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The Lost Mothers: Truth About Maternal Deaths in Gambia

Naba Dabo, 25, holds her day-old baby at the maternity ward of the Brufut Minor Health Center (Samantha Reinders for NPR)

In The Gambia, the joy of welcoming a new child into this world can quickly turn into a devastating grief when the mother dies during, or after childbirth. It is one of the most painful, unforgettable and often preventable tragedies that can befall a family.

Maternal mortality is one of the main indicators of the quality of health care delivery in a country. Officially in the Gambia, the ministry of Health recorded 221 maternal deaths per 100,000 live births in 2019.

While pregnancy, labor and delivery come with inherent risks in the Gambia, cases of failure or negligence by physicians, deficiencies in health care and poor medical attendance as well as inadequate attention have often contributed to instances of maternal mortality. Maternal care is such in limbo in certain areas of The Gambia to an extent that death can happen during pregnancy, at delivery or during the postpartum period – even up to a year after childbirth – with leading causes being severe bleeding or hemorrhage.

A maternity ward in The Gambia

The recent public attention on maternal deaths in The Gambia is out of the growing psychosis in the citizenry after a series of reported cases in the media of women losing life while giving it to a new born child. With citizens losing faith in the country’s health sector the minister of Health Dr Ahmadou Lamin Samateh said, in September, that the media reports on women dying to give life are over exaggerated.

Beyond numbers, the painful stories of unacceptable maternal deaths

Modou Lamin Davis, a resident of Bakau a kinfolk to the late Fatou Dibba who died early this year due to maternal death, narrates what he knows about her neighbor’s death. “We took her to German clinic where she was supposed to give birth to twins and she delivered the first baby normally. But for her second baby to come, she was performed a cesarean and it developed complications

Davis said the lady’s husband and cousin rushed Fatou to EFSTH. When they arrived at the hospital’s gate, she had already lost lot of blood and was gasping for air. Yet, the hospital attendants told them they are not going to touch a bleeding Fatou in fear of a coronavirus contamination.

Her husband’s nephew drove all the way From Banjul to MRC and he was told pretty much the same

The late Fatou Dibba left twins behind, hours after she delivered

thing; that MRC cannot attend Fatou, prompting the family to return to German clinic where the cesarean was performed. They were once again referred to EFSTH. And once more, the hospital attendants in Banjul refused to attend Fatou as she was left in the ambulance gasping for air. Fatou finally died in the ambulance”, Modou Lamin Davies said.

Contrary to the EFSTH staff presumptions’, when the late Mrs. Dibba COVID-19 test came out, it was negative. The avoidable death of Fatou Dibba sparked a wave of emotion in The Gambia prompting EFSTH to announce an internal investigation on the matter.

But when The Chronicle contacted EFSTH administration for an update on the said investigation, we were told by the hospital’s Public Relations Officer, Kebba Samuel Nyancho Sanneh that the hospital is done with the investigation a long time ago. Yet Mr. Sanneh would not elaborate on the outcome of the investigation he said was complete. “The outcome of the investigation is online, go and do your own research”, Mr Sanneh ordered us. Though we searched the report on internet, like suggested to us by the EFSTH spokesperson, it was nowhere to be found.

The family of the late Fatou Dibba has equally confirmed to The Chronicle that it never received from the EFSTH any report on the findings of the hospital’s purported internal investigation. Meanwhile, the late Mrs. Dibba’s twins are being cared for by their paternal grandmother in Bakau.

There are a lot of untold sad stories like that of Fatou Dibba in The Gambia. Whilst the families of the women who have died in such circumstances may want to seek for justice, they’re generally left with no recourse leaving them with only grief, pain and total distrust to The Gambia’s health system.

Fakebba Touray, a husband, lost his wife to childbirth early last year, after 10 years of happy marriage. “This was her sixth pregnancy. Almost all her previous pregnancies were delivered at home. She always gave birth without any complications. We thought she would deliver this time without a problem“.

She swept the house and prepared breakfast. At midday, she was lying in the room complaining of labor pains. We thought she would deliver without a problem, as in her last pregnancy”, he said.

