Whenever Mama Hassan recalls the events of 1994, tears flow down her wrinkled face.
That year, there was an outbreak of polio and measles in parts of Mandera. The 65-year-old says every homestead lost at least one child who had not been vaccinated against any of the diseases.
Mama Hassan lost her three sons.
Today, she has eight other children, but she will forever miss those who left.
“When we got complications in giving birth and when a disease outbreak hit our community, the religious leaders and our husbands would sit down and read the Quran all day long, as they uttered special prayers in hopes that the situation would improve,” Mama Hassan says.
She comes from Dandu village where, like most parts of Mandera, residents have lived for decades without immunisation or birth control.
Their nearest hospital is in Ethiopia, about 150km away, but there are no ambulances.
As a result, hundreds of women die during childbirth every year. That is, about 3,795 deaths for every 100,000 live births, according to the Kenya Demographic and Health Survey.
This is one of the world’s highest childbirth related-death rates, surpassing that of wartime Sierra Leone (2,000 deaths per 100,000 live births) and far above Kenya’s national average (448 deaths per 100,000 live births).
But the government and its partners are moving in to correct the situation. The county government, the United Nations Population Fund and medical equipment maker Philips have opened a Community Life Centre, a pilot health facility that is easily modifiable to serve the health needs of about 40,000 people.
The idea is to use the latest technological innovations to solve health challenges in one of Kenya’s remotest regions.
The pilot centre is situated in Dandu ward of Mandera, and its success could alter the way health services are rolled out in similar regions.
This is the second CLC sponsored by Philips in Kenya, after Kiambu in 2014. A similar one was opened in the Democratic Republic of Congo in 2016. The company aims to introduce the CLC model across the continent.
The centre rolls out the latest medical equipment and technology, available in Nairobi’s top private hospitals, modified to suit village needs conditions.
It offers a full technology package, comprising solar power, durable indoor and outdoor LED-lighting, healthcare equipment to enable patient monitoring, diagnosis and triage, laboratory equipment (especially for antenatal care tests) and refrigeration for blood storage.
CASE STUDIES
A few kilometres from the facility in Dandu ward, we enter the homestead of 30-year-old Habiba Sheikh, who was diagnosed with Antepartum Haemorrhage at initial stages of her pregnancy.
This is a condition characterised by heavy bleeding.
She survived the pregnancy and gave birth six weeks ago to her seventh child. Ordinarily, she would give birth at her home with the help of a traditional midwife. But this time she chose to go to a distant hospital as her life was in danger.
Doctors say she has been suffering from the condition for more than 10 years, but it only worsened recently.
Habiba says in the early stages of their marriage, her husband asked her not to use contraception as they believed it was against Islam.
“When women get pregnant here it is a matter of life and death. If they are lucky not to have a complication during birth then the traditional mid-wives can help them, but if it arises, most of them never make it to the hospital,” Sheikh says.
About 20 kilometres away from Habiba’s home is Noor, a mother of five, who is expecting a sixth child soon.
Noor narrowly survived her fourth pregnancy after normal delivery went wrong.
She survived the ordeal only by defying her husband and seeking medical help.
“It is a taboo for a man to help a woman deliver a baby in our culture, and my husband would never let me go to the hospital to give birth there because he heard that men handled pregnant women,” she says.
The medical attendant at Dandu reveals that the new facility will be able to handle such complications.
He says some of the worst complications at birth come as a result of female genital mutilation.
The Somali community still practices FGM as part of their culture, which can resort in drastic consequences at childbirth.
It can extend labour by hours and cause tearing; sometimes women simply bleed to death.
MARGINALISATION EFFECT
Since Independence, Mandera has been a marginalised region. Thousands of residents lacked basic services such as healthcare.
At the inception of devolution in 2013, the county had only three operational health facilities, which lacked basic equipment and medicine.
Governor Ali Roba says medicine and facilities such as ambulances were never accessible in the region.
Roba and 14 other governors from the 15 high-burden counties signed a communiqué in 2014 that formed the basis of their efforts to address maternal health and proper health services.
Over the four years, the county government has increased investment in health care, improved infrastructure for emergency obstetric and newborn care, increased investment in the rights and education of adolescent girls, and support family planning services, among other core actions.
“There was one doctor in the entire county. Just three out of 57 health facilities were working and the main town was almost a no-go zone for government officials,” Roba said.
“Women and children were the most affected and mostly died before receiving medication because most of those facilities considered to be health centres were just structures with no services to render.”
The county has a low contraceptive prevalence rate at 4.5 per cent, skilled birth attendance rate of 20 per cent against the national average of 44 per cent, while the Immunisation coverage stood at 53 per cent against a national of 83 per cent, according to the latest Kenya Demographic and Health Survey.
Philips Africa CEO Jasper Westerink says the CLC concept was introduced in Mandera as a pilot, which would help to determine if it could be spread out to other hardship areas.
“If this concept can work in Mandera then we can introduce it in any part of the Kenya and the world, and it will work because Mandera has been identified as an area of hardship that was generally affected by marginalisation,” Jasper said when he visited Mandera recently.
He noted the flexibility of the CLC platform allows it to be tailored to the local healthcare requirements, in terms of the service package offered, the volume of patients, and local needs and circumstances.
Phase two of the project will include IT-solutions (storage of patient data) and water supply and purification (preventing waterborne diseases). In addition to the improvement of the facility, Philips has also supplied Outreach Kits that allow community health volunteers to extend basic health services into the community.
Dr Ademola Olajide, UNFPA country representative to Kenya, said: “The inauguration of the CLC in Mandera is an important milestone in finding new ways of significantly advancing maternal and newborn health outcomes in the six counties in Kenya, which contribute close to 50 per cent of all maternal deaths in the country. We look forward to continue learning from its operations and seeing how it will contribute to improvement in the lives and well-being in the community.”
Philips has been developing and modifying the CLC platform since 2014, when it opened its first site in Githurai, Kiambu county.
“Our partnership comes at a time when the county has a high incidence of infant and maternal mortality resulting from preventable causes and lack of medical facilities,” Kiambu Governor William Kabogo said at the time.
“With Philips contributing towards solar energy solutions and state-of-the-art equipment, the county government was able to focus on the construction of the infrastructure and on hiring new staff. This co-operation is reflective of the kind of partnerships we seek to participate in with the private sector that results in uplifting the lives of our communities.”
The company says it involves community members in the assessment and design of the centres to create ownership.
The centres were developed by the Philips Africa Innovation Hub, which is based in Nairobi.
The centre has been involved in the development of several products in use in Kenya and some in Europe.