This is the last in a series of stories about Jhpiego’s work in support of the Tanzanian government’s efforts to strengthen and improve health care for women and families.
Zanzibar, Tanzania—Sitting on her bed in the Makunduchi Health Centre, Hidaye Hassan looked down at her newborn son and proudly proclaimed, “When you see him, you see his father so you know he’s handsome.”
The petite woman had arrived at the two-room maternity ward four days earlier with moderate labor pains and dangerously high blood pressure. Concerned that the 25-year-old was at risk for eclampsia, the nurse-midwife on duty checked Hidaye regularly until she gave birth to the healthy baby boy now sleeping on her lap, swaddled in a bright orange and green kanga cloth customary in East Africa.
Hidaye was among five women in the tidy maternity ward on this steamy summer day, all of them being cared for by nurse-midwives who had participated in a government-sponsored program to save the lives of women and babies by strengthening basic emergency obstetric and newborn care (BEmONC). Funded by the U.S. Agency for International Development in Tanzania and supported by Jhpiego, the Mothers and Infants, Safe, Healthy, Alive (MAISHA) Program is also focused on reducing the number of HIV infections transmitted from mother to child. In 300 facilities throughout Tanzania and Zanzibar, health providers with updated skills are delivering competency-based care to women and adopting new practices to prevent infection and encourage women to give birth in a facility. The goal of the MAISHA Program is to keep mothers and infants, safe, healthy and alive.
At the Makunduchi Health Centre, the hallmarks of this program can be seen—from the pairs of white rubber boots and aprons to protect the seven nurse-midwives who work there to the newly-washed, traditional kanga cloth wraps for babies and nutritious porridge for moms. Women who give birth without any problems are kept for 24 hours to ensure that they and their babies are fine. Others remain at the facility until the nurse-midwives determine that they have improved enough to return home. The center, tucked away off a rutted, dirt road in the north of Unguja island, serves a district of 20,000 people, many of whom earn their living working on spice and fruit farms and trolling for king fish.
When Hidaye arrived at Makunduchi , the nurse-midwife on duty knew she needed close supervision. Late in her pregnancy, Hidaye visited the facility’s prenatal care clinic. A checkup showed she had high blood pressure, a possible indication of a potentially life-threatening, pregnancy-related disorder known as pre-eclampsia. When a woman arrives to give birth, midwives are taught to check a woman’s blood pressure and the level of protein in her urine (a way to detect pre-eclampsia).
After Hidaye gave birth to a 6 pound (2.8 kg) boy, the nurse-midwife gave her a life-saving drug to contract the uterus and prevent postpartum hemorrhage—just as she had been taught by Jhpiego trainers under the MAISHA Program. Later, when mother and baby were comfortable, she gave Hidaye vitamin A supplementation to reduce the risk of developing a deficiency common in breastfeeding women.
Although, as it turned out, Hidaye did not have pre-eclampsia, the nurse-midwife on duty successfully managed her high blood pressure throughout labor and the early postpartum period.
Three days after giving birth, Hidaye was released to go home with medication for her high blood pressure. She hopped on the back of an uncle’s bicycle while her grandmother began carrying the new baby home. Hidaye is expected back at the center for a one-month, checkup.
For Kazija Haminu, the baby boy wrapped in an orange and white paisley kanga and cradled in her arms was her third child. But the 23-year-old mother experienced something new with this birth. Instead of her baby being whisked away after birth, he was dried, placed on Kazija’s chest and covered with a cloth as part of the skin-to-skin contact the midwives now encourage as a result of their training. Kazija looked down at her son and smiled: he looked like her.
“I was told the baby needs the breast and to feel the warmth,” she said hours after giving birth. “The baby was crying. When I put him to breast, he was sucking, hard, strong.”
Kazija was glad that she had chosen to come to the facility to have her third child. “It’s nice to be here. Good people. Good service.”
Mayasa Ali had given birth to a boy, her seventh child, three days earlier. But the baby wasn’t nursing properly so the staff kept the pair for further observation. Her son improved over the days, the 42-year-old mother said, and was now suckling and crying well.
The five mothers presently at Makunduchi all arrived via the health facility’s ambulance, a new service offered to women in the surrounding villages to encourage them to give birth at the health facility. The presence of a skilled health care provider at delivery is a key intervention to ensure that a woman survives child birth, and in Tanzania, approximately 50 percent of women give birth with a skilled provider. During prenatal care at the facility, women are given a cellphone number to call to summon the facility’s ambulance—a white Toyota Land Cruiser that was donated by the United Nations Population Fund.
Ghanima Shehe, the head nurse-midwife at the center, said she sought the support of village and community leaders and explained the possible dangers of giving birth without a skilled attendant. In March, a young woman gave birth at home and started to bleed, she said. A traditional birth attendant had been at her side and the placenta had not been completely removed, a major cause of hemorrhage. By the time the woman arrived at the health center, she said, the staff couldn’t save her.
Health education classes in the community also have piqued interest in Makunduchi, where previously 40–45 births took place each month. Since the ambulance service began in early spring, the number of births has increased to 60–65 per month at the five-bed facility.