Health outreaches give Butaleja women hope

Rehemah Bagume had to walk long distances every time she was pregnant for her antenatal visits. This was not only tiresome but strenuous for her in her condition. In fact she recalls missing some of her antenatal visits not more than once. But that was before World Vision Uganda started community integrated outreaches.
“I attended every antenatal visit for my last two pregnancies because thanks to World Vision Uganda services were brought closer to my home. Despite being heavy I am able to walk to Bubalya Primary School and get checked and advised by midwives and other health workers on my pregnancy,” Bagume who is currently eight-months pregnant says.

Juliet Cherabira, a 36-year-old mother of eight, has had to walk a longer distance, from Gayaza village, which is about 6kms away from Butaleja Health Centre III. Every time she needed to visit the health centre, she had to dedicate the entire day just for that.

“At the time of seeking medical care (immunisation and treatment) for my twins, Winnie, my 10-year-old third born, would miss school on those specific days to help me carry the other twin since the distance was long and my husband was always busy with livestock to support the family. Setting off was always at 8am and returning home was at 4pm,” she recounts.

Cherabira always felt bad that her children would also go a day without lunch. She would also return home very tired and worn out because she had to carry the child on her back as she walked on foot as well as wait for long before she was attended to.

Ray of light
One day, a call was made in her village by the Village Health Team that health workers would be visiting to attend to health needs of the community members. At the time, she was expecting Joan, her 8th child.
She narrates: “I felt relieved and happy that I didn’t have to walk a long distance anymore to attend my antenatal visits.”
The outreach post is at Bunghaji Primary School which is 500metres away from Cherabira’s home so she could easily attend all the four antenatal visits. She would also take her twins every month for growth-monitoring as advised by the midwife at the outreaches.

“Winnie did not have to miss school. I now first go to the garden and prepare food for the children on the day I attend clinic. I usually spend two hours at the outreach and when I come back home, I complete the chores,” Cherabira says.

It is not outreach services alone Bagume and Cherabira are thankful for.

The humanitarian Christian organisation also offered Bagume a transport voucher which on her last visit to health facility will enable her access transport from any motorist to the health facility to deliver her baby safely.

The midwife who had just examined her, Patricia Asekenye, from Bubalya Health Centre III, said that Bagume is fine and is expecting a healthy baby.

“I have advised her to check into a health facility or better still a hospital so that she is adequately helped on delivery,” Asekenya adds.
Mark Lule, a community development facilitator with World Vision, Uganda, says that community integrated outreaches started as immunisation outreaches but when World Vision came to Butaleja, they suggested to the district to integrate in other services.

These include antenatal and postnatal care, immunisation, family planning services. “By integrating, we wanted to tap into the missed opportunities for example mothers who come for antenatal services should also bring their children for immunisation. We also factored in the issue of distance for example here at Bubalya Primary School outreach post is 3kms or more to the closets health unit, Bubalya Health Centre III. The reason was to bring services closer to the people in communities,” he says.

Today, an expectant mother can get a lot more than antenatal care. She would only go to Bubalya Health Centre when she is in labour and ready to deliver.

Asekenya commends World Vision for linking communities with health workers at community level, and ultimately bringing services nearer to the communities which has contributed to healthier people.

“Village Health Team members have done a good job in mobilising community members to come to the outreaches,” she observes. One of the VHTs at at Bubalya Primary School, Merab Were says has been mobilizing people for 10 years.
“I mobilise community members for health outreaches during which we encourage them to improve hygiene at home and places of work, have better feeding and nutrition patterns. For expectant mothers, we always encourage them to come for antenatal visits,” Were says.

Change in trend
She adds that community integrated outreaches have contributed to higher antenatal visits since they take service closer to expectant mothers.

During antenatal visits, enrolled midwife Asekenya explains that expectant mothers get more than advice. They screen their blood and examine them, immunise children and give general medical care and advice.

“In case of any abnormalities in case of pregnant women, I refer them to the hospital. Even if a woman is bleeding, I refer them to hospital or she has a contracted pelvis. Young prime graviders (girls who are pregnant before 18 years) are also referred cases,” the midwife explains.

During the first antenatal visit, Asekenya explains that expectant mothers are screened, tested for HIV/Aids, given routine management like tetanus injections, folic acid supplementations, iron supplementation and intermittent presumptive treatment (preventive treatment for malaria).

On the second visit, the mothers are taken through abdominal examination to find out whether the heart of the baby is beating then tested again for HIV/Aids, given the tetanus vaccine and are given health education.

During the third visit, Asekenya says that expectant mothers are given iron sulphate supplements, examined and given last visit dates.

On the fourth and final visit is when expectant mothers are given tips on how to prepare for delivery, given a preparedness plan on where she would give birth and what to carry to hospital for example Mama Kits which are supplied by both government and World Vision.
“We also teach mothers about the signs that should alert them to come to the hospital or health centres for delivery. These include lower abdominal pains, pains in the waist or in the back and vaginal drainage of fluids,” the midwife says.

Steps
Screening: During the first antenatal visit, expectant mothers are screened, tested for HIV/Aids, given routine management drugs.
Examining: On the second visit, the mothers are taken through abdominal examination to find out whether the heart of the baby is beating then tested again for HIV/Aids, given the tetanus vaccine and are given health education.
Iron: During the third visit, Asekenya says that expectant mothers are given iron sulphate supplements, examined and given last visit dates.
Tips: On the fourth and final visit is when expectant mothers are given tips on how to prepare for delivery, given a preparedness plan on where she would give birth and what to carry to hospital for example Mama Kits which are supplied by both government and World Vision.