By Maimunat Adeomi
In 2007, during my National Youth Service (NYSC) in Ilara Mokin, a small town in Ifedore Local Government of Ondo State, I experienced first hand working without needed resources. I was awakened at 3am in the morning by some old women who came calling at my window asking me to come to the health center to assist a woman who had just given birth but had retained placenta (the placenta would not come out after the baby). I got to the center and everywhere was dark except the “delivery room” where a midwife and her “assistant” held a lantern. I got to the room asked for a quick history and realized this was a multiparous (has had more than one pregnancy and delivery prior to this) woman who had fallen in labour at home, came to the health center when she had progressed to a certain point in her labour and was delivered of her baby in little time. All was well until the placenta refused to come out even after about 30-45 minutes. That was when I had to be sent for.
All my training and sense of judgment reminded me to refer to a secondary health institution in the nearby city. I made a quick mental note and realized we did not have an ambulance or functional vehicle to transfer this woman to a hospital-I had walked to the health center from my house . Her relatives would not even hear of transferring to another facility as they stood helpless. We did not have a blood bank or a functional theatre to perform any procedures if we had to. Heck! We did not even electricity to move around the room freely without bumping in to stands or trays lying around. With increasing anxiety both inside and outside the delivery room, I wore my non-surgical gloves, reached into the woman’s uterus and began tugging on the placenta gently, and simultaneously I had to apply pressure on the lower abdomen while the midwife held up the lantern for me to see.
After what seemed like eternity, but on hindsight only an hour, I was sweating, pulling, praying and getting blood stains all the way up my forearm, the placenta came out and we were relieved.One thing was certain however-things could have gone the other way and the woman could have bled to death. She was in danger during the procedure and even in greater danger if we adamantly insisted on transferring her to the nearest hospital in the next town without any care in transit. In spite of all my training and experience, despite all the recommended guidelines from the WHO and ministries of health, the resources were not available and she could have died. We just got lucky! (Even though I do not believe in luck). Would I do this again if the same situation repeated itself? I leave that to all other health professionals to answer. Even though this happened as far back as 2007, I dare say the same still obtains as of today in certain areas.
What does this have to do with anything you might ask? Well I say it depicts the work environment some health workers function in and the state of the health system in the rural areas of the country. It shows that it is not just enough to say we have a ratio of 50 doctors per 100,000 population or a nurse population ratio of 150 or thereabout. We must ensure access to health care by employing more health workers. After the health workers are employed, it is even more imperative to ensure that resources or structures are available for them to work with. We must consider if measures are in place to ensure that events like I described above do not occur in any health center no matter how remote.
I do not claim to have the answers but I know there is an urgent/critical need to go back to the drawing board to address issues of lack of social amenities and basic infrastructural needs, we will not see considerable progress in the health of the populace.