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Dear Tingasiga,
When Leonida Kobusingye, 27, entered Fort Portal Regional Referral Hospital (Buhinga) last week, she was looking forward to the birth of her third child with the joyful anticipation common to all mothers.
In a few days, she hoped, she and her husband would take home their new bundle of joy and present him or her to the siblings, two girls of five and two years.
Mr Saturday Rukundo wa Zirahagye, her 35-year old husband, must have had mixed emotions. His brother, who died a few days before Kobusingye’s labour, had just been buried in Mparo, Rukiga, Kigezi. Not even the birth of his child would ease the pain of losing a brother.
His thoughts must have been with his own father, Mr Narais Zirahagye, who, like most Ugandans, spent more time in mourning than celebration.
The birth of the baby would bring smiles to the old man and other bereaved relatives.
It would certainly bring a smile to Kobusingye’s widowed mother. You see Kobusingye was an only child.
Everyone kept their mobile phones charged, ready to receive the news from Fort Portal.
When the news came, it was that Kobusingye had died, along with her baby, victims of preventable complications of childbirth.
According to Zirahagye, his daughter-in-law had been in labour at Buhinga Hospital for one-and-a-half days. Delivery by caesarean section was accomplished, but the baby died. Kobusingye bled profusely, resulting in her death.
The family does not know what happened. Robert Boy Zirahagye, Kobusingye’s brother-in-law, told me that the baby died because of “a problem with the umbilical cord,” which does not say much.
News of Kobusingye’s death hit me hard, not because Zirahagye is my friend, but because she, along with another 15 women who died on the same day due to pregnancy-related causes, did not have to.
Based on the information that the family has shared with me, the deaths of this young woman and her child were preventable.
Replace the name Kobusingye with Akello, Acanit, Ajaruva, Emojung, Kisembo, Naikoba, Nanziri, Onzia or Wesesa, the story is the same across the country, as it is in most of sub-Saharan Africa.
Women of 15-49 years continue to have an unacceptably high death rate due to preventable pregnancy related causes.
We lose 438 Ugandan mothers per 100,000 live births every year, a figure pretty much unchanged in nearly 40 years. Our hope had been that by 2015, this maternal mortality rate would have fallen to about 211 per 100,000 live births.
Likewise, babies continue to die around the time of their birth at very high rates.
Uganda’s perinatal mortality rate (stillbirths and baby deaths between seven completed months [28 weeks] of pregnancy and seven completed days after birth) is 40 per 1,000 pregnancies that reach at least 7 months. The most dangerous places to be pregnant in Uganda are the West, South West and central regions, with perinatal mortality rates of 54, 48 and 47 per 1,000 pregnancies, respectively. The lowest rate is in Northern Uganda, reported to be 22.
This is a story we have told in this column several times. It is a story we shall keep telling, for it reminds us that in 2015, the target year of the Millennium Development Goals (MDGs), the dream of drastically improving the health of women and their babies remains unrealised.
This is not due to lack of knowledge or documented pathways to achieving these modest goals. The Uganda government and the health care development partners have excellent policies and programmes in place.
The challenge is to collectively embrace the necessary cultural change that will enable us to invest our time, our skills, our resources and our minds in a national programme that translates our sentiments into action.
Space does not allow a thorough discussion of the contributors and possible solutions to these high death rates.
Suffice to say that the government must increase spending on health to a minimum of 15 per cent of the total national budget. The bulk of the increased spending should be invested in very well-trained, skilled well-paid ethically committed multidisciplinary teams of health professionals whose brief is to ensure best outcomes for mothers and their babies.
Those charged with responsibility to provide service to mothers and babies must be held accountable for any actions that put lives at risk.
A truly regionalised and interlinked maternal-child health programme, complete with a reliable ambulance transport system, is an essential component of a successful approach to the problem.
Whereas the government already mandates that all maternal and perinatal deaths be reported and reviewed, there remains a significant opportunity of improvement in this area.
The death reviews are not designed to lay blame or point fingers. They are a vital means of identifying gaps and recommending corrective measures so as to improve outcomes.
In a telephone conversation with Mr Zirahagye yesterday, he told me that the family had many questions and were hopeful that there would be an independent death review and a report on the death of his daughter-in-law and grandchild.
Nothing can bring Kobusingye and her baby back. However, Mr Zirahagye said: “This has happened to me, but it should not happen to somebody else.
