As 20-year-old Susan Boke lies nervously on an examination bed, Jackson Nyanamba, a midwife at Ntimaru Sub-County Hospital, Ntimaru West, Kuria East, Migori County conducts an ultrasound scan of her pregnant belly.
With a tablet in his left hand and a probe in his right, he moves it skilfully, applying just enough pressure upon the enlarged abdomen.
A foetus's body parts flicker in and out of focus with the probe's movements. Suddenly, an image that is unmistakably a baby's face springs up on the screen and the expectant mother's eyes brighten as she smiles.
Boke, a resident of the nearby Siabai village, arrived at the hospital for her regular antenatal clinic (ANC) and got a lot more than she expected - she was able to see her baby and hear its heartbeat.
The scanner, a portable version of the conventional bulky ultrasound machine is made up of a tablet (installed with Lumify software) and a probe (transducer). The device has brought ultrasound services closer to villages.
"I come for clinics because I cannot risk my life and the baby's too: I feel safer coming to the hospital. I will also come when the baby is due for birth," she says. Boke has been told about deaths of pregnant women that have occurred in the village (even before she was born) either before, during or after childbirth. For her, the scan represents assurance and confidence.
"The scan has some sentimental value as well: when a mother is able to see her baby and hear its heartbeat, they feel encouraged to gracefully carry on with the pregnancy journey," says Dr Dan Okoro, an Obstetrician and Gynaecologist (ob-gyn) who also serves as the sexual and reproductive health advisor on Kenya at UNFPA.
In the neighbouring Homa Bay county, a trip from mainland Mbita town to Mfangano island in Lake Victoria takes just about one hour using the ferry.
Sena Level 4 Hospital is Mfangano's premier health facility. Even so, the hospital received its first-ever ultrasound scan machine in April 2021.
"The hand-held device is a primary health tool," says Elvis Orimba, the nursing officer in charge at Sena.
"It helps us confirm the pregnancy and gives us the gestational age. The scan also assists us to detect abnormalities that may need medical intervention. For instance, if the foetus has developed spina bifida or macrocephaly (large head)," Orimba says.
Before 2021, all pregnant women in Mfangano - as well as three other neighbouring islands: Takawiri, Ringiti and Remba - would have to travel to better-equipped mainland hospitals for the scan.
Dr Okoro says the ultrasound scan has a variety of functions.
"Critical among them is to pick out abnormalities. Some pregnant mothers have the placenta attached in a way that covers the cervix: we call it placenta praevia. Such a pregnancy cannot be delivered normally. We risk losing mother and baby. The mother has to be referred (in good time) to a facility that can perform a Caesarean Section (CS)," he says.
"The only viable way to detect placenta praevia - or an abnormally placed placenta - is through an ultrasound scan. It is therefore critical in saving a mother's life," Dr Okoro says.
A handful of other scenarios may also call for the use of an ultrasound scan. Kepha Machoka is a Diagnostic Radiographer at Kisii Level 5 Hospital.
He says: "The scan can detect an ectopic pregnancy (when the foetus implants in the fallopian tube and not in the womb). It can also detect if the foetus in the womb is still alive or already dead - a situation that would require a quick response," Dr Okoro says.
For hospitals like Sena - separated by a large body of water from the nearest referral facility - lacking the scan condemned many a woman to death.
"The scan was, therefore, a game changer for us: though there is a lot that still needs to be done," Orimba says.
Sena is among four previously scanless health facilities that received the Lumify portable ultrasound device, funded by United Nations Population Fund (UNFPA).
Amref International University (AIU) provided training and capacity building for 20 midwives - five in each facility - who today operate the devices.
