Long distance from care means nearness to death

Pwani Oil's Detrex Brand Manager, Evah Kariuki, hands a gift hamper to Pauline Mukei, a new mom at the Machakos Level 5 Maternity Ward [Jenipher Wachie, Standard] In the steep, misty hills of Mount Elgon in Bungoma County, Mary Amoit went into labour knowing that help was far away. Her home, like many in the region, was hours from a functioning hospital. When complications arose, her relatives scrambled to find a way to get her to care. There was no ambulance. They eventually secured a motorbike. By the time Mary arrived at a health facility capable of handling her complications, precious hours had passed. Her baby was born, but did not cry. "They told us the baby had not breathed," a relative said softly. "We just stood there." Mary survived. Her child did not. Far across the county in Bumula, John Ekai still remembers the night his wife went into labour. "She was strong. We thought everything would be fine,'' he said. But complications came. There was no nearby facility equipped for emergencies, and transport was nearly impossible. By the time they arrived, it was too late. "She was bleeding too much. They tried, but we lost her,'' John said. Now John must care for their children alone, explaining a mother's absence in ways he struggles to find words for. "I don't know how to explain it to them, they keep asking where their mother is,'' he stammered. These are the human faces behind Kenya's staggering maternal death statistics. At least 15 mothers and 92 newborns die daily, mostly from preventable causes. The causes are well documented: postpartum haemorrhage, hypertensive disorders, infections, prematurity, birth asphyxia, and delays in accessing timely care. "The problem is not that we don't know what to do, the problem is that the care is not always available when it is needed,'' said Edward Serem, the head of the division of Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) in the Ministry of Health. A 2024 national assessment found only 37 per cent of facilities fully meet basic emergency obstetric and newborn care standards. Many lack blood, oxygen, or essential drugs. Staffing shortages mean that sometimes only one provider is on duty in maternity wards. "You can arrive at a hospital and still not be safe," Serem said. And yet, even within the same health system, outcomes can be dramatically different. In Kavonge village in Makueni County, Jackline Kioko's story stands as a testament to progress. Jackline had previously given birth four times, each delivery complicated by severe postpartum bleeding that required transfusions. As she prepared for her fifth child, anxiety weighed heavily on her. "I was always scared. I thought maybe this time I would not make it," she said. Her midwife, Stephen, knew her history. He prepared the maternity ward carefully, ensuring all necessary supplies were ready. When Jackline gave birth to a healthy baby boy, he administered heat-stable carbetocin (HSC) within the first minute, a critical intervention for preventing postpartum hemorrhage. This time, the bleeding was minimal. Jackline did not need a transfusion. She did not feel weak or dizzy. She simply held her baby. "It was different. I could finally enjoy my child without fear," she said. Jackline's experience is part of a broader effort by the Accelerating Measurable Progress and Leveraging Postpartum Haemorrhage Impact Project (AMPLI PPHI), which introduced HSC as a key intervention in Kenya. In facilities like Sultan Hamud, health workers have nicknamed the drug "Kausha," Swahili for "the dryer," because of its effectiveness. Even maternity ward cleaners notice the difference. "I used to help mothers to the toilet because they were dizzy from heavy bleeding, and then clean blood from the floor. Since HSC was introduced, the floors have stayed dry. My work is much easier,'' said Josephine, a support staff member. Njeri Nyamu, a project director at Jhpiego, said that by 2025, Kenya Medical Supplies Authority had procured 720,000 doses, with all 47 counties placing orders. Costs dropped from Sh2,700 to Sh 95 per dose, making the drug accessible across public facilities. ''Further government investments totalling $78 million (Sh10 billion) aim to procure additional maternal and newborn health commodities, train providers, and expand the programme to priority counties,'' Nyamu said. These interventions are part of Kenya's RMNCAH+N Investment Case (2025-2029), valued at Sh460 billion ($3.54 billion), focusing on equity, quality, and accountability. If fully implemented, projections suggest thousands of maternal and newborn lives could be saved by 2030. For Mary in Mount Elgon and John in Bungoma, the solutions arrive too late. For Jackline in Makueni, they arrived just in time. She rocks her newborn son gently, her smile faint but unburdened by fear. Her story shows what is possible when innovation, collaboration, and government leadership align. Until every woman has access to timely, skilled, and fully equipped care, the human cost will continue.

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