With about 52,000 pregnant women dying yearly, maternal mortality remains one of Nigerias biggest health challenges. TOYOSI OGUNSEYE, who spent three days in rural communities in Ondo State, reports on a government initiative that is using mobile phones to save the lives of indigent pregnant womenApart from a small maize farm in Igbara-Oke, Ondo State, 29-year-old Tolu Adeniga has only one prized possession: a cheap mobile phone.For many, a mobile phone is a tool for business or pleasure. For Adeniga, it is an object of unending fascination and a life saver.I go everywhere with it. I dont allow my children to touch it; I dont want them to spoil it, she says with excitement.It all started two years ago, when she went to the Basic Health Centre, House of Abiye, Molete, Igbara-Oke, in her native Ondo, pregnant with her second child. What she went for was antenatal care, what she got, in addition to the care, was a mobile phone. She was told to use it to regularly update a health worker assigned to monitor her pregnancy.Chuckling like a child, she remembers it all, That was my first time of having a phone. The nurse gave it to me and said I could call her any time with it. She monitored my pregnancy with it. Any time I was feeling sick, I would call her. Even if it was a little headache, I would pick my phone to talk to her because calls to my nurse are free. I kept the phone, and when I became pregnant with my third child, my nurse was always calling me to be sure I was fine.Abiye, a Yoruba word meaning Safe delivery, was the name that the Ondo State Government gave to an initiative meant to protect pregnant women from sundry maternal illnesses and complications. The Abiye phone is small cheap slim black one which performs the basic functions of a phone. The government decided that Ifedore Local Government Area, where Adeniga lives, should be the location of the pilot scheme.Despite its glittering capital city and other major commercial centres like Lagos and Port Harcourt, Nigeria, as census after census have shown, is a nation of rural dwellers. A World Bank report published in 2008 says that 51.6 per cent of Nigerians live in rural areas.Most of these are cut off from modern medical facilities, making many pregnant women vulnerable to easily preventable sicknesses.The state Commissioner for Health, Dr. Dayo Adeyanju, describes Abiye as a home-grown initiative meant to bridge the gap between rural pregnant women and modern medical facilities.We needed a home-grown initiative that would reverse this ugly trend (maternal mortality); and that was how Abiye came to being, he says.What Adeyanju meant by ugly trend is Nigerias high mortality rate. According to Consultancy Africa Intelligence, more than 600,000 women die due to childbirth or pregnancy-related complications around the world annually. Nigeria is responsible for about 10 per cent of that figure.Across the country, however, this rate differs. Different studies have put the estimated average maternal mortality rate around 1,000 for every 100,000 births. But maternal mortality is much higher in the North-Eastern region of Nigeria, accounting for 75 per cent of the countrys maternal deaths, compared to the South-East and South-West regions.Lanke Akintoye, 20, a tailor and mother of two, is one of those who have had cause to smile because of Abiye. Akintoye has been using her Abiye phone for a year.Three years ago, she had her first child in a private hospital through caesarean section and didnt enjoy the experience.I didnt like the operation; it was God that saved my life. Also, it was too expensive. It took all our life savings. So, when I became pregnant last year, my husband told me that I had to attend a government hospital because we didnt have the money to afford a private hospital again, she says.When she got to the health centre, her nurse gave her the Abiye phone.I didnt know how to tell the nurse that I didnt know how to operate a phone. I never had one, she smiles with embarrassment. I guessed she noticed my discomfort, so she taught me how to use it. I didnt learn it immediately; she kept teaching me until I understood it properly.Out of excitement of having a phone, Akintoye would call her nurse in the morning to say good morning; she would repeat the pleasantries in the afternoon and at night before going to bed.She remembers the day she had a false labour. I was at home when I developed diarrhoea. My baby was kicking and it was really painful. I thought my baby was on the way and I was the only one at home. My husband does not have a mobile phone.The first person I called was my nurse. She came to my house immediately with a First Aid box and placed me under observation. It turned out to be false labour, as I did not give birth until three weeks later. She said it was a good thing I called her anyway, as many women die under similar condition if help does not reach them.Unlike Adeniga and Akintoye whose first contact with telecommunications