Day 100 of Flight For Every Mother! What a long way we had come by now!
This morning we said a sad goodbye to Kwame – he had another filming assignment to attend to in Germany! But the good news was that Becky would stay until the end of Flight For Every Mother in Swaziland. I was really pleased that finally we were formally recording some of the project’s activities with the aim of putting together a documentary to raise the profile and interest in women’s reproductive health.
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Ross also left – to go to Barberton in South Africa to do an advanced mountain flying course with CC Pocock.
And so Becky moved in with me at the Peace Hotel in Mbabane!
After breakfast we were on the road South to Matsangeni – a rural, secondary level hospital 2 hours away. After leaving the city, the road passed through rolling hills with scattered villages and few other vehicles.
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The matron at Matsangeni was Ruth Dlamini and she showed us around the small, single story maternity block. She explained that the nearest referral hospital was 100km away and that the hospital ambulance was non-functional. So a woman in labour who had a problem, such as a distressed baby in the womb, would have to wait for an ambulance to come from elsewhere, if available, and then travel over 90 minutes to reach more specialist care. As there was no operating room (theatre) at Matsangeni transfer in labour wasn’t an uncommon occurrence. The doctors were frustrated that they were unable to keep up their clinical skills by operating and that their patient’s lives were sometimes endangered by these delays.
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We ate lunch on the way to our next destination of Siphofaneni. Becky was also keen to do some interviewing in the car on the way! I’m not sure I was so keen!
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Siphofaneni clinic served a population 40 min by road to the East of the capital. It had once been a well functioning midwifery-led birthing unit, but now was only able to cater for emergency deliveries. The four midwives staffing the clinic expressed frustration that they were only able to provide antenatal care and that despite adequate skill locally they were forced to advise their patients to travel to the city when in labour for delivery. Their experience was that many women declined and rather delivered at home without supervision – a potentially dangerous situation for both mother and baby.
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Within the clinic, the birthing area now housed the cupboards and desks enabling the role-out of anti-HIV and anti-TB medication. The workload that this service brought, together with lack of physical space, was the reason that deliveries could no longer safely take place.
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In addition to the logistical issues surrounding delivery experienced by the clinic staff, we also discussed the fact that HIV can’t be looked at as a problem in isolation, but rather in the context of so many other maternal health issues. The midwives at Siphofaneni felt that other significant obstetric issues were sometimes overlooked because of the focus of HIV, and whilst an important problem, other issues deserved attention too. Hope was expressed that now, given such a well established HIV programme and good uptake of anti-HIV drugs, there might be some changes in focus.
Family planning (contraception) was also offered by the clinic. Interestingly, in their experience the progesterone injection was the most popular method, with women giving the reason of their male partners being unable to see or feel the fact that there was a contraceptive method in use – evidence that Swazi women are perhaps unable to discuss such issues with their partners and may not be expected to be in charge of their fertility.
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I promised to raise the logistical issues with the Minister of Health at my debriefing session, and with that promise I was on my way.
Time for a night in!