“Health care is not a privilege, it is a universal human right,” Keturah Adams stated when talking about her passion to provide access to adequate health care to underserved communities in Nigeria. “We don’t chose who we are or what we suffer, and therefore we shouldn’t have to choose whether or not we have to treat it.”
In an interview with the YALI Network, Adams said that, as a child, she was diagnosed with osteomyelitis — inflammation of the bone marrow — in her shoulder. She recalls that she underwent a series a surgeries — “too many to count” — that left her constantly recovering from or preparing for the next procedure. She felt fortunate to have come from a privileged background that allowed her family to afford the health care needed. However, she was ostracized because of her illness, unable to play with her schoolmates because she was viewed as being too fragile.
Adams says that during this time in her childhood she related to people who were marginalized and ostracized in impoverished communities. “Every day I think about a child in the slum who, just like me, is diagnosed with a health condition,” she says. Because they don’t have access to quality health care, “he or she ends up paying with their life. Worst still is watching the underserved lose their lives from minor preventable causes such as malaria, malnutrition, diarrhea, etc.” Her childhood experiences inspire the work she does today at Kabash Love Foundation, which focuses on ensuring a safe environment and overall well-being of women, children and youth.
Securing safe and infection-free births
“Some cultures have traditions for childbirth — either women have babies by themselves or at home without the necessary technology and materials that ensure a safe and sanitary birth,” Keturah explains. She continues to say that infection is one of the major causes of child mortality, with 80 percent of maternal infant mortality rate due to infections, and a major source of infection is via the umbilical cord.
Knowing that changing the cultural mindset of people in rural villages was unlikely, she decided to take a different approach: meeting in the middle and utilizing the traditional birth attendants (TBAs) – women who have little or no medical training yet provide the care during delivery.
Much of her success was due to the methodical approach and research she conducted, not only about the problem, but about possible solutions. First, she searched for information about health issues through the government and by touring primary health facilities to get a better understanding of possible solutions.
Keturah and her team took a data sample of 1,000 people in 25 camps and talked to TBAs. Many of the women she spoke with in the camps were internally displaced and didn’t have enough money for decent care or medical supplies. She trained women on best practices for general hygiene, environmental sanitation, and procedures for cutting umbilical cords. She also distributed birthing kits, which included gloves, clamps for preparing to cut the umbilical cord, a liquid extractor and an antibiotic gel – supplies that help to prevent infections in newborns.
Team members conducted a performance-based assessment – trials on how to distribute best practices and materials to find out what worked and what could be improved – before creating a system for distributing their care packages. This approach was critical for reaching women in rural villages, Keturah says. The process required frequent meetings and check-ins with stakeholders, including employing a variety of methods and listening to feedback from TBAs. She explains a few of their findings:
- For their first method, the team provided pregnant women with instructions to go to hospital to pick up their kits. However, logistically, women could not access hospitals either because of religious reasons or a lack of transportation.
- The team then tried telling TBAs to go to the hospital to retrieve the birthing kits. They discovered that, upon arrival, TBAs were either charged money for the kits or that some of the contents of the kits were missing.
- Once team members established a functional distribution mechanism, they discovered they had to train women on how to use the contents of their kits, and so began their effort to develop instructional materials.
Additionally, when speaking with the TBAs, the team educated them about postpartum care and how to identify warning signs of conditions such as depression and symptoms of hemorrhaging. For treatment, new mothers receive tablets that are preventative or curative measures; women may also be referred to doctors. Through her efforts, Adams has reached about 1,000 mothers and has no record of maternal or infant mortality.
Health care, not wealth care
Adams’ long-term goal is to build the first community-based health center and test a health insurance system scheme that provides people at the bottom of the pyramid with access to health care. She is currently championing the Healthcare Not Wealthcare campaign, which seeks to ensure free first aid by hospitals and clinics in emergency cases.
In her mind, it’s also a matter of economics. Adams says, “for any economy to grow, there needs to be health care… that is the first step.” She adds that in Nigeria alone 158 million people, or 79 percent of its citizens, don’t have access to health care or insurance.
Some of the challenges she sees when it comes to health communications – and, specifically, providing free health care in rural communities – is notifying people in advance when health providers are available.
Keturah Adams, a 2017 Mandela Washington Fellow from Nigeria, has more than six years’ experience in community development. As founder of the Kabash Love Foundation, she focuses on ensuring