tools was through the Abiye phone, Fatima Lawal, 32, says she had a mobile phone before the health centre gave her another one. The hair dresser says she got another phone when she went to the clinic for a routine check-up last year. She was safely delivered of her son, Teslim.She says, Even though I had a phone before, I misplaced it, so the Abiye phone was like a replacement for me. All through when Teslim was in uterus, my nurse would always call me to ask after my health. She made me feel special and that made me tell her all the pain I was feeling. It was my easiest pregnancy. She is my sister now.Akintoye, Adeniga and Lawal are in a group of 35 patients and outpatients under the watchful eye of Mrs. Mercy Olaseinde, a health officer.Under the Abiye initiative, a Ranger is the parlance used for health officers and nurses that closely monitor pregnant women in the locality.Olaseinde, who has worked for 10 years in the hospital, is one of the four Rangers in the clinic.She has done this for 18 months and says she has safely delivered 80 women of their babies.She says, The Abiye phone is a major attraction for them. Before the state government started giving pregnant women these phones, they hardly came to the clinic. Most of them patronised traditional maternity homes and they were always dying with their children. But in almost two years, I personally monitored 80 of them. I have 80 healthy babies and 80 mothers who are alive to take care of their children. That makes me happy every day.Besides steering vulnerable pregnant women to the government clinics, the phone is also helping health workers to track maternal statistics in the state.Olaseinde says, Word went round that we were giving out phones and they came in droves. We were able to track almost all the pregnant women in our local government area. I have one of the phones too and it is toll-free. Once they come in and get the phone, I pester them with calls. The first strategy is to be friends with them. I take interest in their jobs and families well-being and visit them often.Ranger Olaseinde and the women in her cluster group are like an extended family. We are family now. We are a sisters. They all come to my house and I go to theirs. The phone has made us very close. All through their pregnancies, they called me every day to tell me how they were feeling and in cases of emergencies, we went to their homes on a motorcycle with a First Aid box. If it is something we cant handle at the centre, we take them to the general hospital.Another ranger, Mrs. Fola Fakayejo, who works at the Comprehensive Health Centre, Ilara-Mokin, has 25 patients in her cluster group.Forty-five women gave birth in my care in less than two years and that is tremendous, considering what used to happen before, she says with pride. You know, this is a rural area, and almost all of them patronised herbalists who knew nothing about maternity. If the mothers did not die in those homes, the children would die. It was that bad. Unfortunately, we didnt have the statistics of maternal or infant mortality in this area before the Abiye scheme.But look at it this way: we have four rangers in this centre and each of us has monitored a minimum of 50 pregnant women in 18 months. So, in 18 months, we have delivered at least 200 babies and I am telling you that we did not lose any child or mother. Before the advent of the Abiye phones, we had less than 30 women coming to this centre in two years to be delivered. Look at the percentage difference.It is almost impossible for a mother or child to die, because I see each of them once a week; I know their medical histories, I am always discussing with them on the phone if I am not in their homes. I know when they sneeze or cough. You know, calling within the group is free; so they call me at any slight discomfort. If anything is beyond me, I tell the doctor to attend to them. If it is beyond us, we take them to a bigger hospital. But that is rare because of daily monitoring.The Primary Health Coordinator, Ifedore Local Government Area, Mr. Omololu Martins Ade, says as at April 2010, 1,200 Abiye phones had been given to pregnant women and another 700 phones have been given out this year.I can tell you confidently, that we can track all the 1,900 women, he says.Even though there are no comprehensive data in the state, statistics from the Ministry of Health show that the total number of pregnant women that registered in all the health centres before April 2010 in Ifedore LG is 240. Out of the lot, only 97 of them came back to be delivered of their babies.However, since the inception of Abiye, 4,900 women have gone for antenatal registration in the LG, and about 1,900 deliveries have been recorded, with one maternal death.Also, the records show that 40 traditional births were recorded in the LG in 18 months. This number was tracked when the mothers brought their children for immunisation in the clinics.Adeyanju, the health commissioner, explains