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Preventing Maternal Deaths in West Africa

Roland Marke, July 4, 2010

Hassanatu and baby Fredanna. (Photo: Fredanna M'Cormack)

Healthcare in Sierra Leone faces an enduring mortality rate among pregnant women and lactating mothers and their infant kids. Dr. Fredanna M'Cormack is conducting research in Sierra Leone and co-founded the Bele Uman Project to help reverse the current trend.

Roland Marke: How and why was the 'Bele Uman Project: Saving Mother, Saving Lives' conceived?

Fredanna M'Cormack: The reason why we [Fredanna, her sisters Fredline M'Cormack-Hale and Freida M'Cormack, and colleague John Yannessa] started this project was because of our concern over how many pregnant women were dying giving birth. At the time the maternal mortality rate was between 1,800 and 2,100 per 100,000. I had done some research in the past and an internship with the International Rescue Committee (IRC) and really found this problem to be widespread. To further understand this problem, my colleague, Professor John Yannessa, and I applied for a small grant to conduct research. As it is focused on saving lives of pregnant women in Sierra Leone, we coined the phrase.

RM: What is your background and why is this project geared toward the welfare of pregnant mothers and their babies?

FM: First and foremost, I am a Sierra Leonean and my heart is always with folk in the motherland. Anytime I have the opportunity to do something in Sierra Leone, I seize the opportunity to do it. My siblings are the same way. Also, I have an interest in the overall well-being of women. I have worked at women's centers as a rape awareness coordinator and a volunteer advocate for victims of sexual assault, rape and domestic violence. I have worked with the Women Infants and Children Supplemental Food Program in the U.S., trying to improve the health status of pregnant women in St. Louis, Missouri by improving their nutrition. I also did an internship in Kenema, focusing on the emergency obstetric care (EMOC), which looks at improving pregnancy outcomes by getting pregnant women to the hospital in enough time for them to deliver. The experience was eye-opening because of the difficulties pregnant women face and the complications that could arise when pregnant women did not seek delivery services in a timely fashion.

A couple of years ago, I conducted a research project in Freetown as part of the dissertation for my PhD in health education, to determine what factors may influence pregnant women's anemia status. Poverty, lack of transportation and limited access to necessary supplements were always raised or identified as problems the women faced. I felt that a lot more needs to be done and I am glad the opportunity has arisen to enable us to build on the previous research and move forward with this project.

RM: Walk us through the project, including the research strategy you wish to employ in achieving your objectives, the financial challenges and the credibility factor.

FM: I will be working closely with nurses such as Alice Kabbah in Kenema, Wuyata Kelfala and others particularly at the Kenema Government Hospital and in rural Kenema to identify pregnant women and postnatal women who have recently given birth. We hope to interview about 300 such women to ask them about their pregnancy experiences and the choices they made to deliver at home or at a PHU or hospital. We also want to ask them about their experience, since the government has recommitted to providing free health services to pregnant women. For those healthcare officials/health workers in the field, we would like to ask them what challenges exist in providing health service.

Unfortunately, due to time constraints and funding restrictions, we will only be able to go to Kenema district. However, as the project develops and we receive additional funding, we hope to expand our scope of research and focus on preventive measures, not just emergency response. Down the line, we would like to develop training programs for service providers, educational programs for pregnant women, and alternative opportunities for traditional birth attendants, based on the findings of our research.

RM: Why is this project personally near and dear to your heart?

FM: While I was in Kenema, I met a woman who delivered a stillborn baby. I also met young 17-year-old girl Hassanatu, who changed my life. Being poor, uneducated and arriving at the hospital with a complicated pregnancy, Hassanatu came to the hospital really late after almost 30 hours of labor and the pregnancy was obstructed. The baby's heart rate was really low and was experiencing severe distress. The only available outcome for Hassanatu was to get a cesarean section, an operation that cost Le 250,000, approximately $80 at the time. This is an astronomical amount of money for someone whose household income was less than $30 a day for a family of six. In addition, the doctor on duty was reluctant to perform the surgery if he was not paid upfront. Hassanatu's story seemed like it would have a grave outcome. Thankfully, because of EMOC services provided by IRC at Kenema Government Hospital and interested parties, who rallied to raise money for a necessary cesarean section, Hassanatu delivered a very weak baby girl the next day (16 hours after arriving at the hospital) via c-section. During the night, Hassanatu was in severe pain but was cared for by the nurses at the hospital. After the baby was born, she needed oxygen for those first few hours. At that moment I knew that something needed to be done to make sure that more women do not face the complications Hassanatu faced.

With the Sierra Leone government's implementation of free health care services for pregnant women, I hope that women will be able to feel comfortable using the medical services available. Also, I hope that the healthcare services include transportation to the healthcare facility, provision of delivery services, and cesarean services conducted by able physicians. We have to find ways in which a woman's hopeless financial resource does not determine that woman's pregnancy outcome. I am looking forward to more happy endings. Right now, a healthy, precocious two-and-a-half year old, who bears my name Fredanna, is in Kenema, and I am so happy that I was part of her story of survival.

RM: How will this research help bridge the gap between Sierra Leone, the United States and other countries as far as healthcare is concerned?

FM: Right now, this is a relatively small project, with just enough funding provided by Coastal Carolina University and Seton Hall University for data collection equipment, supplies, travel and stipends for interviewers. We hope that when people hear and see our efforts, they will be willing to invest their time, services, expertise, money and equipment toward this worthy cause.

We plan to share the results of the research with the global community to be used as baseline and a foundation to develop appropriate and effective programs. Sierra Leone's commitment to providing free healthcare services for pregnant women and children could be the beacon for other countries to address what is usually a needless tragedy.

RM: Are there future plans to expand your study beyond the borders of Sierra Leone?

FM: Right now we are just taking the project one day at a time. With the Bele Uman name, it is geared towards Sierra Leone. However, as the project progresses, who knows where we will end? Only time will tell what God has in store for this project.

RM: What is your long-term vision for the project? Do you have any other message to convey to the world?

FM: Long term, we see this project being part of a larger cause that addresses girls' and women's issues more broadly, and which also impacts maternal health outcomes. These include working on teen pregnancy prevention, sexual rights empowerment and crisis pregnancy counseling, all of which are related to improved pregnancy outcomes.

My message: God has given each of us a destiny that can be fulfilled. If you can think it, with God's grace, you can do it, so make it happen!

Roland B. Marke is a Sierra Leonean writer, commentator and activist for the poor and vulnerable. He is also the author of Teardrops Keep Falling, Silver Rain and Blizzard, and Harvest of Hate: Stories and Essays (Fuel for the Soul). His website is www.rolandmarke.com.

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