In this piece, ENE OSHABA recounts the experiences, near death challenges pregnant women faced during the covid-19 lockdown.
Nigeria, like other countries of the world, had its fair share of the pangs of the Covid-19 pandemic, even as the federal government’s lockdown order to stem the spread of the pandemic had exposed many, especially women and children, to even more hardship.
The lockdown order led to the cessation of inter-state movements especially in Lagos, Ogun, and Abuja, which had high number of cases, for an initial period of 14 days, from Monday, March 30, 2020, except for persons with emergency cases and essential workers all others were expected to remain indoors.
While the essential workers were listed, but emergency cases were not, this left citizens in emergency situations at the mercy of security personnel to determine which case was considered an emergency and which was not.
Consequently, some pregnant women who needed to go for their routine antenatal at the hospital did not have access to these facilities most of which had been converted to Isolation centres at the time.
‘I’d high BP, needed urgent attention but …’
Achetu Onuh, a mother of two, who resides in Mararaba, Nasarawa state, and was pregnant during the lockdown, shared her experience during an outreach by PAGED Initiative, Non Governmental Organisation (NGO) with focus on unravelling untold stories of women especially those at the grassroots.
“I was trying to get access to the hospital for check up and was turned back at the bridge linking Mararaba on the outskirt of Abuja, where I live, to Karu close to the abattoir, where the army, police and other security operatives mounted road block during the first phase of the Covid-19 lockdown.
“Though I was pregnant, but my stomach was protruding yet as I was just in my first trimester, all my explanations and pleadings that I had high blood pressure during pregnancy and needed urgent medical attention fell on deaf ears.
“My visibly swollen feet and hands was not evidence of situation but I continued making attempt until the fifth day that one of the soldiers recognised me and allowed me.
“One would have thought that I was then free but this was not the case because as I approached the A.Y.A Bridge, I was asked to turn back at another road block.
“According to the security personnel, my situation cannot be an emergency since I could still drive myself. Defeated I headed back home,” she narrated.
Continuing she said the next day she decided to visit the Nyanya General Hospital, after going round in circles this time on a motorbike to avoid security personnel, but on getting to the hospital she was again disappointed as the guards at the hospital gate refused her entrance insisting they were authorised to admit only emergency cases.
“I told the security that he is not a health personnel and may not know an emergency case was and he responded saying those in emergency won’t come to the hospital on their legs but somebody would bring them.
“I say their leg no go carry them. Na person go carry them and the way them go the shout and run sef na race we dey take open gate for them (meaning, the scurry that comes along with emergency, the shout, fear and the rush, no one needed to be told as it will be apparent and they will have to open up immediately),” she narrated.
According to her, “I was later advised to go to the Nigeria Custom Hospital in Karu, however, it took me two days to book a date as the nurse in charge was not always in seat. On the third day, I was told I could not see a doctor immediately as there were procedures whereby I would have to be scheduled and the available date was in three week’s time.
“Fortunately, the first lockdown was over and another was in place but this time not so strict but it was still tedious and tiring as the security personnel allowed only one lane movement.
“On a normal day with all lane available the traffic on the Mararaba/Nyanya route always had gridlock, reducing it to just one vehicle per time made the whole situation worse as road users complained of sitting long hours in the vehicle.
“Again, a pregnant woman could leave her home as early as 6am just to attend antenatal and get back home in time but the gridlock would make the whole situation worse than imagined.
“We usually leave before 6am and most times get home by 5pm or shortly before 6pm. It was not a healthy situation for me and other pregnant women,” she stated.
Speaking further she said, “Finally, gaining access to the Garki Hospital I met a doctor who could not handle my case efficiently. This was evident because for every complaint I made she would go into the next consulting room to confer with her colleague. Then asked why I did not resume ante natal earlier considering my history and ended up just prescribing clopedogrel tablets for me.
“This medication is actually a blood thinner, which at this point should not be prescribed for me. She also asked that I monitor my blood pressure twice a day, morning and night, and if there was no improvement I should return in the next three days but nothing changed.
“The third day I went back and met with another doctor and to my shock, when I told him about the medication his colleague had prescribed he was adamant that such was not prescribed in the hospital: “not in this hospital,” he repeated severally.
“I was livid and disappointed as he refused to acknowledge their mistake and unprofessional conduct. Not swayed by his spirited denials, I asked him to check my records to verify and when he realised it was true he only offered excuses, no apologies.
“Notwithstanding, we were able to manage my rising blood pressure (BP) for about 30 weeks but as medication could no longer keep it down I was booked for Caesarean Section to avoid the BP and edema induced pre or post-partum eclampsia.”
Delivery time approached for Onuh and since she was booked for Caesarean Section she got to the hospital a day before the operation as directed, and was allocated a bed by the nurses.
“There were things I was supposed to put in place before being allocated a bed but I can’t tell till date why the nurse I met at the nurse’s station did not carry that out and at the time I should have been in the theatre that was when these procedures were been filed.
“I had taken my last meal at about 6pm the previous day and as at 12noon I was still waiting to be operated on not until about 2pm. Now hungry, angry, exhausted and anxious, I was eventually wheeled into the operating room. Thank God it was a success but another woman may not have been as lucky as I, perhaps that is why there has been maternal mortality for ages.”
