By Phyllis Mbanje
Zimbabwe has experienced a serious disruption to its health delivery service like maternal health since the onset of the COVID-19 pandemic.
In the early months of the outbreak, lockdowns made it extremely difficult for pregnant women to access health facilities.
Most clinics were closed. Initially, it was out of fear of infection, but that fear became a reality as hordes of health workers became infected.
Harare acting health director at the time, Kudzai Masunda, said the antenatal care (ANC) visits were reduced to avoid crowding.
Many pregnant women gave birth at home assisted by untrained birth attendants like Mbuya Gwena of Mbare high-density suburb, who became an instant heroine.
To establish the extent and impact of the disruptions, NewsDay explored the experiences of pregnant women in different communities.
An investigation by NewsDay, which was made possible by the Voluntary Media Council of Zimbabwe (VMCZ) reporting initiative, revealed harrowing tales of women giving birth by the roadside, while some of them lost their new-born babies due to the impacts of COVID-19 on health services in the country.
Kadoma and Epworth diaries …
As the only public facility handling deliveries, Rimuka Maternity Home in Kadoma, Mashonaland West province, was so overwhelmed that expecting mothers struggled to be accommodated.
The clinic came under heavy criticism after it turned away pregnant women as the staff failed to cope with increasing numbers.
Heavily pregnant women had to wake up as early as 3am to join the queue, but only a handful would be attended to when the clinic finally opened five hours later, around 8am.
The facility, which was designed to handle only a few patients, was over-crowded.
Twenty-three-year-old Fatima Juma from the sprawling suburb of Rimuka is one of many women who failed to secure a booking.
“When COVID-19 cases were first recorded in Zimbabwe, I did not worry much,” she said. “I was actually at the mine where my husband works.”
Her husband is an artisanal miner.
Unfortunately for Juma, the first lockdown was announced while she was still at the mine and almost due to give birth.
“I was a few days away from giving birth and so we decided to travel back to Kadoma,” she explained.
Fearing for her husband’s status as an illegal gold panner at a time when there was heavy police and army deployment along the roads, Juma travelled alone back to Kadoma.
“I started experiencing labour pains a day after I arrived in Kadoma,” she said. “My mother-in-law went to the clinic to enquire about the process of admission. She was told about the early morning queues.
“We had no idea how bad the situation was until we arrived at the clinic at around 3:45am.”
Juma’s real nightmare had only just begun. She was not immediately admitted.
“We went back home, but the labour pains intensified,” she said.
“My mother-in-law was scared. This was my first baby and we had no money for private care. My mother-in-law approached a few traditional midwives from the Apostolic Faith Church, but there was no more space.”
Sensing that her baby was now on the way, Juma told her mother-in-law to plead with one of the midwives to come and assist. She only agreed to come after being promised an undisclosed sum of money.
Juma delivered a healthy baby boy. She named him Nyasha, a Shona name for grace.
Speaking on the crisis at the Rimuka clinic, a representative of the Kadoma Progressive Residents Association, George Goliati, said his association had raised the issue with the local authority and campaigned for the attention of various stakeholders.
“It was sad the way pregnant women were being treated,” Goliati said. “Some would sleep outside the clinic in the cold to be able to register early in the morning. Corrupt practices soon surfaced.”
In similar fashion to the Rimuka nightmare, the expectant mother in the equally sprawling high-density suburb of Epworth, east of Harare, also endured untold suffering.
The pregnant women of Epworth also woke up early in the morning to secure a place in the queue at the clinic.
“Imagine that at any given time, the women of Epworth all vied for only five spots,” said a sympathetic vendor who sells her wares just outside the clinic gate.
“It is sad to watch, and many of them went back home to give birth on their own, usually with the assistance of untrained delivery attendants.”
She narrated how some women in labour were turned away at a time when they could hardly walk.
In the midst of the maternal services crisis, midwives find themselves in a dilemma. While obliged to save the lives of women and their babies, the midwives also have to contend with many other challenges.
These include the threat of being infected by the dreaded COVID-19 virus, which has killed thousands of health workers globally.
Sister Nokuthula Nkomo, a senior midwife at Mbuya Nehanda Maternity Home at Parirenyatwa Group of Hospitals, said the current experience reminded her of her true calling.
“It is not an easy task being a midwife,” she says, “because I am expected, according to my professional conduct, to assist expecting women to deliver in a safe and clean environment.”
Another issue the midwives have to contend with is that of the fear arising from the spread of COVID-19.
“The patients were afraid because they had been told that the hospitals had recorded cases and were potential superspreaders. We had to explain to them until they understood and felt comfortable,” Nkomo said.
According to Parirenyatwa public relations officer Lenos Dhire, “coverage by midwives was greatly affected as some of them tested positive and required long periods to recover. Others were in contact with positive colleagues and relatives and required a number of days in quarantine.”
He said there was a reduction admissions in 2020 compared to 2019.
“There were 11 539 admissions in 2019 compared to 7 985 in 2020. We had a total of 7 609 deliveries in 2019, compared to 6 315 in 2020,” Dhire said.
“In terms of caesarean section deliveries, there was a decline as well. In 2019, there were 2 704 C-section deliveries, but in 2020 during the COVID-19 era, only 2 224 were performed.”
Meanwhile, health stakeholders have expressed discontent over how maternal services were rendered in Zimbabwe.
Citizens Health Watch’s Fungisayi Dube strongly believes maternal and child mortality increased during this period.
She explained that there was no clarity regarding how women should access maternal health services.
“There was no uniformity in services as some facilities completely closed for maternal health services,” she said.