Madam Nafizatu Abukari, a 27-year-old expectant mother, delayed in reporting to the hospital for several hours after a rapture of the membranes.

Her uterus dilated until the baby started to present, but with the legs.

Stuck in between her legs, family and friends looked on as she laboured on with deep groaning and screams until both mother and baby became weak.

Forms of delays

Finally, someone called the Wa West District Hospital at Wechiau, where emergency cases are referred to.

The only resident medical officer at the Wechiau District Hospital, who doubles as the Medical Superintendent, Dr Benjamin Aminyuure, quickly dispatched his official 12-year-old pickup vehicle to convey the patient because the hospital's ambulance had broken down.

Dr Aminyuure then got his theatre and staff ready for the arrival of the expectant mother from Gurungu, about 19 kilometres away from the district hospital at Wechiau.

Dr Aminyuure told the Daily Graphic with a sense of pride that a cesarean session performed on the woman was successful and that saved the mother and baby, and they are now hale and hearty.

He cited the case to buttress how three forms of delay, namely reporting late to health facilities, lack of transport to convey patients to health facilities and a lack of medical interventions had contributed to maternal mortality (child delivery-related deaths) in the region and indeed in the Wa West District.

However, the health directorate has instituted measures to address each of the identified challenges with the support of various assembly members, the Member of Parliament (MP), traditional authorities, elders and public in the 226 communities the hospital served.

Causes of delays

The delays, it has been observed, borders first on the decision to report to the hospital for antenatal cases, especially when it turns out to be an emergency.

Sometimes, after the decision to report has been reached, the woman in labour has to either wait for instructions from her husband or means of transport to get to the health facility.

Dr Aminyuure said sometimes delays in administering the required intervention in such cases were also factors.

There are poor attitudes on the part of the health staff and physical assault of expectant mothers during delivery.

The Medical Superintendent, who arrived at the facility about a year ago, realised from the hospital's annual review that the four community-based health planning services (CHPS) zones had 171 home (unskilled) deliveries, suggesting that the women preferred to deliver on their own instead of seeking the services and support of the experts at health facilities.

He said the people in the communities gave reasons for their action to include the poor road network, inadequate means of transportation to access the facilities and the poor attitude of the midwives towards the patients for whom they have been employed.

Another challenge is also top-up or extra charges taken from expectant mothers at the hospitals many of whom cannot foot the bills.

Remedies

For now, the hospital has taken up the transportation of pregnant women to the facility free of charge.

"We instituted free ambulance services for maternal cases, beginning with the four CHPS zones. Later, we involved other sub-districts, where there are health centres, and eventually extended it across the entire district," he recounted.

Technology

The hospital also created a WhatsApp platform for maternal and child health care delivery involving all the stakeholders of the District Health Directorate.

What happens is that if there is a maternal case that will require hospital delivery in any of the sub-districts, it is put on the WhatsApp page with the key facts to enable the Medical Superintendent to play an oversight role over all labour cases.

Based on his advice, the situation is expected to be resolved within four hours before further action, if any.

Dr Aminyuure said when the case needed a referral to his facility, the ambulance was immediately dispatched or in his absence, his 12-year-old pickup vehicle came in handy.

The platform also discusses maternal and child health care issues to keep one another in tune with trends.

The third intervention to prevent maternal and child mortality is the abolition of the top-up charges which included monies collected for the purchase of items such as detergents, pads and rubber sheets for delivery, with the hospital underwriting that bill on internally-generated funds (IGF).

Series of staff durbars have also been organised to assist the staff to change their minds and attitudes toward maternal and child health care.

Additional measures

The hospital authorities have also asked the traditional authorities to institute some kind of "bye-laws"for pregnant women to attend anti-natal services and sanctions on husbands whose wives deliver at home.

"For the road network, we continue to plead with the district assembly and government to assist with that because we cannot do much about that," Dr Aminyuure said.

These measures, instituted mid-last year, have contributed significantly to changing the story from one of sadness to positive outcomes, with zero maternal deaths by the end of last year.

According to figures sighted in the hospital's half-year report 2021, the district recorded 178 skilled deliveries (deliveries in health services) as against 124 skilled deliveries in year 2020. The deliveries included 29 caesarean sessions, with the rest being through normal deliveries.

Way forward

Dr Aminyuure said while the hospital would continue to improve on the achievements, it would strengthen laboratory services to enhance maternal care delivery.

For its IGF, the hospital will run a mobile laboratory which will move round to take samples of pregnant women and run the labs for them under the cover of the National Health Insurance Scheme (NHIS).

He appealed to the government to augment the staff strength of the hospital, especially with additional medical officers and mechanised staff, including a number of them for the pharmacy.