighbours who were worried about Letizia’s state of health.

“I rushed back and after a few arrangements, we managed to take her to Sena Health Centre. After examining her, the medics confirmed that she had high blood pressure,” he explains.

Previously, Letizia had attended her antenatal clinics at the hospital and going by her clinic book, she had had this problem for a while during the pregnancy.

“But the hospital didn’t have drugs so we had to rush to the nearby chemist to get the medication,” explains Bernard.

But this wasn’t enough, and so Letizia’s condition never got better. As the process to transfer her to Mbita Sub-County Hospital was ongoing, things took a worse turn at around 8:30pm when she began convulsing.

“Fortunately, we managed to complete the transfer paper work. But then the problem was that there was no means of transport to transfer her from the island to Mbita mainland.”

He says they had to seek a boat ambulance from Sena, but then they had to buy 20 litres of diesel for fuel at about Sh3,200. But at that time the boat was not at the hospital, and it had to come from Kitawi Centre, some 30 minutes away.

When eventually they managed to get the boat, they had to carry their kin by a stretcher to the boat. “We left Sena for Mbita at around 9:15pm accompanied by one nurse.”

It was a windy night in the lake and considering the boat was small, they couldn’t sail with speed. But they managed to navigate through and eventually reached Mbita point at around 12:30 am, three hours later.

The nightmare for this family hadn’t ended as at Mbita point they could not find an ambulance.

“I took a motorbike, leaving the rest in the boat. I rushed to Mbita police station to borrow a vehicle, but I was not lucky because I was told it was on patrol,”

When he came back, they had no choice but to walk from the shores of Mbita point to the hospital – some two kilometres away – while carrying the pregnant woman, who was now wailing in pain.

According to Bernard, they arrived at Mbita Sub-County Hospital at about 1am on Friday. 

She was admitted but three hours later, Letizia’s condition worsened and the only option was to transfer her to Homa Bay County Referral Hospital.

“We reached the hospital just at 7am and the doctor immediately began treatment. But then again we were told to buy magnesium sulfate drugs and gloves before the treatment could start.”

Thereafter, they began administering treatment to Letizia, but at around 8 am, the worst news was broken to this family. Letizia had died. The baby didn’t survive either.

A medic at Sena Health Centre who opted to remain anonymous says the facility can only handle simple outpatient lab tests and procedures for pregnant women.

“When it comes to serious matters such as operations, then patients have to be referred to the Mbita Sub-County Hospital,” he says. He says the centre doesn’t even have a theatre and though the building meant to hold this unit has been erected, it hasn’t yet been equipped.

“Plans to upgrade Sena to level 4 hospital to serve as a referral facility for all the health facilities within Mfangano Island have been in pipeline for years, but to date, nothing substantial has been achieved,” adds Okeyo.

Besides that, he says the only ambulance boat that supports Mfangano Island community with medical emergency transfers is run by a community based organisation in the area, and it is not well equipped to handle child birth complications.

Efforts to get a comment from Dr Okomo about this were futile. He did not respond to our questions via email.

George Obel, a former marine officer who currently works as a coastguard in Remba Island, says there are some islands like Takawiri that have boat ambulances . However, the ambulances are just normal wooden watercrafts with neither medical equipment nor paramedics.

“Pregnant women rely on patrol boats of beach management units, which are not reliable.”

According to a 2015 National Council for Population and Development report, the Maternal Mortality Ratio (MMR)in Homa Bay County  is 583 per 100,000 live births.

This is higher than the national average of 488 and the leading factors contributing to this, the report says, are poor access to and low utilisation of skilled birth attendance during pregnancy, childbirth and the postnatal period.

And as the electioneering period hots up, Okeyo is worried that as always the issue of maternal health for Remba women will resurface, but only as a voters bait. 

“As the campaigns intensify, politicians will be expected to flock the island on hired fiber boats, helicopters and/or through public ferry services that transport their vehicles.”

But immediately that period comes to an end, he says, just as the chopping sound of the helicopters or the cavitation of the motorboats vanish, so shall the promises to the pregnant women of the islands of Lake Victoria.

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