SATURDAY MAGAZINE
Men in the labour ward
Boniface Cheloti, Aga Khan University Hospital.
SUNDAY NATION
We enter the labour ward in silence, believing that this is one area of Kenyatta National Hospital where our silence will be highly appreciated. We allow our guide to lead the way for fear of straying into "a no-go zone".
When we get to the reception, we realise that contrary to our earlier belief, this is one of the hospital's noisiest areas. We don't quite know what to do, until a short man in uniform approaches us.
"Meet Mr Peter Gakere Kuria, one of our male midwives," announces our guide, a woman from the public relations office. The introductions over, we start talking to "daktari" (as the patients fondly call him), about how he landed in this profession. As we speak, we hear a few groans from the nearby wards.
"It all started in 1987 after I joined the Kenya Medical Training College, (KMTC)," he begins. "My younger sister, Rachel Wairimu, and I applied and we were both admitted."
While his sister was posted to KNH, Kuria was taken to Lamu District Hospital. Sixteen years later, after working in different hospitals, Kuria wanted to further his career, and an opportunity presented itself in midwifery.
He joined KNH's private wing in 1994, where for 12 years he was responsible for ensuring that cost-sharing patients received the best possible nursing care. In 2006, he decided to upgrade his career yet again, so he did a higher diploma in midwifery.
Reason? "It is a specialised field and career growth is guaranteed. Besides, I love children," he explains. He also believed that nursing without midwifery skills was incomplete. "Imagine a fully qualified nurse who cannot help a mother deliver!" he remarks, explaining his switch to the labour ward three years ago.
Kuria, who has to be on his toes throughout his 14-hour shifts, has a job with unexpected twists and turns. "Things can look okay when you are receiving an expectant mother but within minutes, you are heading to the Intensive Care Unit (ICU)," he says.
And this is common at KNH, mainly because it is a referral institution. Many patients are brought here when other hospitals cannot handle their cases. "Often, they are in very bad shape when they get here but we are very quick in responding to emergencies," he says confidently.
On average, the hospital records 20 to 40 normal births a day, with another 10 to 20 being Caesarian sections. On a typical night, Kuria personally handles about five deliveries, but during the "high season" (September and October) the number can go up to 10.
Kuria, 41, is very comfortable with his profession. He tries to be cheerful when not handling an emergency because on many occasions, he has to effect sudden changes of plan. "I try to be happy at all times. I deal with mothers in pain so I cannot also afford to be gloomy. They need assurance that all will be well," explains the father of three.
One of the four men at the KNH labour wards, Kuria says many hospitals are experiencing a shortage of midwives. The ideal midwife to patient ratio is 1:3 per working session, but this has been achieved only in private hospitals. At KNH, for example, there are about just 20, which is only half the number required.
"The work is intense and the cases unique. Burn-out rate is high and the fewer patients one handles, the better," he asserts, adding that midwifery is not for the fainthearted.
So, any memorable cases? Kuria starts off by saying that any event-free birth makes him heave a sigh of relief. But a case brought in from a health centre in Rongai stands out.
According to the report accompanying the patient, the baby had died and the mother informed accordingly."But when I examined her, I realised that the baby was alive, so I rushed her to theatre and we saved the baby," he recalls.
The mother's joy at this happy turn of events moved him. "One moment the mother thinks the baby is dead, the next moment I tell her the baby is okay, all because I went the extra mile to examine her further. She screamed with joy, and I was just as happy," says Kuria.
He also had a memorable night early this year. Five mothers were referred from Pumwani Maternity Hospital with obstructed and prolonged labour. The operating theatre was already busy, yet here were life-threatening situations.
"We were jolted into action but unfortunately, one baby had already died. I felt really low after that disheartening experience," says Kuria.
Kuria works closely with doctors, and they consult each other. "We frequently exchange views. Each of us is a professional in his own right," says the Nursing Officer I, who wants to do a Masters degree so that he can train younger midwives.
His vision for the profession? "We need to support traditional birth attendants by giving them more training. This will help them detect problems early and thereby reduce deaths during childbirth," he says, adding that 60 per cent of deliveries in the country are managed by unskilled people.
Boniface Cheloti, 25, Aga Khan University Hospital
He dropped out of an information technology class a year into the course to join Kisii Medical Training College. He had wanted to become a doctor but did not score high enough to study medicine, so when an opportunity to study community health nursing arose, he grabbed it.
After a three-and-a-half years' training, the former Bungoma High School student joined Aga Khan Hospital in Nairobi as a midwife. Just nine months into the job, the only man at the hospital's labour ward, knows that dealing with mothers in pain is a daunting task.
