Speak Magazine

Field Notes

The Road to Maternal Health

From here, women in labour are carried down the mountain.

From here, women in labour are carried down the mountain.

“I have carried uncountable women down the mountain, down to Wli.”

Patrick stares at the ground. Remembering the women he and his friends have had to carry on a stretcher down the mountain path.

“It is very difficult…once I remember a lady, Helen. She was suffering. It was rainy season, and by the time we reached the [trail] we fell.”

“Then when we get to Wli, we need to get a car. Many people lose their lives when they’re waiting for the car.”

Patrick Gborbortoi, 21, otherwise known as Happy, is a resident of Wli Todzi, a small village situated in the Eastern Highlands of the Volta Region. Perched on a fertile plateau high above the tourist destination of Wli Falls, the village is cut off from contemporary Ghana. The only access the villagers have is the narrow mountain trail.

There is no road leading to the village, and if a woman experiences complications during childbirth, she has to be carried down the mountain. The only other option is a circuitous and expensive 7 km route through Togo and back into Ghana.

The mountain trail can be a hazardous journey, and for women about to give birth, its rendered even more dangerous.

“Women in labour are the most vulnerable…” says Togbe Agbenato the III, Chief of Wli Todzi, referring to those most impacted by the lack of road access to the village.

There is no midwife or doctor in Wli Todzi. Few healthcare professionals, be they nurses, midwives or doctors, want to work in the village as it is too remote and access is difficult. The last midwife left Wli Todzi in 2008. Since then the only healthcare givers present in the village have been community health nurses, who are not qualified to deliver babies.

Women who can afford it stay in Hohoe during the weeks leading up to their predicted delivery dates. Others are forced to give birth in Wli Todzi or descend into Togo, where they have to pay at least 65 Ghanaian cedis to deliver.

Due to this lack of critical infrastructure, many young women have died in childbirth, “Many, more than I can count” says Gborbotoi.

He starts naming those who have died. “Auntie Adjua’s daughter, Agbli, she died at Wli.” She was 24 years old. Awoku Gborbotoi, 28 years old. A young woman named Sena Mote, 22. Another, Adalila, was 30.

He tries for more names and asks his mother who is sitting across from him, she shakes her head and looks into the fire.

“You know, those things are so horrible, they don’t want to speak of it” says Happy.

Deborah Zatey, 21, is lucky. Originally from Wli Todzi, she has given birth to three children in three different places, in Wli, Hohoe and Togo. When Zatey was pregnant with her latest son, Dixon, she decided to go to Hohoe three days before giving birth. “I walked alone down the mountain, I had pains all the way” she says.

The easiest experience she had was when she decided to go to Togo to give birth to Wonder, her oldest son, “…even though the cost was very high, it was still the best…[At the time] I had no other choice.”

Maternal health is a serious issue in Ghana. To date the government has been unsuccessful in decreasing maternal mortality rates to the desired 2015 Millennium Development Goal target of 185 deaths per 100,000 live births.

Although Ghana has seen a decrease seen since the year 2000 (when the figure stood at 540 deaths per 100,000 births), the number has recently stagnated. The initial decrease was owing to an improvement in healthcare infrastructure. Today however, more needs to be done to decrease the numbers from the current 350 deaths per 100,000 births.

“If you have many bad roads, those clinics will not have any use. The roads are very important. In Hohoe [district] the roads are very bad, very bad” says Dr. Felix Doe, Municipal Director of Health Services for Hohoe District. “If you look at the rate we are reducing maternal mortality, we won’t achieve [the MDG], so we need to do something fast.”

Yet things aren’t happening as fast as the Dr. Doe would like. Wli Todzi was in 2007 promised a road by then Vice President Aliu Mahama. Funds were allocated and a contractor, Cannery Construction, arrived on site and began work. Shortly thereafter the project was inexplicably abandoned. Since then, there has been no word from the government regarding their promised road.

Ghana’s Ministry of Roads and Highways Pilot Program Based Budget for 2013-2015 lists a feeder road from Ahor to Wli Todzi as one of its main priorities. In the time of writing, there is no sign of it.

The feeder road, says the report, will “…have the added impact of expanding access to social services and employment opportunities especially to women…”

Volta Regional Manager of the Department of Feeder Roads, Osei Nketia says that they are currently assessing the situation and will, in two months, have a proposal for the central government.

“We are doing everything that we can…to get the designs and regulations ready so that subject to the availability of funds, the road will be awarded” says Nketia.

The questions of funds however, is a difficult one because “as a lower middle income country we don’t have enough money for all the roads” he says.

It is certain that the road will cost a lot, as the terrain is very demanding and is sure to require many resources, yet Nketia remains optimistic. He says he is sure that the road will be completed.

“Transport” says Sylvia Deganus, “plays a key role, we can’t do without it.” Deganus is the Maternal and Newborn Health Technical Advisor at MamaYe, a local organisation dedicated to improving maternal health in Ghana. She says the government pays constant lip service to the issue, but until the proper resources are allocated to doing so, health and mortality rates will suffer, and the MDG will not be met.

If maternal health suffers, so does Ghana’s society.

“Maternal health is one of the key indicators of a country’s development” says Deganus.

Maternal health is multifactorial, by improving a mother’s health you are improving the entire society’s access to infrastructure, to healthcare and to essential skills. Perhaps most importantly, she says, healthy pregnant women and mothers are a strong indicators that the female half of the population is educated.

The value of having healthy mothers to care for children is unquantifiable. The trauma visited upon a child, family or even a community when losing a mother is also immeasurable.

“There is nothing like seeing a woman bleeding to death. Its an experience you don’t want to have” says Deganus.

Happy has already seen too many of his sisters die from loss of blood.

“It has been very difficult. Sometimes I blame my forefathers for coming here. Why do we need to experience this? But sometimes its the way God wants it. You send the person to the mortuary and come back.”

Happy trails off. He stares somewhere beyond the red earthen floor of his compound.

“Its not easy at all.”

 

 

 

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