My baby didn’t survive the ordeal – Esther
Also sharing her experience, Esther Ogwuche a resident of Auta Balaifi, a suburb of Nasarawa state and one of the border towns of the FCT, said her baby did not survive the ordeal.
Ogwuche is a petty trader, who sells groundnut and banana. She had gone for her usual ante-natal and was asked to run a scan then lockdown happened.
Movement being restricted she could not return to the hospital and could not read the result that showed that her amniotic sac was draining, a very serious issue that required immediate medical attention. However, because she was not feeling any pain or discomfort she did feel the need to seek medical attention.
According to her, “When I got there, the clinician asked why I did not taken my result to the doctor I explained why and he said it was an emergency and the health centre could not handle such cases as it will require operation. He then gave me a referral note.
“That was when I knew it was a serious issue. I could not sleep throughout the night. Early the next day, my husband and I went to Asokoro District Hospital, we explained our situation and was directed what to do.
“We were attended to that very day but at that time, it was already late as my baby came out dead. After six years of trying to get a child, we ended up losing him.”
Where Nigeria stands
According to the World Health Organisation, Nigeria accounts for nearly 20% of all global maternal deaths. Between 2005 and 2015, it is estimated that over 600,000 maternal deaths and no less than 900,000 maternal near-miss cases occurred in the country.
In 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100 000 live births, with approximately 58 000 maternal deaths during that year.
By comparison, the total number of maternal deaths in 2015 in the 46 most developed countries was 1700, resulting in a maternal mortality ratio of 12 maternal deaths per 100 000 live births.
In fact, a Nigerian woman has a 1 in 22 lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion.
But in countries with still overall weak health systems like Nigeria, Covid-19 is causing disruptions in medical supply chains and straining financial and human resources.
Visits to health care centres declined due to lockdowns, curfews and transport disruptions, and doctors fear for their safety and attended to less number of patients.
A gynaecologist in one of the government hospitals in Nigeria, Dr. Mathias Okoh, has disclosed that, the government had expected that hospitals were supposed to be up and running during the period of lockdown as a result of the Covid-19 pandemic but of the truth adequate measures were not on ground.
“Except for the primary Health Care Centre most hospital were running skeletal services and making room for only few emergencies as the doctors too were scared for their lives. This is because protective kits were not provided as some of them had to make this available with their own resources,” he said.
Okoh added that the PHC have limited capacity and cannot take care of some major emergencies like operation of any sort.
Maternal mortality has been a long time issue – Onwu
However, the Director Head of Department Community Health, Convener for the Maternal Mortality Intervention Centre of the Primary Health Care, Ministry of Health, Dr. Nneka Onwu, explained that aside Covid-19 pandemic maternal mortality has been a long time issue in Nigeria and the ministry of health as well the PHC are doing all they can to reduce these figures to what is acceptable.
According to her, the pandemic created a downslide on health, which is not just peculiar to Nigeria with its weak health system, as those with strong health system had challenges.
“For us, we had to put in some strategy as people were afraid to go to the hospital for fear of being infected,” she said.
She further explained: “So we pull together resources and set up a call crisis management centre geared towards sensitisation, reaching out to people in communities, like the chief, staff of the health system at all level which include the healthcare workers, trained them on what to do.
“On the record statistic, around March during the lockdown there was a decline but after the training and subsequent sensitisation it improved to a reasonable statistics, especially for Ante-natal, immunisation and delivery.
“This training centred on how to handle patients, in case of delivery, and informed that not all illness that have the same symptoms Covid-19 is Covid-19. They were also taught how to manage these scenarios and not panic as well as what their first port of call or actions are.”
She explained further that during the lockdown the executive director ensured that the hospitals were functioning, adding that a team went round wearing their tags showing they are essential workers.
Onwu said, “The executive director made announcement to make people aware that hospitals are open and that doctors and nurses were on ground to attend to them especially emergencies.
“Recall that in 2015 it became a concern due to the surge of maternal mortality and we discover that women and children are dying of preventable cause, we concluded that no woman deserve to die from something that is physiological this has made the federal government declared a state of public health concern and set up a national emergency especially on maternal centres with the focus on the delay.
“We are doing what we call optimising, recognising the issue of pandemic, with innovative approach; one if it is the booking of ante natal appointment as it approaches a reminder is sent, this will ensure that the facility is not overflowing and patients will be taken care of. “The pandemic has actually created a forum to get better at the things we do and put in place those things we have been thinking about.
“We cannot down play the issue of inadequate human resource for health which poses a huge challenge and sometimes this interfere with quality and timely delivery of services,” she said.
Case for urgent innovative strategies
In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby.
As stated by the Lancet Global Health, maternal health have maintained that there is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system.
“If management integrate the Covid-19 response into essential care, health services everywhere, with improved hygiene measures as a new normal, this could trigger long-term strengthening of fragile health-care systems.
“If we fail and let one disease over-influence care and further debilitate frail health systems, unacceptable suffering and premature deaths will follow,” the organisation stated.