Mr. Touray said until after 2:00 pm, his wife did not deliver. It was decided to take her to the hospital. Unlike the late Fatou Dibba, Fakkeba Touray’s wife was attended. But it took an additional 6 hours of labor before she delivered. “She bled a lot and needed blood urgently. I contacted my niece to put it on social media. We thought that it was the fasted way to get a blood donor. Unfortunately, my wife died before the two donors who volunteered to save her life arrived in the hospital” Touray explained.

Fakebba believes that no woman should die giving birth in this age and time, especially when the death is the result of unavailability of blood. “All our hospitals and health centers should have enough blood in case of emergencies, like labor and other related accidents” Fakebba Touray fumed.

Haddy Gaye and Mama Samateh died in September after they delivered

A laboratory officer who prefers not to be named said that sometimes pregnant women are escorted to the hospital by old women who are not fit to donate blood. In addition, most men are always reluctant to donate blood and prefer to buy blood. He however said the trend is changing gradually.

One day a woman about to deliver was brought to the hospital around 9:00 am from another health center. The doctor checked her and asked the midwives to observe her.”

Our source said strangely, the woman was just lying on a bed until 48 hours later and when finally a doctor took her to the theater. “He first tried an external cephalic version which failed before a cesarean section was performed. The patient was wheeled dead from the theater” our source revealed.

So are the shocking stories of women unacceptably losing life to give life. Haddy Gaye died on September 13th at the Edward Francis Small Teaching Hospital, just days after losing her baby during delivery. Four days later, Mama Samateh of Brusubi died from postpartum hemorrhage, shortly after giving birth.

Shocking enough to trigger citizens’ actions

Concerned citizens and philanthropists are helping to minimize maternal deaths in the country. In October, a group of concerned Gambians called “Mbama Care Foundation” in partnership with “Gambian Women’s Lives Matter” held a protest march against the rising maternal deaths in The Gambia.

Gambian women’s live matter on protest march against maternal deaths

The Gambian women lives matters” movement is one of the few foundations that is addressing the issue of maternal and infant mortality in The Gambia. Its founder, Matida Bojang said, “We believe that we can reduce maternal and infant mortality by providing aid in the areas of maternal care, blood donation and health education et cetera.”

The foundation pays for individuals to donate blood to women in dire need of blood and is planning to do a blood drive to help mothers who are in desperate need of blood during or after delivery.

Another campaigner for improvement of maternal health services available to women in The Gambia is the “NDA Mariam Jagne Family Foundation” (NMJFF), founded by Gambian international football player, Pa Modou Jagne (a.k.a NDA) and his wife Ndey Mariam Jobe.

Pa Modou Jagne knows lost his mother during childbirth. He has since set up the NMJFF foundation to help end maternal mortality in The Gambia. Pa Modou’s wife Ndey Mariam Jobe wants to believe her dream that “A reduced rate of maternal mortality in The Gambia is possible if the issue is a concern to everyone and seriously tackled”.

Maternal deaths hits rural Gambia harder

The Bundung maternal and Child Health Hospital (BMCHH) is among the hospitals across the country that register maternal deaths every year. This year, the hospital has already registered five maternal deaths, the highest number in the history of the hospital.

Bundung maternal and Child Health Hospital Maternity ward

Majula Kinteh, a senior nursing officer at the maternity unit in Bundung maternal and child

health hospital said the common cause of maternal death in BMCC are postpartum hemorrhage and excessive bleeding after delivery.

The hospital holds maternal mortality audits after every death and holds anyone involved in mother’s death accountable.

She said sometimes, mothers are a contributing factor to maternal death as some of them do skip antenatal care as well as other important checkups. “Some will complain of financial problems while others will complain of poor road networks and so on and so forth”.

Dr. Mamady Cham (PhD), the Chief Executive Officer of Bwiam General Hospital said the

most common causes of maternal death in The Gambia are bleeding during pregnancy and [or] after delivery, high blood pressure. Sometimes, it has to do with an obstructed labor, when the passage is too small for the baby. There are also cases of anemia, when women lack the sufficient needed amount of iron.

Clearly, the mortality continue to remain higher in rural areas as compared to the urban zones because of the unavailability of well-equipped health facilities. Already in the national demographic and health survey 2013, the mortality in rural areas accounted for 36 per cent of all deaths among women with the victims aged between 15 and 49 years, while little seems to have changed since.

