Uturo village in Tanzania : Where maternal death is a ‘taboo’

Memories of graves—small and large—still linger on the mind of Mr Wilson Chotamganga, as he recalls the days he first arrived at Uturo village, Mbarali district, Mbeya region in 1993.

“To me, those were dark days,’’ says the 60-year-old medic who will soon be retiring from his job at the village dispensary he has served for the past 24 years.

“In the 90s, when I was posted by the government to work here [at Uturo Dispensary], I was stunned by the graves that I witnessed at the homes I visited in the neighbourhoods. I later learnt that almost each grave meant the life of a woman or child lost,” he recalls.

“But there was no real data. No proper records of the deaths. All that people were doing was bury the dead—that’s all. We could just count—one, two, three deaths…up to five in a year,’’ he says.

When a woman died with her unborn child, you could hear people say, ‘siyo riziki,’ meaning, ‘It was God’s plan.’That amounted to giving up."

When a child died during birth, at times it was kept as a family’s top a secret. It was believed to be a curse for the family.

“For yet another four years, I witnessed more women dying for reasons that could have been avoided. People here could mourn for so long whenever a pregnant woman died. But then, something struck me. I said to myself; come on!! Pregnancy is not a disease, why then, should this continue to happen?’’ he told Your Health.

After a storm, comes a calm

Behind this sad tale of Uturo memories, lies a success story. One told by Mr Chotamganga and other villagers. That no woman in Uturo has died due to pregnancy-related complications in the past 18 years, as far as the community can recall.

To them, death of a pregnant woman has almost become a taboo. “We don’t want awoman to die in this village,’’ insists Chotamganga.

For over 18 years, no maternal death

In 1998, the residents of Uturo and neighbouring hamlets, covering a population of over 5,000 people, decided to “wage war” on maternal deaths. This was under the co-ordination of the village government, inspired by Mr Chotamganga, a clinical officer.

At that time, a special team of peole who now comprise of 36 members was formed to complete the task. “We named them commandos. They were going to face an enemy of the village—the maternal deaths,’’ says the Village chairman, Mr Charles Mtambalike.

One of the members, Ms Josephina Sakarani, now aged 50, says, “We realised that pregnant women risked their lives by giving birth at home; without assistance from a skilled personnel.”

“The only thing women knew was to endure labour pains and push the baby out of the womb at the time of delivery,” says Ms Sakarani, a midwife who has been working in the community for the past 20 years.

“Women could simply push. It did not matter whether the unborn child was lying in the right position or not. Clinic visits were just a foreign concept. Men didn’t know they had a role to play. But today, all that, is history. The community has changed, male involvement is so high,’’ she says.

“We had to educate the community. We first underwent training. The village health team, led by Chotamganga, sounded a warning to the village. That it was against the village’s norms for a woman to deliver at home.”

Ms Mariam Kipangule, the village health secretary, says the special team—the commandos—were tasked to ensure close monitoring of all pregnant women, fast response for all women carrying risky pregnancies for referrals and mass public health education campaigns to the residents.

This has been going on for years. The village health workers and local authorities are keen on village principles. A family that, for instance, doesn’t adhere to the principles could be fined up to Sh50,000 for a pregnant woman who doesn’t attend antenatal clinic visits.

Today, arriving at the dispensary, one doesn’t have to ask the hospital authorities to provide data—it’s all placed on the walls of the building.

Although, supplied with electricity, most of the information is kept in files. A United States-funded program, Walter Reed, donated a desktop computer which is only used to store data for HIV patients at the Care and Treatment Centre (CTC).

Not privileged, as could be thought to be

However, Uturo is not a privileged dispensary. Mr Allence Mvili, a clinical officer who is now in transition to succeed Chotamganga, says, “Here, we face the same challenges as any other public health facility.” But, there is no waiting for donor support to work on pressing issues, he adds.

“In cases of an emergency, we have to call for an ambulance over 100 kilometers away from here. If it doesn’t come, we, as a community raise funds for a private vehicle,” Mr Mvili says.

“Another big challenge is, the road from this dispensary to where we refer patients in Mlangali ward is in bad shape. As we wait for the municipal authorities to help, we have decided to work on it,’’ he says.

“Residents here have already raised contributions to kick-start the construction of a maternity ward. Currently, delivery is done in an improvised room,’’ he says. It is estimated that the ward‘s construction will cost about Sh300million.

“We could have waited for the higher authorities to come and help build it but, ---until when? Whatever the government brings here, or donor support we get, will be considered as top-up and we will just thank them for it,” he reveals.

Painting a picture of the village

Last week, when Your Health arrived at Uturo village, almost every community member was at work, women carrying stone aggregates and men filling up pot-holes along the 5-kilometre road that heads to the village dispensary.

Led by the village chairman, Mr Mtambalike, Uturo villagers joined forces with the neighboring villages of Mtamba and Ukwama in repairing the road.

“This road was causing delays whenever we wanted to transfer a pregnant woman to the district hospital in cases of emergency. We have decided to act,’’ said Ms Rose Jackson, one of the residents, panting and sweating as she hauled stone aggregates into a truck.

In Tanzania, about 8,000 women die every year due to pregnancy-related complications. Maternal mortality ratio has risen from 432 to 556 per 100,000 live births, according to the 2015/2016 Demographic Health Survey (TDHS).

For many years, communities are still glued on the receiving end of the maternal health services in Tanzania’s struggle to improve maternal health, says Dr Dismas Matovelo, a specialist at the Catholic University of Health and Allied Sciences (Cuhas).

Uturo village has been described by high profile government officials as a learning example as experts say the power of communities is key to dealing with maternal mortality.

The Permanent Secretary of the Ministry of Health, Community Development, Gender, Elderly and Children, Dr Mpoki Ulisubisya, recently asked regional authorities across the country to borrow a leaf from Uturo’s success story.