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“We do not want any woman to die. Whether she is somebody’s daughter, sister, granddaughter, mother, wife or girlfriend, no woman deserves to die!” Those words with the tone of alarm for quick response and due diligence constituted the admonition uttered by Ekem Emmanuel John, a medical doctor and Akwa Ibom State Commissioner for Health, while addressing participants at a three-day master training of trainers on the management of postpartum haemorrhage in Uyo, the state capital.
The “we” in the commissioner’s words refers to the Akwa Ibom State government under the headship of Governor Umo Eno. Often used PPH, the abbreviated form of postpartum haemorrhage, in common parlance, means “bleeding after birth”. It is widely said to be the major cause of maternal mortality.
The three-day workshop is part of a 10-month training programme embarked upon for training of healthcare workers on how best to handle PPH. The training, which started in April is done in collaboration with SCIDaR, an acronym of Solina Centre For International Development and Research. SCIDaR is a Nigerian non-profit non-governmental organisation focusing on health and education largely through consulting and programme implementation, as well as research.
Like some other indices of human development or underdevelopment, available statistics on maternal mortality ratio, MMR, does not situate the sub-Saharan Africa in a position to relax. For instance, a report indicates that in 2023, 197 deaths occured per 100, 000 live births across the globe, 80 per cent of which was occuring in sub-Saharan Africa and South Asia, largely through PPH. Within the period under consideration, 10 per cent of global maternal deaths happened in Nigeria.
Worldwide, brighter picture of MMR is in Finland, which has three to eight per 100,000 live births, and Sweden, with a record of four deaths per 100,000.
Chinedu Obikili, a maternal health specialist, who works with SCIDaR, told SUNDAY INDEPENDENT that “in Nigeria, maternal mortality is higher in the northern part of the country, hence a lot of intervention started there.”
SCIDaR, which has its spread across Nigeria’s 36 states and Abuja, Nigeria’s capital, works on maternal health in 11 states. According to Obikili, the NGO “started work on maternal health in Niger, Lagos and Kano states and later expanded to Plateau, Ebonyi, Delta and Katsina Sates.”
With data showing that Akwa Ibom has 774 deaths per 100, 000 live births, the state is rated one of the highest in MMR in Southern Nigeria. Regarding the grim picture, the commissioner told SUNDAY INDEPENDENT that “Nigeria is a far cry to the United Nations’ Sustainable Development Goal, UN-SDG, and since whatever affects the country affects all within it, Akwa Ibom cannot be an isolated case.”
“The beautiful thing”, in the words of Dr John, “is that we recognise there is a problem and we are working towards the solution of that problem. In what seems to be a veiled reference to the COVID-19 era, in which stakeholders in Akwa Ibom health sector were controversially singing in discordant tunes over statistics on the pandemic, John said, “where we used to quarrel in time past was where there was a problem and we played the ostrich by not agreeing there is a problem.” Referring to methodology of the Akwa Ibom State Ministry of Health under his watch, John said, “we identify and design pathways to solving problems.” Still on the necessity of rolling out the training programme, the commissioner rationalised thus: “When we find out there are health indices that are disturbing, we owe a duty to the government and the people of Akwa Ibom to take steps to correct such.”
While disclosing that “there is a lot of investment in maternal healthcare made by the federal Ministry of Health and Social Welfare”, Obikili also revealed that “Akwa Ibom is among one of the places that have not got a lot of the PPH intervention yet.”
Lauding the commissioner for facilitating the state to play its collaborative role effectively, Obikili explained to SUNDAY INDEPENDENT that “the Akwa Ibom State government has been central to everything SCIDaR does, even before coming to the state.’
Justifying the necessity for the training further, Dr Dachun Alexander of the federal Ministry of Health and Social Welfare, who admitted that “Postpartum haemorrhage remains one of the leading causes of maternal mortality in Nigeria”, expressed displeasure that ‘despite progress over the years, far too many women still lose their lives to preventable complications related to childbirth.”
As observed by this reporter, the three-day training exercise, could be said to be a classroom and laboratory outside a school environment. Referring to what is called EMOTIVE, Alexander explained that the intervention strategy designed to reduce maternal mortality and morbidity caused by excessive bleeding after birth “emphasises early detection, timely response and coordinated care to prevent and manage PPH effectively.”
Asserting that “the training is coming at the right time” Dr Aniedi Etuk, a Chief Nursing Officer, listed important aspects of the training to include “provision of guidelines, standard precaution on what to do — the standard order on how to handle any patient having PPH”, among others. She said: “The training has made us to know when to start action, when to call for help, when to look for other trained personnel.”
On meeting the UN-SDG, which is targeting drastical reduction of maternal mortality, Obikili, however, opined that it may be difficult to get to the target.” He pointed to inaccurate data, which he said constituted hindrances in ascertaining how close one is to the goal. Saying that it would not be easy to arrive at the SDG, he stressed the need for continuous push.
To Aniekan Abasiattai, a professor of Obstetrics and Gynaecology, the training has been “very significant to reducing maternal mortality.” Although he opined that achieving the SDG target is in the realm of probability, Abasiattai, sees hope because “all hands are on deck.” Specific on Akwa Ibom, Mrs Etuk told SUNDAY INDEPENDENT thus: “If we can step down the training to everywhere in Akwa Ibom, down to community health workers, as scheduled in the programme, the rate of maternal mortality will greatly reduce in the state.”
Another problem identified in the case of Akwa Ibom revolves around indulgence of unethical practices, such as the preference of many to go for child delivery at non-medical places like “spiritual” homes and churches, Abasiattai mentioned that “one of the reasons women do not go to hospitals, which forms barrier for women accessing health care services has to do with attitude of healthcare workers and respective maternity care.” According to the professor, that poor behaviour is “one of the things that has been noticed and well documented.” He added that much was emphasised on that in the course of the training.
The envisaged objectives of the exercise may have much to do with what Alexander, who represented the Director and Head of Reproductive Health at the federal ministry of health, Dr Samuel Oyeniyi, told participants at the event: “The success of this programme depends not only on what is learned but how effective it is translated into practice.”
The unwell situation, particularly at the circumstance of maternal mortality rate in Akwa Ibom, as said by sources close to the commissioner, has contributed in making Dr John, who always appears restless on healthcare matters, not to relax. The commissioner told SUNDAY INDEPENDENT thus: “We are bracing up to the challenge.”
He added: “Medicine is a professional space in terms of speciality. It requires continuing medical education, training and retraining for doctors, pharmacies, nurses and other health workers. So, the state government, right now, is not just focusing on employing people and sending them to places, but on training them, giving them the right skills and equipping them to do the work. That is what informs the workshop.”
It was gathered that the workshop for women to live long in Akwa Ibom is one of the measures put in place by John towards ensuring efficient and effective health care delivery in Akwa Ibom.
Dr Edidiong James of the Akwa Ibom State Ministry of Health, who coordinated the workshop disclosed to SUNDAY INDEPENDENT that the next phase of the 10-month programme will include “stakeholders engagement and sensitisation.” According to him, it will include parleying with traditional rulers at all levels and women groups, mostly at market places and churches.