that the baseline survey that was available before Abiye commenced showed that only 16 per cent of those who registered in the health centres in the state came back to deliver their babies.It dawned on us that we needed to track these pregnant women and help them return to the health facilities, he says.According to him, delays in seeking, reaching, receiving and referring health care are the major reasons for maternal mortality in Nigeria.He says, Delay in seeking care is the reason we have to track them and put them on a toll-free, caller-user group that is prepaid by government. When we did that, we were able to track the pregnant women. The 1,200 initial numbers had 50 health rangers attached to them. The rangers would then see one pregnant woman per day. Because they are on toll-free lines and the health rangers are in touch with them every minute, the delay in seeking care is minimised to almost zero.This also takes care of delay in reaching health centres because we station four-wheel ambulances to convey the pregnant women when they call in the wards. One per ward, so at every point in time, they can reach health care.In terms of delay in referral from the basic health care, when necessary, they are referred to the comprehensive health care centres and then the general hospital. That way, we have succeeded in saving about 1,900 babies and their mothers in 18 months.Even though Abiye phones have been able to save more lives in these communities, SUNDAY PUNCH gathered that the scheme has its challenges.The scheme is being practised in rural areas where most homes are very poor and sometimes, the Abiye phone is converted to a commercial phone by the breadwinner of the family and used to generate some income.Ranger Fakayejo says, When some of the pregnant women get home with the phones, their husbands will collect them and start using as theirs. It defeats the purpose they are meant for, because even when you call, the husbands wont be at home to give the phones to their wives so that you can speak to them.There is also the challenge of poor connectivity. One of the pregnant women told our correspondent under the condition of anonymity that it is sometimes difficult connecting with her ranger. I will try her number so many times, but I wont be able to reach her because of network problem. But if I am persistent, it will connect. It hardly happens, but who knows if its when I really want to talk to her that I wont be able to reach her.Dr. Lawal Oyeneyin, the Chief Medical Director, Mother and Child Hospital, Akure, who is also on the Abiye committee, says solutions have been found to these challenges.He states, The issue of connectivity is a technical one that the network provider is working on. We have been in meetings with them on that.Talking about improper use of the phone, we will be giving only SIM cards out in the next phase of the project, which we have dubbed Abiye Plus. Because, the issue is, how many women will we keep buying phones for'However, for pregnant women that cant afford phones, we will still give it to them, but the SIM cards will be built into the phones so that the phone can only work with the Abiye SIM card. Then we will ensure that at least every community has one Abiye phone which we will give to the women leader and she can reach us on it if there is any problem.To improve our maternal mortality data bank, a bill of confidential enquiry into maternal mortality has been passed by the House of Assembly and it stipulates that every woman that dies in pregnancy or that is associated with pregnancy must by law be reported to the government. Failure to report it attracts punitive measures. We want to know what is happening outside the facilities. All care givers must report maternal deaths so we can know the degree of the problem in the state.SUNDAY PUNCHs findings showed that there were two traditional maternal homes in Ifedore LG. One is operated by the wife of a traditional ruler in Igbara-Odo Road, Igbara-Oke; while the other is located at Oke-Igande.When our correspondent visited both centres, the members of staff refused to answer questions posed by SUNDAY PUNCH because their directors were not around. The wife of the traditional ruler was said to have travelled out of the country, while the prophet who runs the second centre had reportedly travelled to Abeokuta, Ogun State.In 2008, the World Health Organisation listed Ondo State as the state with the worst maternal index in South-West. Less than 20 per cent of pregnant women, it said, were going to give birth in health facilities.This made the organisation visit the state and agreed to sponsor the Abiye project. Three years after, the global body hasnt released new statistics; but with the help of Abiye, and a recent WHO grant to help the state replicate the phone initiative in 17 local governments, Ondo States reputation as a maternal minefield is certain to change.
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