This was our first assignment...
(1) Write 2- 3 pages double spaced 11/12 font size paper of your own experience in seeking health care either while in the US or outside of the country.
Growing up, I was a bit of a hypochondriac, so hospital visits and trips to the doctor’s office were fairly regular. Whether I had a sprained wrist or strep throat, (both self diagnosed, of course), my mom would call up Dr. Gupta and within the hour, we would be sitting in the waiting room. My whole life, this was something I took for granted; being able to drive five minutes down the road to the family doctor did not seem like any sort of privilege to me. That was until I decided that I wanted to pursue a career in medicine. In my research and exploration of the field, I was exposed to a world of healthcare that I did not know existed. For years, I had been so sheltered, living in a small town in Northern New York. My worldview in this area (and in many others) did not consist of much, and it wasn’t until I made it my goal to get informed that I realized the true depth of healthcare development across the globe.
As I mentioned before, I made quite a few trips to the doctor as a child. No ailment was ever too serious or in dire need of medical attention, but the trip was made, quickly and easily and typically without much worry about cost due to decent insurance coverage. My sister and I both had chronic ear infections and pink eye when we were little and I can vividly remember the five-minute trip to the doctor’s office, sitting in the waiting room for about twenty minutes, a quick ear or eye check, and the administration of a prescription for antibiotics. After a stop at the pharmacy on the way home, we were on the path to recovery. Most office visits, including yearly checkups and vaccination updates went smoothly and efficiently (aside from my aversion to needles).
Considering all of my ailments – legitimate and self diagnosed – I have never broken or sprained any bones and have only needed to have two fairly minor surgeries; I had three plantars warts removed from the bottom of my foot in seventh grade, and in tenth grade, I had my wisdom teeth removed. The latter is typically a necessity for almost all young adults and finding a respectable doctor with the credentials to perform the surgery is not a difficult task. I know that there are at least three of them within a thirty-mile radius of Massena, NY (my hometown).
Beyond the scope of medicine and primary care, I also paid several visits to the physical therapists office. I am a dancer with bad knees and a swimmer with shoulders that tend to pop out in the middle of races, so physical therapy was a necessity. I had about five separate rounds of physical therapy for various reasons. In eighth grade, I tore my meniscus in my knee and had to go for a month to physical therapy. There, I was walked through several exercises and stretches and put on strengthening machines, all to ensure a quick and painless recovery. Twice, my shoulder popped out and for about three years, I was in and out of physical therapy for the same reason.
I have been considerably lucky in terms of accessibility and affordability of healthcare. The hospital/emergency room is a quick ten miles from my house and just across from the hospital, the street is lined with physician’s offices where you can find everything from pediatrics to gastroenterology. Our town has actually just opened an urgent care unit in addition to the emergency room in an attempt to leave the emergency room available for true emergencies and directing the less time sensitive cases to urgent care.
Over the past few years, I have begun to really understand not only the importance of healthcare, but the fact that it is not universally available as it has been for me growing up. A lot of my interest in Africa came from a series of conversations with my aunt about the hardships of healthcare delivery and her own experiences in working with Doctors Without Borders in southeast Africa. I realize that children in these areas in the world don’t get to just call up a doctor and run over because they have an earache. I am aware that there is no such thing as yearly checkups with the pediatrician. I understand that vaccinations are not easy to come by and that livelihood is compromised significantly. I know that I have been privileged to reputable physicians and an extensive scope of healthcare administration, both widely available and at a close proximity. And I realize how fortunate I have been to live in a nation where many employers offer premium healthcare coverage to their workers at little to no cost. There are so many things that the privileged have not only taken for granted, but come to expect because they know nothing different.
Question: can quality healthcare be made available and affordable to all people? For now we can only hope to achieve such a goal when like-minded individuals of all nations come together in a worldwide effort with the desire to make it happen. In the meantime, we can give our time and energy to assist in providing support, comfort, and relief to those less fortunate.
Final Paper:
Maternal Healthcare in Kenya
Elizabeth Mauch
Summer Healthcare Program
Wairimu Ndirangu
Motherhood: the greatest joy in a woman’s
life, right? Creating new life, starting a family, watching it grow, what’s not
to celebrate? For a majority of the women in Kenya where the maternal mortality
rate is through the roof, there’s actually quite a bit not to celebrate. Imagine, you’re a 15-year-old girl, married off and
already pregnant; a child with child. Or a college student who got pregnant by
mistake and your only hope of staying in school is to seek out some back alley
abortion because there is no other option. How about a woman in your late 40’s
giving birth to your eighth child, when you can barely feed the other seven. No
matter the age or the situation, the commonalities that most often tie these
women together are their inability to access to proper care, their lack of
education on maternal healthcare, their inferiority to men in a misogynistic
society, and the array of problems that result from these barriers. The issue
of maternal healthcare has found its way into almost every aspect of this trip,
so clearly its effects are widespread. In this paper, I will not only discuss
the problems associated with this issue, but also, what is currently being done
to lessen or prevent them altogether.
