My colleague and I took a two hour journey to a village outside of Kumasi to conduct interviews for his documentary on maternal mortality in the Ashanti region; we stopped at a hospital in Jacobu where the matron pointed us in the right direction.
“It’s only thirty minutes from here,” she kindly informed us.
An otherwise smooth journey began to change: potholes, ridges, unintentional speed bumps. The final thirty minute stretch felt like hours, and not just for me. My colleague, Kwabena Ampratwum, had traveled to many rural areas on similar roads but few were as rough as this.
At last, we pulled into the village of Abuakwa. Until two years ago, most pregnancies there were managed by traditional birth attendants – TBAs – who were usually untrained; then the Abuakwa Health Center opened.
Maternal mortality is seemingly low in the village: since 2010, we were told that one resident died of pregnancy complications. While this statistic sounds promising, it unfortunately does not reflect the grim reality of maternal health in the area.
The Ashanti region had 253 maternal deaths in 2011, the highest recorded in Ghana. 154 of these deaths occurred at Komfo Anokye Teaching Hospital in Kumasi. Last month alone, KATH had 17 maternal deaths – including the one from Abuakwa.
Many of KATH’s cases are referrals from villages outside of Kumasi. By the time patients reach the facility, it is often too late. Part of the solution is having smoother, more efficient roads and access to vehicles. The Abuakwa Health Center does not have a car or ambulance so they depend on surrounding villages.
“The bias towards large-scale transport still exists in national governments and donor agencies, and is reflected in terms of budgets, personnel and professional training,” found a recent study from Kwame Nkrumah University of Science & Technology.
We spoke to Vida, a midwife at the center. “It becomes so difficult. Sometimes we have to send a motorbike from this town to the next village, which is almost an hour, before we can get a car to transport our clients.”
“Two weeks ago, we had a lady who was delayed in the second stage of labour,” the head nurse of the Health Center told us. “We referred her at 1 pm… we were waiting for a car, making calls… the car got here at around 5.”
They put her in a stretcher headed toward St. Peter’s Catholic Hospital in Jacobu, the first referral point. In addition to the pain of being in labour for four hours, she was taken on a turbulent route that can induce other complications for her and the child. Approximately forty minutes later, she reached Jacobu.
“The uterus could no longer contract. The lady started bleeding, so Jacobu had to refer her to Komfo Anokye,” the nurse continued.
She was then taken for an hour-long journey to Kumasi. The roads are paved but the traffic is often congested. Even when the roads are wide open, the trip is long enough to worsen critical conditions. She arrived at the hospital over six hours after her complications began.
Sadly, her story ended there.
There were multiple moments throughout the story where her life could have been saved. Inadequate resources, poor communication, and lack of personnel all likely played a role. Transportation is a particularly troubling factor, and addressing it will require a heavy reallocation of funding towards rural development.