Mantoe Phakathi
MBABANE, Jul 21 2010 (IPS) – Affectionately known as Gogo Zondo by the community of Ndvwabangeni in northern Swaziland, Margaret Zondo is a traditional health practitioner who helps treat the sick and delivers babies.
I also give expecting mothers traditional medicine so their labour doesn t take too long, she told IPS.
She is aware that the Swazi government is discouraging these kinds of practices by traditional health practitioners.
Instead, Zondo and her colleagues, who number over 11,000 according to the Traditional Health Practioners Association of Swaziland, are being urged to refer all expecting mothers to health facilities for neonatal, delivery and postnatal services.
It s impossible to turn away someone in labour when you have the skills to help, said Zondo. However, now I mostly help with emergencies because I m aware that government says we should refer expecting mothers to hospitals.
But Zondo complained that her community is very far from the nearest health facility, Piggs Peak Government Hospital. The hospital s waiting huts where women due to deliver are housed were closed down. This left many women with no option but to give birth at home.
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According to the 2007 Demographic Health Survey, about a third of Swazi women deliver their babies at home. The Kingdom has one of the highest maternal mortality rates in the world at 589 out of 100,000 live births.
Phumzile Mabuza, the programme manager for the Reproductive Health Unit at the Ministry of Health, said although the high number of women who die while giving birth cannot be attributed to home deliveries only, this is cause for concern.
Most are assisted by traditional health practitioners, said Mabuza. That s why government is partnering with them to help us get as many women as possible to deliver at health facilities.
But with the long distances to health facilities, traditional health practitioners are unable to quickly refer emergencies.
Dr Mohammed Mahdi, the deputy director for the Elizabeth Glaser Pediatric AIDS Foundation-Swaziland (EGPAF), expressed his disappointment at the closure of waiting huts.
We are urging government to revive these facilities, he told IPS.
EGPAF is an NGO which helps pregnant women living with HIV to access Prevention of Mother to Child Transmission of HIV (PMTCT) services at public health institutions.
Adding to the problem, Mahdi says, the maternity wings at clinics, which are more accessible to communities, have also been closed down. There have been instances where women who failed to reach a health facility on time have given birth in buses or on the street.
Mabuza said the closure of waiting huts was because there were insufficient resources to keep them functioning, but there are plans to reopen them. We re renovating waiting huts because they were rundown and no longer fit for human habitation, she said.
Crime was also a factor. We used to have on-call nurses at clinics who helped pregnant mothers deliver at night but government had to stop this because a lot of nurses were getting hurt by criminals. Thugs come pretending they have a woman in labour then steal government equipment, said Mabuza.
Government is now working with communities on how best security could be provided at clinics, said Mabuza.
Some traditional healers are still reluctant to abandon their role in delivering babies. We re conducting training to encourage them to refer pregnant women to hospitals and clinics and refer infants for immunisation, said Nhlavana Maseko, president of the Traditional Health Practitioners Association of Swaziland (THPAS).
Swazis perform rituals on newborns but most of our members are now beginning to better appreciate the problems with because of the trainings with the Ministry of Health, said Maseko.
Traditional health practitioners willingness to partner with the health services have also been spurred by the growing numbers of complications they are witnessing.
Haemorrhaging is the most common problem and some women lose their lives, said Zondo.
Mabuza attributed the rise in birth complications to the Kingdom s high disease burden. Swaziland has the highest HIV prevalence in the world at 26 percent of the productive age group of 15 and 49 years.
Efforts are also being made to improve the attitude of nurses by developing their interpersonal skills. In all the communities that we ve been to mobilise women to give birth at health facilities people complain about nurses attitudes, she acknowledged.