1. Improving mat
The Agony of Childbirth
A
By Sulaiman Momodu those living in the rural areas, realizing the Ministry of Health (MoH).
dream of motherhood can be risky. One As Liberia emerges from the devastat-
out of every 16 women dies while giving ing civil war that destroyed much of the
t the Redemption hospital
birth in Liberia. In the developed world, country’s infrastructure, including hospi-
in Monrovia, Joana
only one out of 3,800 women faces such a tals and clinics, improving maternal health
Denmia, 25, has delivered
tragedy. Beyond the risk of women losing and reducing child mortality -- two of the
twins. “My parents
their lives while giving birth, one in every eight UN Millennium Development Goals
brought me to this hospital
four children in Liberia also dies before (MDGs) -- are among the priorities of the
because I was very sick,” she says, busy
the age of five. government. The United Nations
breastfeeding her babies. “This is my fifth
Among the causes of maternal deaths Children’s Fund (UNICEF), the World
born. Two of my children died before the
in Liberia are hemorrhage, hypertensive Health Organization (WHO) and United
age of five.” Though anaemic and com-
disorders of pregnancy, unsafe abortion, Nations Fund for Population Affairs
plained of bodily pains, Denmia was lucky
prolonged or obstructed labour, (UNFPA) are among the organizations
to have given birth safely. Next to her bed
Infection/sepsis; other direct causes supporting the government’s efforts. The
in the maternity ward, Ruth Jallah, 28,
include malaria, AIDS, and anaemia. The task ahead, however, is enormous.
says she was admitted to the hospital
highest cause of child mortality is malaria, In addition to destroying the health
because she was bleeding profusely, which
accounting for about 42 per cent of cases, facilities across the country, the civil war
caused her five-month-old pregnancy to
followed by diarrhoea with 22 per cent, also took the lives of several medical pro-
abort. “This is my second miscarriage,”
and acute respiratory infections account- fessionals. Many others fled the country
she lamented.
ing for about 12 per cent, according to during the war and are reluctant to return
For many Liberian women, especially
22 UNMIL FOCUS June - August 2007

2. MATERNAL HEALTH
medical personnel say a woman in labour safe birth.
has to walk for days to reach a health facil- Currently there are 364functional
ity. Compounding the scenario is the high health facilities in Liberia, including hos-
prevalence of teenage pregnancy in the pitals, heath centres and clinics. By and
country. large, deliveries in health facilities are
To help improve the delivery of med- very low and are sometimes done by tradi-
ical care across the country, the United tional midwives or trained traditional mid-
Nations Mission in Liberia (UNMIL) has wives (TTM), who are not competent to
funded 15 newly-built or rehabilitated handle complex cases. Health authorities
health facilities in eight counties through have begun training middle-level health
its Quick Impact Project. “Health is workers to ensure they are well equipped
wealth. We must help you generate this to carryout their functions. The MoH and
wealth. Without healthy children, there partners work with TTMs in the communi-
will be no healthy Liberia,” says Alan ties to improve their skills and encourage
Doss, the Special Representative of the them to refer cases. MoH, in collaboration
Secretary-General. Peacekeepers also with partners, is also undertaking immu-
carry out medical outreach activities in nization to prevent child mortality.
towns and far flung areas, sometimes Now that Liberia is moving from an
trekking for miles to render free medical acute humanitarian situation to one of
assistance to the ailing. recovery, some non-governmental organi-
“There are a lot of gaps in service zations which came to the country’s assis-
delivery in addressing emergencies that tance during the height of the civil crisis to
kill our mothers…having skilled person- rehabilitate health facilities and carry out
nel in service delivery is key to reducing free medical services are folding up their
maternal and child mortality,” says Dr. operations, a development that is of great
Musu Julie Conneh-Duworko, the Family concern to the government. Efforts are
Health and Population Adviser at the being made to fill the gap when many of
WHO. The organization is supporting the the organizations would have finally
government in its drive to improve health pulled out by 2008. Working conditions
delivery across the country. It has provid- are also being revisited to make them more
ernal health is a major priority in Liberia ed both financial and technical support for attractive so that doctors and other medical
home due to poor working conditions and the development of the “Maternal – new practitioners can move from the city to the
facilities. Today, Liberia is faced with born health road map,” which defines the counties.
acute shortage of qualified medical staff to vision of the government to address the One of the major challenges of the
meet the health needs of the population. situation of maternal and child health Liberian health sector is the lack of statis-
Dr. Eileen Reilly of Scottish issues. tics. MoH officials say they are putting
International Relief, who works at the The MoH is putting in place a strategy their records in order. Meanwhile, a just
government hospital in Tubmanburg, is to accelerate child survival in the coming released 2007 Liberia Demographic and
the only gynaecologist for the population years through interventions that are high Health Survey (LDHS) points to encour-
surrounding the area. There is just one impact and low cost. Dr. Isabel Simbeye, aging trends in maternal and child health.
government doctor in the hospital. “We the Project Officer, Health and Nutrition at The survey shows that the current fer-
have only one ambulance serving three UNICEF, says the UN agency helps with tility rate in Liberia is 5.2 children per
counties…most times pregnant women technical support, equipment, drugs and woman, down from 6.2 children in
come to the hospital bleeding and almost training. In areas that are inaccessible by 1999/2000. The under five mortality has
at the point of death. The maternal health vehicles and motorbikes, health personnel been cut in half to 111 from 219 deaths per
situation here is absolutely appalling,” she use bicycles or trek several miles in order 1,000 ‘10 to 14 years before the survey.’
laments. Without the voluntary medical to render medical services and to sensitize During pregnancy, 79 per cent receives
assistance rendered by the Pakistani doc- people on healthy living. anti-natal care from a health professional
tors stationed in Tubmanburg who also In Foya district, Lofa County, the and 78 per cent of births are protected
provide free drugs, the operation of the WHO, in collaboration with UNFPA and against tetanus. However, only 39 per cent
government hospital will be a nightmare. the MoH, has introduced “appropriate of children are considered fully immu-
In some towns and villages, pregnant technology ambulances.” They are motor- nized against childhood killer diseases.
women and other sick people have to bikes with a cushioned carrier fixed to it to Despite the marginal progress being
either walk or be transported in ham- transport pregnant women to the nearest made, much remains to be done to
mocks. In Grand Kru for example, which functional health facility. The pilot project improve maternal health and reduce child
is referred to as the “Walking County,” is called “Wolorkendia,” a Kissi word for mortality in Liberia.
23
June - August 2007 UNMIL FOCUS