"I have already started feeling the heat, but my colleagues are good company and they encourage me," he says of his 39 female colleagues. The hospital registers some 200 deliveries a month, and on a normal working day he personally manages three births.
Since it is a private hospital, standards are high and personal services highly rated. "Here, each mother is allocated a nurse, who serves her from the time she is admitted until she is discharged," he explains as he shows us around the sparkling clean wards.
As a mother's best friend at this challenging time, Cheloti says, he has learnt to develop a relationship with his patients. "You have to be friendly, empathize with them and see that they are satisfied by your care," he says, adding that the social status of hid patients means many of them are sensitive to the way you handle them.
The soft-spoken Cheloti reveals that he has come to respect women because of what they undergo during childbirth. "Some are in labour for 18 hours. I am sure many men cannot withstand something like that. I appreciate any mother when I see such a case," says the clinical nurse.
Cheloti, who is single, says one of his greatest challenges is that some men prefer to have a woman attending to their wives during childbirth."Some people see it as a private issue, while others bring in religion. They even ask for a female doctor," he explains.
But he is not complaining, because some women prefer male nurses."We respect a client's preference but you see, I am the only man here and I might not be available," he says before adding, "I think medical issues should be looked at from a professional rather than a gender perspective."
Cheloti's first depressing experience, which took place two months ago, is still very fresh in his mind. He was helping a mother with obstructed labour and when the baby was finally born, it turned yellow immediately.
"He was baffled. He and the doctors sprang into action to save the baby but it was too late. "I watched helplessly as the baby succumbed to the mysterious illness after a few days," he narrates.
Such incidents, he says, are attributable to lack of proper ante-natal care, which he considers the most serious problem for expectant mothers. With this care, Cheloti says, it is easy to detect problems before they become complicated."Mothers are also given health education so that get to know what to expect during the whole process," he explains.
Cheloti has a warning for mothers, especially those in urban areas, who tie khangas tightly around their stomachs after giving birth. "They say it helps them regain their shape but it is very risky. Abdominal muscles need to be exercised for them to return to normal, " he explains.
Cheloti, who is opposed to Caesarian births unless it is "absolutely necessary", believes his career brings him many blessings "Every time mother and baby are safe, they ask God to bless you. It makes me feel good," he says.
Cheloti intends to further his studies in midwifery at the hospital's university.
Anthony Ndwiga, 33, Pumwani Maternity Hospital
"I fear that many women are not strictly following their prescriptions for contraceptive pills. Some are shocked that they conceived in the first place."
That is how Anthony Ndwiga explains the rise in the number of births at the country's busiest maternity hospital. His hands are always full, given that the hospital records at least 60 deliveries a day. He can personally receive 20 mothers and on a normal working shift, oversee up to 10 deliveries.
Ndwiga, who prefers working at night when there are more births, says his heart beats faster every time a baby cries loudly after birth and is given a clean bill of health.
"It makes me happy because I can evaluate myself immediately. I can tell how I am doing professionally by the number of successful deliveries I oversee," says the father of one daughter.
Ndwiga, who has worked in some very small clinics, is happy that facilities and service delivery at Pumwani have improved.
"There were allegations that babies were stolen here some time back but personally, I have never seen this happen. All that bad publicity is behind us now," he says confidently.
After Secondary School, Ndwiga joined Findenza Nursing Home in his Embu home district before proceeding to Thika Medical Training College, where he did a diploma in nursing.
He joined Pumwani four years ago, and his first challenge was the high number of births daily. "Sometimes we get overwhelmed. You see, we deal with all sorts of people," says the nurse.
But there are other challenges as well. Many poor women seek medical attention when it is too late.
"They first go to backstreet clinics and then rush here when things go wrong. It is sometimes difficult to save babies in such situations," Ndwiga says..
He believes a comprehensive training programme for birth attendants would check the high mortality rate. "Many mishandle pregnancies and misjudge delicate situations but with adequate skills, they will be able to refer cases before things get out of hand."
He does not have a particularly memorable experience, but is satisfied with the critical role he plays in helping expectant mothers.
"A mother might take all the necessary precautions during pregnancy but if she is mismanaged during labour, the result can be disastrous," says Ndwiga.
Over the years, Ndwiga has learnt to attend to any distress call immediately. During the interview, he keeps rushing out to check what is happening every time he hears a groaning patient thrashing around on the bed.
At one point, he rushes out following a loud scream and then comes back to announce that the patient is in the advanced stages of labour.
Ndwiga is certainly doing a good job, going by what matron Severin Mwiria says. "I have never received a complaint about him since he came here. I get very good feedback from mothers."
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