Four
hundred and thirteen; for every 100,000 live births in Kenya, 413 women will
die. Put another way, one out of every thirty-nine women will die due to
complications during childbirth. Compare that to 6.6 per every 100,000 live
births in Canada, or, 16.6 per every 100,000 live births in the U.S.[1].
Why the disparity? Generally speaking, maternal death is the international
standard by which a nation’s commitment to women’s status and their health can
be measured. This fact on its own speaks volumes in terms of the cross-cultural
importance of women to society, or the lack there of. More specifically, women
in Kenya face several challenges (including those listed above) in seeking out and receiving proper healthcare.
First
off, Kenyan women often face the challenge of not fully understanding their
responsibilities to themselves and to their children in terms of seeking out
any form of maternal healthcare (antenatal, delivery, postnatal, etc.). They
don’t realize that in going to a skilled health provider to deliver their
babies, or for antenatal/postnatal checkups, they can infinitely decrease the
chance of death for themselves and for their babies. It is typically recommended
that beginning within the first the months of pregnancy, mothers should have
12-13 antenatal checkups. In Kenya, the statistics are subpar; only 52% had 4
or more antenatal checkups, only 11% sought antenatal care in their first
trimester, and less than half receive care before the 6th month of
pregnancy[2].
On
the other hand, many of these women do
realize the lifesaving benefits of such care, but do not have the means of
getting there. For starters, infrastructure and transportation in many parts of
Kenya is in no way conducive to seeking healthcare, maternal and otherwise.
This is something we have experienced first hand in places like Kibera where
the “roads” can barely fit one car, Nogoswani where there are no roads, and in
Nairobi where you might sit in traffic for hours, waiting to get to a hospital.
More often than not, women are left with no other choice than to walk miles and
miles to the nearest healthcare provider and many times, the trek will take
days. For people like the Masai, for example, this is out of the question, as
it is the women who do all of the work at home while the men tend to their
livestock. A Masai woman cannot spare the days of travel when she must gather fire
wood, fetch water, wash clothes, prepare meals, watch the children she already
has, etc. Therefore, they go without any antenatal care, deliver by themselves
or with traditional birth attendants, and receive no postnatal care. Of course
this is not always the case, but for women who are obligated to put their daily
duties ahead of their and their babies’ health, this is the unfortunate
consequence.
In
these desperate situations, delivery is a matter of life and death, for both
the mother and her child. Two out of every five births in Kenya are delivered
in a health facility while 59% are delivered at home. If a health professional
is present at the time of delivery, the risks of complications that may arise
are reduced significantly, and in turn, death or illness to the mother and/or
baby can be prevented. Considering this fact, only 42% of women are assisted by
a doctor, nurse, or midwife, while 28% use a TBA (traditional birth attendant),
22% are in the presence of friends/relatives, and 8% have no help at all[3].
The 59% who deliver at home also have a dangerously low utilization of
postnatal care services; 81% of home deliveries receive no postnatal care at
all. It is generally recommended that woman receive postnatal care within 2
days of delivery, as this is when most maternal deaths occur. In not receiving such
care, mothers, especially those who deliver at home, are significantly
lessening their chances of survival.
Most
maternal deaths are due to an array of obstetric complications including
hemorrhage, sepsis, pre-eclampsia,, obstructed labor, and unsafe abortion
practices. Most significantly, excessive bleeding after childbirth, or
postpartum hemorrhaging is the number one player in maternal deaths. Typically,
this will occur when the uterus doesn’t contract after birth, allowing it to
continue bleeding and resulting in massive blood loss. Other causes include
failure to pass all of the placenta, forced removal of the placenta, and trauma
to the uterus, cervix, or vagina during delivery. Keeping in mind the 59% who
deliver at home and the 81% who don’t receive postnatal care, it’s no wonder
the maternal death rate due to hemorrhaging is so high. The risk of the causes
listed is unmistakably higher when delivery occurs at home, and the warning
signs cannot be detected when there are no postnatal checkups.