Dr. Mamady Cham (PhD), the Chief Executive Officer of Bwiam General Hospital

We have the highest maternal mortality deaths in the rural area like the central river region and upper river region because the health system there is not well expanded and equipped, so women traveled kilometres to get access to health care services while pregnant”, Dr. Cham confirmed.

According to him, a lot of women die in those remote areas because they have to travel a long distance to get the help they need. “They have to travel to places like Bansang, Kundang and Basse to get the services they need but some die before reaching or after at the hospital.

This year alone, the death of 39 women is in the record books of the Bansang Hospital in the Central River Region. Of these women, one lost her life at the major health center, one died while on referral to the hospital and another one died at home two days after she was discharged. Four other women died during pregnancy before the onset of labor and during labor while other 31 women died during the postpartum period. Of this group of the postpartum deaths, 10 occurred less than 24 hours after delivery and 21 occurred at least 24 hours after delivery.

Basse hospital is the only biggest health facility in the Upper river region of The Gambia, about 350 km from Banjul. There also, maternal death shows no sign of decline. In 2019 the hospital listed 10 maternal deaths in relation; and from January to November this year, it has already registered 9 more deaths. A sign that the number of women losing life in relation with giving birth can be higher than in 2019 should the status quo remains.

Unfortunately, the hospital in Basse, although being the sole handler of every critical health service to the populations in the region, is poorly endowed as it is revealed in this testimony. “Sometimes, it is bleeding that causes maternal death and sometimes, it’s a lack of blood donors”, says Mariatou Damba, a midwife at Basse hospital.

To lessen maternal mortality in The Gambia, Dr. Cham said a lot of efforts are being done. “Health facilities have been upgraded and the government is giving maternal care services to pregnant women free of charge since 2008 and more staff are being trained and laboratory services have been improved in all the major health centers across the country”, according to Dr. Cham.

It’s important to indicate that prenatal care is provided on specific days in each health center and hospital during weekdays only. This gives the impression that maternal health services are only available on official working days, when clinics are held.

Staggering statistics of maternal deaths in Gambia

In a developing country like The Gambia, regular updates of maternal mortality estimates are needed every two or three months to help policy makers prioritize maternal health care. As we speak, it took almost 10 years to conduct a national maternal mortality ratio study because of financial constraints according to a Health expert, Dr. Mamady Cham.

Gambia’s minister of Health Dr Ahmadou Lamin Samateh

Quizzed by National Assembly members in September on the issue, minister of Health Dr Ahmadou Lamin Samateh said in 2014, maternal loss of lives was 208 deaths of women per 100,000 live births. In 2015, it rose to 250 deaths per 100,000 live births. In 2016, it declined to 195 deaths and in 2017 it rose again to 236 deaths. The rise continued in 2018 with 283 deaths.  And as we speak, the figure already gathered up to September this year is 169 deaths per 100,000 live births, according to Dr Samateh.

The hybrid existing statistics are compounded by a weak health sector, due to insufficient financial and logistical support, a deteriorating physical infrastructure, lack of supplies and equipment, shortages of adequately and appropriately trained health personnel, high attrition rates, and an inadequate referral system.

For instance, The Gambia Bureau of Statistic survey on maternal mortality for 2019 and 2020 will be out at the end of year. As it is, the “Multiple indicator Cluster Survey” of The Gambia Bureau of Statistics shows that in 2017, the maternal mortality ratio for Gambia was 597 deaths per 100,000 live births.

This said, the level of maternal mortality in the Gambia is unacceptably high and the country is ranked among the highest of such mortality in Africa. The World Health Organization (WHO) estimates suggest that maternal mortality ration (MMR) has decreased from 730 of 100,000 live births in 2001 to 430 of 100,000 by 2012 but The Gambia still has one of the highest MMR in sub Saharan Africa.

Of the 55,969 average annual number of births in the Gambia, over 5000 (9%) occur in the country’s only referral hospital (Edward Francis Teaching Hospital). The hospital accounts for more than 30% of the annual maternal deaths in The Gambia.

A large majority of Gambian women (86.2%) receive antenatal care from a skilled health professional. This is not dependent on whether the woman resides in an urban or a rural area. However, only 57.2% of all deliveries are conducted by a skilled health professional.

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