Welcome to the world, S.O.U.L. Antenatal Education Center!

By Andrea Koris

Operations, Monitoring and Eval. Officer

It’s 9:00am on Monday morning. I start down the red dirt path to the S.O.U.L. office, eyes to the ground in effort to keep my shoes reasonably dust-free. The twinkling of women’s laughter drifts through the banana trees to my ears. “What day is it?” I think to myself. As the answer hits me, I abandon my careful trek and tear off wildly towards the sound. I turn right at the sweet potato garden, scurry down the trail between the maize fields, and with a flourishing swipe of the matooke fronds in my path, I land among the most beautiful sight: 60 Ugandan women, bedecked in their brightest kitenge, patiently awaiting for the opening of the S.O.U.L. Antenatal Education Center.

Today is not just any other Monday in the sleepy town of Bujagali where S.O.U.L. is located; it is the official opening of S.O.U.L. Foundation’s Maternal Health Network. It’s a labor of love that has gestated and grown over the years. The idea of building a program to address rural maternal health issues in this region, originally conceived around a table between S.O.U.L. and community leaders, has been tended to with collaborative care ever since. And as I walk into the S.O.U.L. schoolyard this morning, wading through the women’s excited hugs and morning greetings, the love and hard work of everyone who molded the foundations of this program is abundantly evident.

 

In the past 5 years, substantial progress has been made across the world to meet the Millennium Development Goals (MDGs); and while significant improvements have been made on accounts to global health and education, progress is far from sufficient in regards to global maternal and infant mortality rates. The Sustainable Development Goals (SDGs) as a result demand a more exacting requirement of the global community, to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

 

Here in Uganda, 360 women die per 100,000 live births. And that statistic only accounts for women who decide to give birth in public health facilities. Considering that only 42% of births in Uganda are attended to by a qualified health professional, maternal morbidity statistics fall short in capturing mortality rates and health indicators for women and newborns who cannot access public care. S.O.U.L. wanted to know how this overwhelming statistic played out in the lives of the mamas that make up the lifeblood of our beneficiary communities, many of whom decide to deliver with Traditional Birthing Attendants instead of qualified midwives. To answer these questions, S.O.U.L. conducted a year long research assessment investigating the barriers that influence women’s maternal health choices and behaviors, and the challenges government health workers face in trying to provide quality care in rural settings.

 

The Maternal Health Network is a result of the findings of this groundbreaking research. The program houses several interventions, each of which attack a different ‘delay’ that contributes to maternal mortality in rural settings: 1) Delay in decision to seek care; 2) Delay in reaching care; and 3) Delay in receiving adequate health care at facility. The Antenatal Education Center, housed within the Maternal Health Network, aims to reduce maternal mortality by disseminating Safe Motherhood and Birth Preparedness education and encouraging male involvement in maternal health for women and their male partners.

 

As I follow the line of mamas into the sunny colored classroom, being pulled along in the tide of excitement, I can’t help but feel a wellspring of joy. The opportunity to walk with the women and men of this community as they invest in their right for health for themselves and their families is a gift; to witness the birth of this program, a blessing; and to be part of its creation, the highest honor.

March 1st, 2012- A Day to Never Forget at the S.O.U.L Birthing Inn/Midwife Center, By Brooke Stern

Today was a remarkable day. A day I could have never planned. A few hours of sheer joy and excitement. A few minutes of heart racing anxiety. A few seconds of uncertainty. An afternoon with an incredible outcome.

As I drove back from my fishpond project site to S.O.U.L.’s main office in the village of Bujagali Falls, I decided to stop in to visit Kalimentina, the local midwife I have been passionately supporting for the past 10 months.

Anyone who knows me, knows about the undying passion and love I have for Kalimentina- a woman in her late 60’s who has been delivering babies since 1974. She is the only midwife in the area and delivers between 5-7 babies per day, thought most of the deliveries take place at night. She is a women filled with incredible energy, kindness, and love. She will tend to women at any time of the day and night, and rarely gets anything in return from the villagers.

