WORKING WITH MASAI WOMEN'S HEALTH IN TANZANIA
The scene in Shame/The Gloaming in which Dr. Dorothea waits out the death of a young pregnant woman was based on a real experience. A young Tanzanian doctor, working in the Lake Natron area, told me how her nurse, eight months pregnant, began to hemorrhage. The doctor frantically rushed around the village trying to find a vehicle to take the nurse to hospital, four-hour’s drive away. At last she found one. But half-way there, on the rough, remote track, the car ran out of petrol. There was nothing the doctor could do but wait for another vehicle to pass. In the end, they did make it to hospital, the mother’s life was saved, but the baby died. I often think of those terrible hours, the vast silence of the bush, the desperate hope for the sound of an approaching car and instead only the buzz of flies.
Pregnancy in such remote areas is so often a death threat.
Tanzania’s maternal mortality statistics are bleak: one in 400 women die from the complications of pregnancy. In the area where I operate with the Natron Healthcare Project, we suspect the rate is far higher: perhaps 1 in 40. Women die mostly from obstructed labor, hemorrhage and pre-eclampsia. If I had been a Masai woman, living in Magadini, I would have died and my babies with me.
Pre-eclampsia occurs in the third trimester. For unknown reasons, the body becomes severely allergic to the baby in utero, and begins to go into toxic shock, which leads to death. It is treatable only by delivering the baby, usually through Cesearian. No one know why certain women develop pre-eclampsia, though it is more common in both very young and older mothers, and women carrying multiples. It is not preventable. However, the early detection of symptoms such as increased blood pressure, is live-saving. If the mother can be transported to primary care, as soon as the symptoms show themselves, then she and her baby has a great chance of survival.
With my project partner, Dr. Penny Aeberhard, we have been working with Traditional Birth Attendants in Magadini and Wosiwosi, two Masai communities near Lake Natron. TBAs are the frontline of maternal care, delivering 99% of births in such remote areas; yet, the government has hesitated to acknowledge and include them in its healthcare system. We found TBAs to be both an asset and a detriment to maternal health, and we created a program to improve their skills and knowledge. Our goal was to improve their obstetric skill as well as their ante- and post-natal care, and this included increasing the referral rate of mothers to primary care for high risk pregnancies.
To help TBAs provide better ante-natal care, we have taught them to monitor anemia and blood pressure. Anemia is a particular issue with Masai women, as they starve themselves in their third trimester in an attempt to ensure a small baby and an easier birth. Severe anemia (we regularly see pregnant women with a hemoglobin level of 4; it should be 12) leads to increased risk of hemorrhage and post-partum infection. It can be detected with a simple color-coded litmus test, which can be done by illiterate TBAs in the field. We have also introduced a specially designed sphygmomanometer; the Maternova Cradle Device is easy for TBAs to use, requiring only a simple hand pump and providing a color code for blood pressure. Just by looking at the color – green, yellow, red – TBAs can determine whether to refer their patient to primary care. Currently, they refer on yellow, when pressure is between 140mmHg and 159mmHg. These are high numbers for slim, fit Masai women, likely to go higher, and allow for the time it will take the community to arrange transportation.
We are currently working with other Tanzanian-based NGOs to further shape and replicate our work, with the aim of helping the Tanzanian government evolve a maternal healthcare strategy for the country’s least resourced rural communities.