Mothers Deserve Better
Dr. Joseph Essombo
Abidjan, Côte d’Ivoire
August 12, 2010
On a sunny afternoon in late July, I arrived at Ebikro-N’dakro, a primary health care center supported by the Foundation, located in the district of Ayamé, about 120 km south east of Abidjan. The center was unusually crowded at this time of the day even though it was a market day. I saw a group of women seated on the ground crying their souls out and wailing while many others were rushing toward the health center.
Ebikro N'dakro primary health care center
Obviously, something sad had happened there.
I learned from the assistant nurse that a 22-year-old woman passed away after bleeding to death during labor and delivery. I walked directly into the midwife’s office and found her in complete shock, standing by the window, her eyes full of tears.
She could barely articulate her sentences when she told me, “I am here waiting for them, but they prefer delivering at home, assisted by traditional birth attendants and just rushing in to the center at times when it’s often too late. This beautiful young lady died today before reaching the health center, I feel desperate and powerless.”
I stayed with her, holding her hand trying to express my deep sorrow and to show support.
Fifteen minutes later, I walked out of her office and I met the woman’s husband who was sobbing silently by the door - he could not have been more than 25 years old. He told me that the baby had died too. Now a family was torn apart.
Their desire and dream to have a baby turned into a nightmare that day. My heart broke as I witnessed the suffering and despair of this strong man. It seemed so unfair.
Country Director for Cote d'Ivoire Joseph Essombo
In the morning, I spoke to the director and the medical officer of the General Hospital of Ayame about the necessity of making basic antenatal care (ANC) services much more affordable for families in rural areas, many who live on less than two dollars a day.
The General Hospital of Ayame, which is supported by PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief) is the center for a network of eight primary health care centers, which integrated HIV services in 2006 through a performance-based grant from the Foundation. Our support to this center is part of our pilot project to streamline direct funding to the public sector. In Côte d’Ivoire, the current policy does not allow partners to directly fund the public sector.
ANC services are supposed to be free of charge, but on the ground, the average cost for the first of four required ANC service appointments is close to $60, mainly due to the price of required biological exams. This is one of the main obstacles for women to receive the 4 complete and required ANC visits, and it also contributes to preventing most of them from delivering in a health facility.
Years ago I began advocating for a free or heavily subsidized ANC package for women, and for the creation of more mother-friendly maternity wards that would encourage pregnant women to deliver in health facilities.
If I had made this dream come true, maybe this young lady would still be alive today, as well as many others who have died at home while giving birth. The sad event I witnessed during my site visit made me realize how crucial free access to ANC is in a country experiencing one of the highest maternal mortality rates in the world.
I came back from my visit with the strong conviction that we should leverage money for a pilot project in Ayamé, because no mother should die trying to bring a new life into the world.
Mothers deserve better. I am committed to making this happen, starting with Ayamé.
Dr. Joseph Essombo is the Foundation's Country Director for Côte d’Ivoire, based in Abidjan. He has been working in the HIV/AIDS field for more than 20 years with a passion and enthusiasm that inspire all those around him.