When I first visited Kalimentina’s birthing center, the roof was leaking, the door was made of cardboard and the windows were broken. There were no beds. No sheets. No materials or supplies- NOTHING! Devastating to see, S.O.U.L has since redone her roof, installed solar panels to provide electricity, put in 3 brand new iron doors, 3 glass windows, 4 mattresses, a bed frame, locks for her doors, gloves, medical supplies, a water collection system, and painted the inside, which is still the bare minimum.

I arrived at Kalimentina’s around three in the afternoon to find her relaxing on the grass, chatting with some other women. Seeing me pull up, a huge smile spread across her face as she walked to greet me at my car. We began walking to the birthing hut to sit and chat but before we could sit down, a young woman came screaming and running towards us, speaking in the local dialect. Kalimentina, barefooted, and barely dressed, grabbed my arm and pulled me as she started to sprint deep into the village, bushwhacking, and listening to the villagers as they informed her as to what awaited us.

I follow. Her stride gets faster. At this point, I am trailing a 60+ year old, and gasping for air. Kalimentina leads the way as others follow us, anxious to help. Up the hill, around the corner, lying on the red dirt a women suffering in pain comes into view. At this point, we are almost a half-mile away from the birthing center. We circle around her and realize that her water is about to break. We lift her, each on one side, and start sprinting with her down the path, out of breath, as each of her arms drape over us. Her pain increases, so we lay her on the red dirt. Once the pain subsides, she chooses to walk, a testament to the toughness of Ugandan women, and we guide her carefully, but with a fast stride, to Kalimentina’s birthing center.

We make it to the clinic with barely a minute to spare, as her water breaks. The beds are disheveled and still unmade following two deliveries earlier in the day. We grab anything we can- garbage bags as sheets, a plastic bag to put beneath the delivering mother, and one cotton cloth. That’s all there is. Kalimentina gives me her 2nd to last pair of sterile gloves and the adrenaline is high. There is NO pain medicine, as is the case in most Ugandan clinics.

The woman starts screaming “mammmmmaaa, maaaaammmmaa Mzungu (white person).” I rush over to her, helping her through each contraction. She is within minutes of delivering when another women enters the clinic in desperate pain. As Kalimentina tends to her, I realized I needed to improvise and grabbed anything in sight. There are no medical instruments. No sheets. No tourniquet. NOTHING. I grabbed a black garbage bag, put it under the woman, took the package from the gloves and used it to clean the area, used an old glove to act as a tourniquet, and a razor blade to cut the umbilical cord (when the time came).

The contractions got closer together. I called Kalimentina over, but she said this one was all me! I said, “Mama Kalimentina IDA SOW WENA (Mama, come here now, fast).” She reiterated that she only had one more pair of gloves, and it had to be used for the next woman, so I had to do this on my own. She encouraged me, saying, “you already delivered two babies in the past, you can do this!!”

Understanding with my whole being that this was a life or death situation, I sat down between her contractions, and yelled push in the local language over and over. And she did. Kalimentina is quiet and calm and confirms my actions when I feel unsure. She is a soft-spoken, confident woman who knows more than I would have ever expected. With the next contraction, the head started crowning. The screaming got louder, the pain grew, and as the head emerged, I grabbed it and slowly rotated the body, pulling the baby out in a clockwise direction to assure the limbs came out together. I was sweating, the woman was quietly gasping in pain, the mother of the woman in labor was screaming in joy and praising me, as I pulled the baby out!!! The umbilical cord was wrapped around the baby’s neck 2 times, and I was terrified. I started to panic. Kalimentina assured me everything was ok. I held the baby in one hand, and unraveled the cord in the other, and within seconds heard that amazing, wonderful, reassuring CRY from the baby. What a relief. A HEALTHY BABY BOY WAS BORN!!!!!!!!!!!!

-Brooke Stern, RN, Co-Founder and CEO