Chama cha Mama Toto
It’s been a while since I’ve written, either for myself or
to post. I have been on call this weekend
and it’s been busy, but I finally got a chance to sit in my front yard, basking
in the hot sun and writing. I have been busy getting the most out of every second that I am here in Kenya. I am
already thinking about coming back to the US (1st weekend of May!) and
therefore already thinking about how I will be able to come back here!
The path today is a little winding but I hope you can follow
my though processes here…
I am constantly reminded of all of the concepts and feelings
and movements that every human in the world has in common. I feel that at home too, but somehow I am
reminded of it more here. I think because sometimes our first reaction is to
see the differences when we look at something; but I don’t think that’s
instinctual, I think it’s learned. When you are able to step outside your own
boundaries, your own tiny world inside the world, you realize we are really all
the same. So much of what binds us are the same needs for our health and care
and the same challenges.
I have been on call frequently recently where I do twice
walking daily rounds on labour ward. I
love the ritual of greeting every patient- shaking their hand, rubbing their
back during a contraction, admiring their newborn baby, congratulating their
beaming husband or (much more often here) their mother or sister. “Habari yako, mama?” I ask. They always
reply “Mzuri” (good in Kiswahili) or “Fine,” if they speak English. (Finally
today a patient said “Not fine!” and
we both laughed when I thanked her for her honesty!) It also gives me the
opportunity for bedside teaching where we can discuss all of the challenges we
face and the best evidence for what we should do to take the best care possible
of our patients. Many of the challenges are
the same here and in the US: when to deliver a patient, when to do a cesarean
section, how to best educate a woman on her family planning options. Some are
much different: how to titrate oxytocin or magnesium in drops per minute (as
opposed to just punching it in on the usual IV pumps we have in the US) or what
alternative we can get since today the hospital is out of the only oral
antihypertensive we have or how much it will cost her family if we have to send
them to the pharmacy to get it.
I am incredibly lucky to have a phenomenal woman as my
mentor here in Kenya and in AMPATH. She has lived in Kenya for over 4 years
working on improving maternal, newborn, and child health in this area with
various initiatives. She has taught me so much in my few short months here and
I am excited to be working on so many amazing projects here. Working with her and in Kenya has made me
realize that so many pieces that are difficult to measure are the things that
really need to be in place to improve maternal and neonatal outcomes. As she
pointed out to me, if every girl in the world had a high school education, we
could decrease the risk of preeclampsia and it’s terrible outcomes. Preeclampsia
is a disease of pregnancy that disproportionately affects young first-time moms
and older women who’ve had many babies.
A high school education alone can empower a woman and provide her with
the tools to be able to make her own reproductive choices.
In my last year of residency, midwives and doctors from our
high-risk prenatal service were starting a program called Centering. It is a
program of group care where women can learn and discuss concerns, challenges,
ask questions and be educated about their health. Our group was applying it to
women with high risk pregnancies and common challenges, like diabetes. Here in
Kenya, my mentor has started a program called Chama cha Mama Toto- Groups for
Mothers & Children. She, in turn,
works with a group from Canada who started a similar group care model. Chama
cha Mama Toto combines the traditional type of chamas in Kenya- whereby women join together to pool money to
support each other and themselves- with maternal, newborn, and child health
care and education. It is amazing how these incredibly simple and intuitive,
yet revolutionary, concepts are changing and improving the way we care for
women all over the world at the same time.
I had the opportunity last week to travel to Port Victoria,
on the edge of Lake Victoria (pictures to come), to meet with the community
health workers leading the chamas. It
was incredibly inspiring to see the effect a program like this can have on so
many communities. They are expanding the number of communities they’re reaching
and finding new ways the chamas can
be used to improve the health of their communities. The possibilities are
endless… One of the most important impacts they have is the ability to connect
so many people to resources- both monetarily and personally. This is another
difficult-to-measure outcome, which undoubtedly improves maternal and child
health. I love that she begins every
presentation about Chama cha Mama Toto with
an explanation of the graphic on the front of their educational book used in
the group care. It is a beautiful drawing of the steps it takes to get a woman
care—connecting her with other women, with a community health care worker and
with the leaders in her village to collect money and find transportation to
bring her to a healthcare center. I will try to find a picture to post of this
painting, but here is a beautiful video created by her wonderful and energetic team
(who are becoming my team too!).
From Port Victoria we traveled to Kapenguria, the
southernmost and biggest city in Pokot County, an incredibly rural area on the
border with Uganda. They have some of the poorest health outcomes with low
rates of education for girls, high teenage marriage and pregnancy rates, high
rates of vesicovaginal fistulas, and a vast area over which they have very to
spread minimal health resources. We met
with representatives of the Ministry of Health and health leaders within the
county to discuss plans for an application for a multi-million dollar grant to
improve maternal, newborn & child health within the County. It is an
incredibly opportunity to make significant changes in the lives of the women
and children of their community (and of course everyone in the community since men
benefit from keeping their wives and children being healthy). We hope to incorporate innovative ideas like Chama cha Mama Toto with more
traditional ones, like staffing health facilities, increasing the availability
of operative delivery, and comprehensive family planning services.
So all this meandering brings me back to my work today: the
16 year old girl with preeclampsia who just delivered a stillbirth, and the 17
year old girl with eclampsia who had had no prenatal care and hid the pregnancy
from her mother, a traditional birth attendant, until she began having seizures.
I had to explain to them that her baby probably wouldn’t survive because it was
too small and that we would induce her labour so that she wouldn’t have a
scarred uterus at the age of 17, setting her up for a lifetime of dangerous
pregnancies. The support of her mother and sister who brought her to the
hospital and who helped us make this difficult decision ensured that she would
survive this pregnancy.
A picture of the team showing off their famous Pokot honey :)
A picture of the team showing off their famous Pokot honey :)
