Dressed in a white overall with gloves on, her nose covered with a cloth mask, Sarah Chemirmir, a traditional birth attendant in her late 70s, checks on an expectant mother inside a dimly-lit room in a mud-walled house in Kabenes, Uasin-Gishu County, about 35km from Eldoret town.
On one hand, she holds a black plastic object, an improvised stethoscope she uses to examine patients. “I use this to listen to the baby’s breathing in the womb. If it is poor, I refer my patient to the nearest health facility. But, if it is normal then I can to deliver the baby,” explains Chemirmir, who has been attending to patients for close to five decades.
One of her patients, 27 year-old Karen Jebichi, says she prefers traditional birth attendants over hospitals for fear of contracting Covid-19 due to congestion.
DROP IN DELIVERIES
Since the Covid-19 pandemic was reported, Chemirmir has had more patients than ever. “I used to handle between four and six patients in a day, but nowadays I am overwhelmed. Sometimes I hardly rest as I handle between 10 and 15 patients daily,” she says.
A spot-check by HealthyNation in local facilities show a drop in the number of patients. Some residents, for fear of contracting Covid-19, also opt for traditional herbalists. For instance, Moi Teaching and Referral Hospital is registering 40 deliveries a day compared to 60 before the pandemic.
According to Dr Philip Kirwa, the senior director in-charge of clinical services at the hospital, between March and May, the number of deliveries at the health facilities dropped by 40 per cent as most expectant mothers stayed away.
“However, this situation is improving since more mothers are now delivering - between 80 and 90 per cent. Some people do not realise this virus is now in the community. Most birth attendants lack access to water, sanitisers or appropriate protective gear, exposing them and their patients to the virus,” he says.
LACK OF PPES
Dr Kirwa, a trained obstetrician/ gynaecologist, says home deliveries are a weak-link as they expose the mothers and babies to the risk of contracting the coronavirus since most birth attendants lack requisite skills and equipment to handle the spread of the virus.
He says health facilities are safer due to measures put in place such as provision of PPEs for workers. “We urge mothers to deliver in health facilities, so that should there be complications, they can be assisted. Traditional birth attendants may also not have the skills or equipment to handle any related complications such as bleeding to death or removal of placenta,” said the director.
Another concern has been that most traditional birth attendants are aged and have a higher risk of contracting Covid-19.
With the ongoing health workers strikes in some of public hospitals across the country, more patients may opt for traditional attendant.
Peter Meli, the National Herbal Traditional Practitioners Association-North Rift chapter chairperson, raises more concerns. “Most of our members lack even a thermo-gun to check temperatures or protective gear and do not know where to get them, yet more patients are seeking medical help from us. We hope the government can consider us,” he says.
With curfews and other restrictions as result of the pandemic, Adrian Kamunde, an association’s official, says there is need for traditional herbalists and birth attendants to be considered essential service providers.
“Sometimes some mothers might go into labour at night and find it hard to get ambulance services to the nearest health facility in remote areas. If the traditional birth attendants can be trained and be included as part of essential service providers, then this will go a long way in assisting expectant mothers and other patients,” he observes.
While there are gains made with free maternity services such as the reduction of maternal and child mortality, they risk being reversed as a result to Covid-19.
According to the Health ministry, between 2013 – when the free maternity services were introduced – and 2016, slightly above 2.3 million women had benefited from the programme.