“Just lie still and relax. Breathe slowly,“ midwife Diana guides Anena, age 24. Anena is attending her third antenatal care at the maternity centre for her third pregnancy.
Diana pressed a fetal stethoscope onto Anena’s belly. “The heart is beating well,” she told Anena. Diana encourages all expectant mothers to attend at least four antenatal services. She works very closely with the community village health volunteers to identify expectant mothers who are then referred to the maternity centre.
“It is important that we encourage the mothers to come to the clinic. There is a misconception about the care that we provide at the health centre,” she explained. “The previous generation gave birth at home, most often with the help of a traditional midwife, who had no professional training. So sometimes they simply do not come to us,” Diana lamented. This makes it difficult to achieve one of our primary goals; reducing maternal mortality among the rural women.
According to the most recent reports, the maternal mortality rate in Uganda has decreased from 438/100,000 women in 2011 to 336/100,000 women in 2016 during live births (Uganda Demographics & Health Survey 2016). Midwives have contributed tremendously to this decrease. Nearly three quarters of women (74%) now deliver with the assistance of a skilled birth attendant (UDHS 2016) compared to 37% in 2006 and 58% in 2011.
Midwives trained to meet rural needs
According to a United Nations Fund for Population Activities (UNFPA) policy brief, Uganda has about 1,043 midwives. Due to shortages of trained midwives, it is estimated that one midwife handles between 350 and 500 deliveries a year, yet the World Health Organization (WHO) recommends that a one midwife should handle no more than 175 deliveries a year. With an estimated 1,800,000 births per year (Country meters 2017) the country needs 9,243 more midwives to meet the required minimum staffing.
Devoted midwives, poor infrastructure
Still, these midwives face a range of challenges while providing services– not only frequent power outages, lack of housing for midwifes on night duty, but also stock outs of supplies such as gloves.
In Gulu, the facility experiences frequent power outages and, because there is no standby generator, the midwives have to use solar power that sometimes does not work well during the rainy season, to light the maternity ward. “The current solar power is not enough to provide adequate light,” Diana explains.
According to a study by WHO and the World Bank, lack of electricity remains a neglected barrier to effective provision of health services in many developing countries including Uganda. A total 58% of health facilities in Uganda have no access to electricity, the study notes.
Grinding poverty also limits rural women’s access to care.
“They need to tend to their crops and take care of children,” Diana said, explaining that many women do not have the time or resources to seek health care. Anena had to squeeze her check-up into a busy day of farm work. Afterward, she returned to the gardens, and also cared for her two young children. “I have to meet my family needs by selling food at the market as well,” she said.
A role model
For her part, Diana says that, although she is sometimes overwhelmed with the workload, she is happy to see an increase in women seeking her services. She hopes to set an example for the next generation. She too, grew up in the area, she explained. When she completed school in midwifery, she wanted to serve her community.
“I have some girls who want to talk to me about my education and some of the parents see that maybe it’s good for their daughters to stay in school. People see what I have done and so they have begun to think, maybe I can do that too,” she said.
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Dear friends,
Greetings and a Happy new year!
Over the last 16 years in stewarding the vision of Karin Community Initiative Uganda, 2017 became a year where many of our dreams and hopes for this organization were tangibly realized and consolidated.
One of those realizations– the increased number of women delivering their babies from the health facilities. Over 50 babies were delivered, the maternity unit stands as a visible record of achievements and a profound piece of KCIU’s mission, in addition to this we provided prenatal and postnatal care to 976 mothers outpatient care to 6350; 496 children completed their immunization, family planning services to 1521 couples; bed nets to over 6000 families, skills training to 53 children and 40 church leaders and teachers and trained many more women groups in the community.
We credit this impact to several factors, the greatest of which is partners like you. Providing access to quality health care services, transforming lives and equipping them to accomplish their dreams is the foundation of KCIU’s mission. We exist to serve the community with quality health care services.
We not only saw the affirmation of our vision, but also the growth of our organizational capacity to advance our work in the areas we have been called to serve. Thank you for being part of of KCIU as we together, steward this vision. I would love to see us continue this service in this year too.
I would like to add that with the great achievements we have made in the last year, our programs may not continue, our funding has greatly dwindled and humbly appeal to you for your support.
Please continue telling your friends and network about our work and how they can be part of this organization. I thank you for standing with us for through your generous support.
Thank you in advance for your contributions.
kind regards
Hope Okeny
Executive Director
Karin Community Initiative Uganda
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Dear Friends,
There are three main indicators commonly used to measure the quality of health care: structure, process and outcome.
Structure refers to characteristics of the care setting, including medical equipment and staff. Process refers to the services that are provided and its consistency within the recommended guidelines. The outcome evaluates a client’s health as a result of the quality of care provided.
For the past months our main focus have been on the structures and outcomes, and for this reason we have seen the need to improve quality of care through process measures.
“When a mother attends antenatal classes, we want to ensure that the mothers blood pressure, weight and edema are checked. We want to see that the mother receives the necessary immunization and counseling amongst other services.” “Our main aim is to avoid low birth weight in children, and of course safe deliveries” says Sarah midwife at the Karin Maternity Center.
“We want to ensure that when a mother or anyone is receiving care at our facilities- the way that care is given is important.” she added
At both Karin health facilities assessments results have showed that while resources are important, the quality of care clients receive can hold greater statistical significance in the outcomes of basic health care in resource-constrained settings.
One of the ways that we ensure that health workers continue to provide quality care is by continuous education carried out at the facilities and quality service delivery assessments. When health workers understand the benefits of process improvement, we ensure that clients are safe.
