Post-abortion care: A new hope for women in Mafia

To the residents of Mafia Island in the Indian Ocean, the name “Mafia” partly originates from the Kiswahili phrase, “mahali pa afya,” literally meaning “a healthy dwelling-place.” The Island’s location also takes the Arabic origin, “morfiyeh,” meaning, “archipelago.”

However, for Ms Mbuke Elias (28), women on the Island are yet to live and enjoy the reality that is in the place’s name, “Mafia.” Reason?—critical shortage of maternal health services on the Island.

Mafia, with a population of about 52,000 people, is home to one district hospital and 16 dispensaries but no Health Centre (HC), a place of primary healthcare delivery, which a dispensary cannot provide. There is only one qualified medical doctor (MD) and a few clinical officers or Assistant Medical Officers (AMOs).

A light at the end of a tunnel

The demand for healthcare—especially the basic maternal and reproductive health—is evidently lacking as the government and health stakeholders spring into action to rescue the situation.

“We have witnessed many women die due to severe bleeding after attempted abortion and miscarriage simply because of lack of immediate facilities and skilled personnel to help them,” says Ms Mbuke, a nurse at Jimbo Dispensary in Jimbo village.

Mbuke, a senior nurse, believes that women’s lives would have been saved if an investment in basic maternal healthcare was given the upper hand on the Isles.

“Most times when such women reported to our dispensary with a bleeding problem after a miscarriage, I would simply give them anti-pains and then refer them to the district hospital; which is located about an hour drive away,’’ says Mbuke who heads the dispensary.

She spoke to Your Health at the Kilindoni town of Mafia District where 32 health workers gathered for a week-long training on how to offer Comprehensive Post-abortion Care(CPAC) for women who happen to experience miscarriage and at times, incomplete abortion.

About 19 per cent of maternal deaths in Tanzania occur due to unsafe abortion, says Dr Mashafi Mashafi, a maternal health consultant at Population Services International (PSI), an organisation that is currently running reproductive health projects on the Isles.

And, for the first time in the history of healthcare in Mafia, medics at lower level health facilities will now be able to provide post-abortion care to women, using a Manual Vacuum Aspiration (MVA), thanks to a new project by health stakeholders and the government.

The project, meant to ensure that maternal deaths caused by lack of basic services do not happen in Mafia, is run jointly by PSI Tanzania and the Ministry of Health, Community Development, Gender, Elderly and Children.

Dr Beatus Nyamuhiba who was training the health workers on the CPAC, says that health workers will now be able to apply an MVA, a medical equipment that is used to remove contents that may remain in the womb after a woman has lost a pregnancy that was still below 12 week.

“Usually, a woman who has had a miscarriage or attempted abortion can bleed heavily due to the contents that remain stuck in the womb, says Dr Nyamuhiba, who also works at the Amana Regional Hospital in Dar es Salaam.

“The MVA is a simple tool that any health worker who goes through a short training can use to remove the uterine contents through suction pressure. It’s easier to use but it was not available here in Mafia,” he told Your Health.

A sigh of relief for Mafia women

According to Ms Fatma Abdallah, the Mafia District Reproductive Health Co-coordinator (DRHCo), women who needed post abortion care, had to be subjected to a more complicated procedure known as ‘curettage’, which is also not readily available in any lower level health facilities in Mafia. Curettage can be used for pregnancies beyond 12 weeks.

“For a very long time here, women who had miscarriage or attempted abortion and wanted post-abortion care were referred to the District hospital in Kilindoni,’’ says Ms Fatma in an interview with Your Health.

“At the hospital, it requires a highly skilled health worker to perform curettage surgical procedure, which is complicated. It also requires the patient to be put under anesthesia,” she says.

Nurses, such as Mbuke who now work at a dispensary—located away from the district hospital—believe that through using the newly introduced MVA, they will now be able to reduce the number of women who were being referred to town for post abortion care.

But for Mr Ashley Daniel, one of the nurses who underwent the training, the knowledge obtained from the week-long course is a useful resource that he would now use to train his fellow nurses where he works.

“I had learnt about an MVA in college, that’s about two years ago. But here in Mafia, it wasn’t available and I didn’t have enough practical skills to apply it,’’ says Mr Daniel of Mafia District Hospital.

PSI has now started distributing MVAs to some dispensaries in Chemchem, Kirongwe, Baleni and Kilindoni as the medics in the health facilities continue to cope with the new tools.