Sepsis is also a major contender in maternal
deaths due to unsanitary birthing situations, certain after-birth traditions,
and absence of antibiotics, all of which would be non-issues in a hospital
setting.
Pre-eclampsia is a complication that occurs during
pregnancy and in the post partum period. It is the rapid rise in blood pressure
that can lead to seizure, stroke, organ failure, and ultimately, death to the
mother and/or baby. As in all the other obstetric complications, death is
easily avoidable with proper access and availability to healthcare.
Obstructed
labor is a huge problem in developing countries like Kenya due to early
marriage, malnourishment, and the inaccessibility of healthcare providers
during delivery. During prolonged labor, the baby’s head will compress the soft
tissues around the pelvis. This cuts off blood flow to the bladder and/or
rectum, resulting in dead tissue, which leaves a hole, or fistula. The hole
causes a constant leakage of urine or feces (or both if the woman has vaginal and rectal fistulas). Without surgical
correction, the woman will most likely be ostracized from her home and community
due to the smell and live the remainder of her existence in this horrible
solitude. I vividly remember learning about women living with this condition in
9th grade; all the girls at my lunch table were talking about it and
we were so confounded, and to be honest, grossed out at the thought. However,
we were 15 and living happily in a country where the problem seemed a thousand
worlds away. After visiting the fistula clinic, this problem became all too
real. A 15-year-old girl who could not deliver her baby because her body was
not developed enough to give birth sat quietly on a hospital bed. An old woman
who had lived her whole life constantly wet and smelling of urine, ostracized
from her community, and unaware that help was available until she was told
about the clinic. Women in their 20’s who were so malnourished that they
weren’t able to deliver their babies, walked around with catheters in their
hands and babies on their backs (if they had lived through the prolonged
labor). The most unfortunate part of the situation, perhaps, is that the
problem is so easily preventable. Had these women been able to easily access
proper care during delivery, their lives and the lives of their children who
didn’t make it could have been saved. Even if they lived through the delivery,
which many do not, their lives are essentially over; their families abandon
them, their communities shun them, no employers want to hire them, and sadly,
the problem typically occurs very early on in their lives.
For
many women in Kenya, family planning is not an option for various reasons, and
consequently, unwanted and mistimed births are widespread. In fact, 20% of births
in Kenya are unwanted (a proportion which has increased over the years) and 25%
of births are mistakes or wanted later. Considering so many births are
unwanted/mistimed, you would think that women are not aware of the preventative
methods available, but it turns out that of the 95% of married women who know
at least one modern method of contraception, only 39% are currently using one.
Also, in 2008, less than half of the population of married women was using
family planning[4]. According
to the World Health Organization, family planning can potentially eliminate 32%
of maternal deaths[5]One of the
many repercussions of the large number of unwanted births is a large number of
abortions, and subsequent death for many who procure them in an unsafe manner.
The problem is that because abortion is illegal in Kenya, women and many times,
young girls are left no other choice. They perform it themselves or seek out
some back alley abortionist, and, when it goes wrong (which it almost always
does), they either bleed to death or somehow manage to get to a hospital. The
“lucky” ones who get to a hospital before they die then face the challenge of actually
receiving help, as many physicians are unwilling to help someone who has done
something so criminal (even though the law says they must give post abortion
care).
In
the year 2000, 189 nations made a promise to combat the extreme deprivations
faced in Kenya through a series of eight millennium goals. Number five was to
improve maternal health. Although some headway has been made in the other
categories, maternal health has been left practically untouched. With less than
four years left to succeed in this aspect of the millennium declaration, the
future of maternal health continues to look grim. As we discussed the problems
faced by women seeking healthcare in almost every aspect of this course, I
began to wonder, what is being done? How do we keep the maternal death rate
from skyrocketing and ensure a future in which women are proactive about their
health and the health of their future children? Astrid discussed some of the
things being done to promote better maternal healthcare, including strengthening
of services, outreach programs, support systems, greater education, etc. I
believe that the major barrier to promoting education and pro-activism is the
lack of unity and support among the women of Kenya. If they could come together
and form support groups of some sort, I think that the empowering affect would
help women to rise up, become educated, and fight for their rights as women and
as mothers.
[1] Hogan MC,
Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray
CJL. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of
progress towards Millennium Development Goal 5. The Lancet. 2010 Apr 12; 375:1609–23
[2] Dr. Zahida
Qureshi, Maternal Healthcare Powerpoint, June 10, 2012
[3] Qureshi,
Maternal Healthcare.