We value the support that you give us to provide quality service delivery. We value your continued support and it is for this reason that we ask you to share our global giving page with your contacts and tell them why you decide to donate to us and why they should do the same.
We urge you to sign up for a monthly recurring donation today.
Thank you for your support!
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Pregnancy is occurring at younger ages than it has in the past and continues to increase in frequency. Uganda has the highest rate of teen pregnancy in the sub-Saharan Africa, with 24% being pregnant before the age of 18. This means that 1 in every 10 pregnant women in Uganda is under age 18. This places them at a greater risk for complications during pregnancy, before and even after; risks increase substantially for those less than 15 years. Not only are they at risk for premature, obstructed or prolonged labor, but their infants are at greater risk for low birth weight and prematurity; death being an even more serious risk for both mother and child.
Due to the developmental stages of puberty the adolescent/teen body is not yet equipped for the birthing process. Having smaller and narrower pelvises creates for a dangerous delivery process. Infants may not be able to fit through the birth canal and may suffer from asphyxiation due to prolonged labor. Furthermore mothers are likely to experience hemorrhagic bleeding, leading to death, due to obstructed labor, bones being broken through delivery of infants. The birth canal is much smaller the first 3 years after menarche and it does not increase in size until late adolescence, more so at the age of 18 and beyond. The teens and adolescents are also at risk for lack in prenatal care, less likely to finish school and sometimes lack in support; whether it be their family, their partner or the partner’s family.
When Charlotte, a 16-year-old teen, came to the center, I immediately paid close attention to her because of her age and also because she expressed the lack of support from her partner’s family because of the pregnancy. Luckily she has the support and compassion of her family, who brought her there to center, who I also sat with and counseled. I came to find out that her partner is also a young teen of 15 years old, Jack. Her parents told me as well that due to the nature of ages in the situation local authorities had become involved, which created for them a stressful dynamic to a new and delicate experience. She has now been directed to receive care and services at Unyama, one of KCIU’s health centers. I cannot help but think that had these two teens known of the risks that could come with pregnancy at a young age they may have sought out guidance on what they should do. Or if they felt empowered enough to speak about sexual activity or engage in family planning counseling they may have been exposed to various lines of contraceptives and how to practice safe sex. She will continue to receive counsel throughout her entire pregnancy and even after. She has the support and care of myself and the Karin team and will continue to be educated at each step she takes.
Karin Community Initiatives-Uganda seeks not only to bridge the gap in education surrounding pregnancy, contraceptive use and family planning but also in the case when adolescent/teen pregnancy does occur that the entire family is taken care of, particularly the mother and child. Both health centers are in the process of developing a youth friendly service program. That prenatal care is provided, and patients are followed closely throughout the entire pregnancy through delivery and after, postnatal, in order to prevent, intervene and ameliorate any complications.
We are able to accomplish all that we do because of the support of our gracious donors. Your support enables teens like Charlotte to be able to get youth friendly services where they can access vital reproductive health information.
Look out more for our youth friendly service program outcomes.
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Baby naming and Hope.
One of the things I have come to know about baby naming is that; expect to tell your story.
For many of the children that come to the clinic I am always curious to know how they were named. The common names we see at the clinic include “Lagum, Rwotomiyo, Anyadwee, etc”
And when I ask ,“How did you choose her name?” as one of my go-to conversation starters with parents with unique names.
Sometimes the response is a vague, “Oh, she came after many years of waiting so we named her “Rwotomiyo,” affirming that patience is usually rewarded.” This name also represents a call to the child to remain patient in time of adversity. Sometimes I get the names like “Achiro or Akanyo" to represent the circumstances around the child’s birth. For those with twins they also have names for the twins and their followers.
But for some the fuss abut giving names to children does not make sense to them. They do not put much time and thought into what names they give their children. However, in most African families the practice of naming is brought about by the profound appreciation of the value of a human being. A child is given a name, because the parents and their families go beyond seeing the child, but a person who will have an identity and a vocation. That the child has a personal dignity right from the moment of conception that needs to be respected and protected. The child is given a name that the parents like. Often times naming their children after a close friend, a relative or a person that they look up to. In many cases it is a religious name given at the Baptism.
In fact, naming is accorded almost the same significance as marriage. Often times, parents take every available opportunity to reinforce the messages behind the names that are given to their children. Using popular African proverbs to drive home their messages. When children do not act according to expectations, they are told proverbs such as: "If you do not stand for something, you will fall for something"; "It is a bad child that does not take advice"; "For tomorrow belongs to the people who prepare for it today."
This week when Adong checked in to deliver, she was very anxious. The thing is, her last pregnancy did not go well, she lost her child during delivery and this was the reason for her anxiety. “My world fell apart when I lost my child, and I was not sure whether I should have any more children,” she shared with pain. “This is my third child and my husband and I have planned to have four children. When I lost my child I became very fearful, because all my pregnancies have been very difficult,” she continued. But I am here to thank God that He has restored my hope. So the baby was named Hope Lakaraber. Lakaraber meaning "from a good place”, and “Hope” after me. So when baby Hope Lakaraber was born we were proud to associate her from a good maternity centre, and that she is a child that will be loved.
Adong is thankful to the Karin Maternity Centre, and thereby naming her child after me. I know that the Lord is being praised here! For His will is being done when we bring hope to this community. At the end of it all, usually there’s often a great story about going through names until one is chosen.
But more importantly, we continue to thank you for the support you continue to provide, enabling the nurses meet their goals of delivering babies in the a safe environment, or recommended an emergency referral to a higher-level health facility.
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