"Maisha" means "life" in Swahili. And in practical terms, the MAISHA partnership between the College of the Rockies and a Kenyan university hopes to bring life to the hundreds of Kenyan mothers and babies who die in childbirth each year.
With $1.6 million in federal government funding, the College of the Rockies is partnering with the Dedan Kimathi University of Technology for five years in the Maternal Access and Infant Survival for Health Advancement (MAISHA) program.
The program's goal is to reduce the number of deaths of women and babies in Kenya's Nyeri and Migori regions. To achieve that, the College of the Rockies and Kimathi are working together to train nursing staff and community health workers, to improve health education, and to provide basic obstetric care equipment.
Since MAISHA's launch in September 2012, three nursing instructors from Kimathi have been trained so that they can lead a five-day course, Emergency Obstetric and Neonatal Care, and they have taken 85 nurses through the course.
Those three instructors, Joyce Jebet, Salome Mukui, and James Ndambuki, are in Cranbrook this week to gather information about how they can improve their services in Kenya.
MAISHA works with eight health care facilities in two regions of Kenya: Nyeri and Migori. The areas are vastly different from each other both geographically and socially. When MAISHA began, 950 rural expectant mothers were asked to discuss care during pregnancy.
"It's amazing what a pregnant women has to go through in Kenya. There are no health benefits, there is no universal health care," said Graham Knipfel, COTR's manager of international business development.
“The roads usually would be dirt. If it’s the middle of the night there may not be an emergency hospital available. And there are cultural pressures around traditional birth attendants – and decision making, too,” Knipfel said.
The Nyeri region is in central Kenya’s highlands, about the elevation of Lakit Lookout.
“They are people who are a bit affluent compared to Migori, in terms of having access to education and access to social amenities like good hospitals,” explained Salome Mukui.
About 97 per cent of people in Nyeri have at least a Grade 8 education. Households earn a living from farming coffee and tea and raising dairy cows. The average family has two children.
“You find the women are empowered, they can have a say in their reproductive health, and family planning uptake is quite high,” said Mukui.
In Nyeri, about 51 babies out of every 1,000 die in infancy.
The Migori region is in western Kenya, close to Lake Victoria, where it is hot and humid.
“In Migori when we did the survey we found a majority of households are peasant farmers,” said Mukui. “They have a lot of land, but if you want to be a farmer you need money in order to plow and seed.”
Poverty is much higher than in Nyeri. About 95 babies out of every 1,000 die in infancy. About 149 out of every 1,000 die before reaching age five. The average family has four children.
“Because of that poverty level, you find mothers are not able to go to the health facility for delivery. One: because of the economic factors, and also because of the infrastructure in the region. It’s quite poor. The roads are impassable,” said Mukui.
If families own a vehicle, it’s usually a motorbike travelling on muddy or dirt roads.
“So you can imagine a mother in labour on a motorbike,” she said.
In Migori, many pregnant woman work on the farm until they go into labour.
“More often than not, the women are saying they still find they still have to struggle, go to the farms, work hard in the farms, look for food, and sometimes they will work hard until they go into labour,” said Mukui.
Things are a little different in Nyeri, explained Joyce Jebet.
“Because the women are empowered, the women from the study say they are even able to hire a house help when they are pregnant. Because they have their own money, they can make their own decisions,” she said.
“In Nyeri, we found the level of male involvement is good. Some of the men were even complaining they were not allowed to go to the delivery room,” added Mukui.
MAISHA is working with nurses in rural health facilities to better prepare them for helping maternity patients and babies, by taking them through the national Emergency Obstetric and Neonatal Care program.
“We are trying to build on their capacity to be able to take care of these patients and reduce the mortality and the newborn deaths,” said James Ndambuki.
The MAISHA program is also training community health workers, who are mostly volunteers.
“They are really the frontline in the community and in households. They are able to assess families, see children. Some of the (major) killers for children in these areas are malaria and diarrhoea. By working and training community health workers we are able to deal with those areas of health concern as well,” said Moritz Schmidt, COTR’s international project coordinator.
“In the emergency obstetrics training, we also have an aspect on neonatal which is part of infancy. So when we give them the skills to take care of emergency cases in neonatal then you are likely to see good outcomes at the end of it,” added Ndambuki.
Schmidt recounted a story he heard during a visit to Kenya in September. A woman arrived at a health care facility in a very hard to reach area in the middle of the night. There was one nurse on duty, who did not have the emergency obstetrics training. However, she was able to call on a fellow nurse who did have the training.
“They were able to deal with that at a very remote facility – a twin breach delivery, which is a complicated scenario, especially when you are an hour away from any hospital on a muddy dirt road. That was entirely due to that nurse’s training in the five-day emergency obstetrics course,” said Schmidt. “That was one of those moments where you know we are doing something that will help.”
The College of the Rockies has also conducted assessments on what equipment is needed at these rural health care facilities.
“Some of the equipment will include delivery kits, basic equipment to help the facilities that right now don’t necessarily have those basic things – (such as) sterilization equipment,” said Schmidt.
“It’s fairly fundamental equipment to help them with their outcomes and improve maternal and child health at those facilities.”
The MAISHA project has just begun, with training only being held over the past two months. Until now, the two institutions have been busy on ground work.
“It seems like a long time but it really takes that amount of time to have a clear picture of what’s happening on the ground,” explained Schmidt.
“With all this hard ground work we will be able to better measure the results that we have,” said Knipfel.
For more information, visit www.cotr.bc.ca/MAISHA.