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Labour of love at KNH maternity in nurses’ strike

Kenyatta National Hospital’s maternity wing is overwhelmed by mothers who flock to the facility due to the ongoing nurses strike, midwives warning that deaths may arise due to the congestion.

The Nairobi facility, where about 45 children are usually delivered every day, is now handling up to 70 births daily.

Each day, more than 30 women are in the queue awaiting surgery due to complications that arise due to delayed medical care as the nurses’ strike enters the 28th day on Sunday.

The log book in which the hospital records the admissions shows that Ward GFA, one of five, had as many as 104 admissions in 24 hours, much greater that its 50-women capacity.

Ms Nereah Ojanga, senior chief nurse and midwife at KNH, told the Nation: “Some mothers land here after going through the whole process of labour. Some have complications that may endanger them and their babies”.

NONEXISTENT SYSTEM

Mrs Ojanga said with most nurses on strike, even the referral system is nonexistent, exposing women to near-death experiences in any of the four stages of labour.

She explained that nurses usually stay in ambulances to accompany mothers who have developed complications such as eclampsia, a pregnancy-induced blood pressure that has been implicated in more than a third of maternal mortalities in Kenya. Usually, the mother experiences severe headaches and swelling of the hands and feet, which may result in seizures and organ damage.

In the ambulance, a nurse administers magnesium sulfate intravenously to prevent seizures, without which the patient would reach the hospital in a vegetative state.

In the last quarter of 2016 at KNH, when all the counties were working, eclampsia accounted for 38 per cent (162) of all the 426 referrals.

Eclampsia is not the only danger.

BED REST

“When you hear ‘the doctor prescribed bed rest’, it is because there are women whose pregnancies are delicate. You keep them in bed, bathe, feed and even allow them to poop there because any movement will result in catastrophe,” Mrs Ojanga said.

She said “when such a woman sits in a public service vehicle or moves from one hospital to another seeking help, she can die in minutes”.

Ms Bibian Wanjiku from Kayole took this perilous journey to KNH on her own. She used to attend clinics in Kayole 2 South. But when she visited the facility last week, she was told that no services were being offered.

“I had to look for help from a private hospital. When they examined me, they said I needed to look for a place with a theatre,” she said.

When she reached KNH at 4am on Wednesday, she was “prepped” for surgery right away. Four other women narrated similar stories.

POTENTIAL COMPLICATIONS

Every stage of delivery, Ms Ojanga said, has potential complications that might have been foreseen while the mother attended clinic appointments, or could just arise when giving birth.

Nurses are aware of these cases, and would arrest and refer them when there is need for surgery.

Past the latent stage, the mother goes into active labour, and the cervix responds by dilating to let the baby pass, a phase called transition.

In this phase, a woman needs two midwives (one to receive the baby and another to assist her in delivery), a standard that means nurses at KNH get burnt out. There are only 39 of them, and the workload has doubled.

Kenya is already operating below par in nursing care: the World Health Organization recommends 25 nurses per 10,000 people; Kenya’s 31,896 active nurses translates to 8.3 per 10,000 mothers.

CARDIAC ARREST

Past delivery is the most dangerous phase. Women can have cardiac arrests as their bodies respond to the blood loss.

“The vitals of both mother and child are checked every 30 minutes. Should she experience post-delivery challenges in between, she dies”.

Women who reach KNH after going through all the stages of labour, and sometimes the complications, deliver babies prematurely through surgery.

Dr Fredrick Okoth, a gynaecologist at the unit, said there are challenges examining the women because they are four in a room meant for one. “There is no dignity for the mother; it’s hard work,” he said.

Even in the surgery, Dr Okoth says “doctors and nurses have to play God when deciding which mothers go to theatre today or tomorrow because of the backlog”.

MAKESHIFT BEDS

On the corridors, Nation say makeshift beds. This happens when patients in other theatres are told to wait as a haemorrhaging mother is operated on.

Some late-comers give birth to premature babies, who end up in incubators in the new-born unit until they gain the required weight to enable them breathe and regulate their temperature.

Ms Anne Kioni, senior nurse in charge of the new-born unit, now has 135 children instead of the usual 60 each day. The unit admits about 13 babies daily.

“We are still receiving the usual referrals. With the counties not working, many people are bringing their babies here,” said Ms Kioni.

Some of the babies were delivered alright, but they swallowed meconium, their own poisonous poop that gets into their lungs and is removed painfully by a neonatologist.

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