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UNICEF Provides Relief to Pregnant Mothers and Newborns in Somalia

© UNICEF/2007/CKMinihane
Five days after the birth of her daughter, mother and child are cared for at UNICEF supported Bossaso General Hospital.

By Christine Kapka

Bossaso, Puntland, November 2007 - To look at her, you wouldn’t think that Amal and her newborn daughter came close to dying. But that’s exactly what happened when Amal, 18 and pregnant with her first child, braved scorching temperatures and traveled more than two days in rough and dangerous conditions from the remote District of Allula to reach Bossaso General Hospital in Puntland, Somalia.

“I was going to give birth at home, as is custom, but then I was in labour for two days and could not deliver on my own,” she said, her voice barely above a whisper. “To reach the hospital, my mother and I traveled for over 45 hours. It was so hot and the dust in the air was so thick, I could barely breathe. My stomach hurt and was very heavy. It hurt to travel on the rocky ground and the bumps made the pain worse. I was unable to sleep, and we had no food.”

“When Amal came to us she and her unborn baby were under a great deal of physical stress,” said Dr. Mohamed A. Mustafa, an Egyptian doctor at Bossaso Hospital, member of a technical support team. “The labour was difficult and prolonged, and we had to perform an emergency cesarean section in order to save her life and the life of her baby.”

Amal was one of the lucky ones. Cesareans were not possible just a few years ago, when the hospital lacked the equipment required to perform such a major but oftentimes vital operation. Medical staff were unable to manage the simplest of tests, such as taking a mother’s blood pressure or listening to a baby’s heart beat, in order to gauge the prenatal health of mother and child.

While today the hospital is able to perform a life-saving cesarean, sadly, it’s an operation most Somali women cannot afford. The going rate? Approximately $300.00 US dollars.

“Add onto that Amal’s transport costs each way, which were about $300.00 USD and she’s looking at a total expenditure of no less than $900.00 USD – a fortune for any Somali woman,” said Dr. Geoffrey Acaye, Project Officer for UNICEF Health sector in Bossaso. “Luckily for her, the mother had a small business and was able to pay. But how many others would be denied access for economic reasons? Amal is just one example of many to show that we need to do more to support communities to make emergency referrals, and to develop a system that will enable vulnerable groups to meet the cost of emergency health care for mothers and newborns.”

Providing Desperately Needed Healthcare Relief

“Usually the only time women come to the hospital is when there is a problem,” said Haweya Abdule Guleed, head midwife at the maternity ward in Bossaso General Hospital. “But we’re hoping to change that now that we have help from UNICEF. Before UNICEF came, we couldn’t do much for most of the women who came to us for help. But now since we have received equipment such as sterilizers, HIV test kits, medicines, stethoscopes, and additional maternity training we are able to treat pregnant mothers and their children much more effectively. We are also able to better identify possible danger signs and health threats before they become an emergency. This helps many women and saves lives.”

Preventing Mother to Child Transmission of HIV

Since proper health and prenatal care are so rare or even nonexistent in many parts of Puntland, many women who are HIV positive unknowingly pass the virus on to their newborns.

“One woman came to us with Hepatitis B and was also HIV positive, but she had no idea that she was infected,” said Dr. Ahmed Ali, acting Director of Bossaso General Hospital. 
“She became pregnant again, but because we received test kits and training from UNICEF we were able to diagnose and treat her in order to prevent the transmission of the virus to her unborn child. Her child has since tested negative for HIV,” he said with a huge smile.

“We’ve accomplished so much and we’re still making progress. We’re looking for funding for more training to further help these women and their unborn babies.”

Partnering with the Ministry of Health to Train Midwives

Midwife training by UNICEF has offered additional benefits to the beleaguered hospital and people of Bossaso.

“We’ve provided additional training to the midwives in life saving skills and the detection of pre-natal problems. This has made a huge difference in the lives of the women in Puntland and also to the midwives who today feel more confident and capable to give help and advice to pregnant women,” said Hodan Ismail, UNICEF Project Officer for Health. “We are now mobilizing resources to treat both normal and high-risk pregnancies and getting women to come to the hospital as a preventative measure, not just when there is a problem.”

In a country where over 97% of all pregnant women give birth in the home that will be a challenge for even the most dedicated midwife.

Spanish Committee for UNICEF brings services to women and children in the most remote areas

UNICEF is supporting hard to reach communities like the Allula district, to improve access to quality health care and ensure a strong emergency obstetric referral system. UNICEF also encourages partnerships with local and international NGOs that have expertise in Safe motherhood and New Born Care to work with these communities to build a critical mass of community resource and resource persons that will ensure sustainability and community ownership.

The Spanish Committee for UNICEF has raised funds to support emergency obstetric care for two years in Allula and Kandala districts as part of an initiative to holistically address issues relating to health, education, water, sanitation and hygiene, child protection and child participation.

Over the two years of the project, UNICEF will assist the districts to establish two Maternal and Child Health clinics and eight health posts. As a result, more than 15 hard-to-reach communities will have access to health and nutrition services for the first time. An Emergency Obstetric Care referral system will also be established, serviced by two new ambulances.

When the project is completed, it will provide access to primary health care for 46,680 people, including 10,270 women of child bearing age like Amal and 9,336 children under five. Instead of traveling for nearly two days to find help, all mothers and children in 10 of the 15 villages in these districts will have a health facility in their community with trained staff - a service most families hadn’t dreamed would be possible. And even for mothers and children in the most remote villages, health care will now be at most a three hour car ride away.



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