[4] Qureshi,
Maternal Healthcare.
[5] World Health
Organization (2010). Sexual and Reproductive Health Package of Interventions
for Family Planning, Safe Abortion Care, Newborn and Child Health.
Reflection Paper...
When I was 8 years old, my Aunt
Maryanne and Uncle Mark travelled to Kenya, Tanzania, Uganda, Zimbabwe,
and Malawi. They worked in hospitals, spent nights in hostels, climbed
Kilimanjaro, and bartered in street markets. When they came back, my aunt was
showing me pictures of all the people she met and the animals that she saw.
From that moment on, I was determined; I was going to Africa, no matter what.
For years, I dreamt of the day I would finally have the opportunity to go.
Then, back in November, when I heard about the summer program, I wrote a letter
to my grandmother. She has travelled all over the world for as long as I can remember,
and her experiences in Kenya only reinforced my burning desire to go there. I
told her about the program and how excited I was, but that I didn’t have the
means to pay for the trip. She was so happy that such a wonderful opportunity
had arisen for me, that she offered to finance my trip. At that moment, I knew that
my dreams were going to come true, and I was so grateful to everyone who helped
get me there.
When the letter of acceptance into
the summer program came in February, I started to cry I was so excited. I spent
the following months preparing for the trip, but I soon found out that no
amount of preparation could prepare me for what I was about to experience. This
trip has been incredibly eye opening and I honestly feel like another person
coming out of it. When you come from a small town in upstate New York, you
don’t get much sense of the world around you. There’s no diversity, no
cross-cultural interactions, no life changing experiences, nothing; I needed to
get out of there.
The first step off of the plane
felt like my first step into a new world. As I sit here now and think back to
that first day (jet lag aside), it feels like a hundred years ago. I was so
excited/nervous to be in a different country so far from my own; a stranger in
a new world. Now, I feel like I belong here. Each time we met someone who
visited and got “sticky feet”, I felt more and more reluctant to leave. I know
that someday, that will be me, whether I live here, or just continue to come
back to spend time.
I love this country; I love
everything I have seen, everything I have done, everyone I have met, and most
of all, I love the person I have become as a result of it all. I think that the
most impacting experience was our time spent in Ngoswani. Dr. Tonya and I had a
conversation the first night after dinner about how she gave up everything at
home to come to the middle of nowhere and work with the absolute bare minimum.
Initially, I thought there was no way I would have been able to do what she
did, but after 3 short days (especially the day spent in the bush clinic), I
could see why she did it. Watching that old woman strip down and demand to
speak to Dr. Albert while she tried to communicate with us is a memory that
will never leave me. This is an excerpt of my blog from our last night at
Ngoswani:
And as
we finished up dinner, Dr. Tonya said, “Don’t ever forget the experiences you
had in the clinic. Don’t forget the face of the old woman, stripping down and
begging for a massage. Don’t forget the unbearable heat of the manyattas. Don’t
forget the flies covering the faces of babies. Don’t forget the women carrying
enormous loads of firewood on their shoulders, jugs of water on their heads, and
babies on their backs. Just don’t forget.” The whole time I was thinking, “how
could I possibly forget any of it?”, and, as if in response to my thoughts, she
continued, “it may seem too much to forget, but life goes on, things happen.
You get busy with school, work, family, friends, and the more time that passes,
the easier it is to forget. I challenge you to never
forget.” ....Challenge accepted.
I
never want to forget any part of this trip. Not the faces of the little babies
at Nyumbani, New Life Home Trust, or Sally Test; not the putrid smell of urine
or the faces of desperate patients crowded into beds at Kenyatta Hospital; not
the renal biopsy we got to watch at Aga Khan on the little girl who was so
swollen the doctors couldn’t get an IV into her wrist; not the stories of the
men whose lives had been taken over by drug and alcohol abuse; not the walk
through Kibera, as traumatizing as it was; not the smell of freshly killed goat
over a bonfire; not the singing and dancing of the Masai around the fire; not
the constant buzz of flies; not the family of lions eating a hippo in the Mara;
not the view of the Kakamega Forest from the top of the hill; not the excited
faces of the boys at Tumaini as we watched them play soccer; not the women
making beads out of Oprah magazines and papyrus out of old newspapers/medical
records at Imani; not the sound of Wairimu’s laugh or Njau’s never-ending
jokes; and not the friendships that have been made and will always be a part of
me. This has been the most exciting and enjoyable experience of my life thus
far and I am so grateful for everyone who made it so.
