When Dr. Abubakar Baasba was in university studying to become an obstetrician and gynecologist, he and several of his colleagues saw a television program about maternal mortality in Abubakar’s hometown of Lamu, Kenya. Abubakar says that the television program served as a wake-up call for him and his colleagues. “We said, ‘Hey, guys, let’s form an organization and let’s see how we can help,’” Abubakar recalls.
So they founded Lamu Against Maternal Mortality (LAMAM). LAMAM incorporates conventional medicine with traditional beliefs and practices to improve maternal and child health care in Lamu. Specifically, the group focuses on educating expectant mothers and upgrading the skills of traditional birth attendants, who help deliver about two-thirds of Lamu’s babies.
“There is a need for collaboration between medical personnel, the community and traditional birth attendants … because all of these are important, key role-players in our community in the provision of reproductive health services,” Abubakar says.
LAMAM trains traditional birth attendants to recognize signs of danger or complications in pregnancy and to help provide nutritional advice to expectant mothers. The organization also combats misinformation in the community, such as the myth that some pregnancies can last for multiple years.
The most important thing LAMAM has achieved, according to Abubakar, is gaining the community’s trust. It helps that Abubakar is from Lamu, so he is not seen as an outsider. It also helps that the organization works closely with village elders and traditional birth attendants to improve the quality of maternal health care in the community.
Going forward, Abubakar hopes to involve more of Lamu’s men in the conversation about maternal health. As he says, “Everyone needs to be responsible in issues of maternal and child health care in our community.”
You can hear Abubakar talk about his work with LAMAM by listening to the YALI Voices podcast or reading the transcript below.
Dr. Baasba serves as a general practitioner and hopes to soon start a post graduate program in Obstetrics and Gynecology.
U.S. DEPARTMENT OF STATE
YALI Voices Podcast: Dr. Abubakar Baasba
DR. ABUBAKAR BAASBA: My name is Abubakar Baasba. I am a medical doctor who started as a clinical officer currently working in Nakuru Provincial General Hospital as a medical officer intern. I’m also a founder of community initiative called LAMAM that stand for Lamu Against Maternal Mortality, which tend to incorporate conventional medicine with traditional beliefs and practices to improve maternal and child health care.
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VOICEOVER: Welcome to the YALI Voices podcast, your home for sharing the best stories from the Young African Leaders Initiative Network. Be sure to subscribe to the YALI Voices podcast and visit yali.lab.dev.getusinfo.com to stay up to date on all things YALI.
It took Dr. Abubakar Baasba a few years before he found what he calls his passion in life. Having initially trained as an electrical engineer, he soon realized that this was not where his heart was; he wanted to help people. So he trained as a medical clinical officer in his native Kenya. And after working in the maternity ward of his local hospital, he decided that there was even more he should be doing. So he started over again, and now he is a practicing obstetrician and gynecologist.
Born and raised in Lamu, he was inspired to confront the challenges facing pregnant women in his rural community and to get them the resources they need for healthy pregnancies and safer deliveries. So together with four colleagues, he created Lamu Against Maternal Mortality, or LAMAM. LAMAM’s primary aim is to educate expectant mothers. LAMAM is equally committed to raising the skill level of traditional birth attendants, or TBAs, which is the preferred choice for many mothers in his community when it’s time to give birth.
Abubakar sees his role as not just a physician, but as an advocate for his patients and his community.
Here now, our conversation with Dr. Abubakar Baasba.
DR. BAASBA: This is the main reason why I’m doing this: It’s because the level of education on health service is poor, especially where I was born and brought up. That is Lamu. You will find that 67 percent of pregnant woman prefers to deliver at home by an unskilled person, who are not formally educated. That is traditional birth attendants. They cannot identify danger signs; they bring patient when it is too late for us to help. They are doing remarkable job because sometimes you get villages where we don’t have nurses, so there is no one to help them — so if we say we are not going to have these traditional birth attendants, I think it will not be ideal because they are doing remarkable job. With the village we don’t have nurses, and these are the people who are helping our mothers there.
However, there is a lot that need to be done. There is a need of collaboration between medical personnel, community and traditional birth attendants to work together, because all of these are important, key role-players in our community, in provision of reproductive health service. Just yesterday my wife called me and said that one of the traditional birth attendant … and she’s a medical student by the way, that traditional birth attendants say I should do this and this and that, for me to get this and this and that, so what do you think? I told her it’s your choice, so just decide what you want because I know they also play important role in your life, in our life as a community. So the level of education on provision of health service is poor, and that’s why despite that I’m a doctor I go back to the community, I teach them, I make them understand the importance of having collaboration between medical personnel and the community. I teach them the importance of the big books they see in the facility, they are not just for recording. These are the records that will be taken back to the government, and the government will use this record for them to decide which equipments to bring to that facility.
I make them understand all that. I make them understand by them going to the facility it is what will make what is their need and by that it is what will make the government to decide on what to bring to that facility. So if we are not going to deliver in the hospital there is no way the hospital will be upgraded. If we have few numbers of people going to seek medical service, there is no way that the government will consider doing that. We as an advocate for rights of reproductive health service, we people who wants to make sure that our mothers get health services including reproductive health service to them, which is entitled in the constitution that it is achieved and we have strong evidence to prove that these people need it. So health education is poor, health awareness on what they need is poor, and that is why we form this organization.
DR. BAASBA: If you ask me what is our best or the most important thing that we have achieved as LAMAM is the trust from the community. If you ask for numbers, I will not give you big numbers. If you ask for good statistic, I will not give you, because there is no way I can measure the trust. But we can feel the trust that the community have with us, and we did not start this thing just yesterday; we had this idea in 2013, and we formed the organization in January 2014. All that time up to now we’re still building the trust, and now community kinda trust us in whatever we are telling them. We were able to obtain this trust because we are recognizing our … ’cause I’m born there in Lamu. I will not be surprised if my mum has been delivered by a traditional birth attendant. I will not at all be surprised for that. So we are using our own traditional belief to make sure that we improve our practice. So considering that, we are recognizing the fact that traditional birth attendants play an important part in our society. We are not kind of person who says that these people are killing our mothers, ’cause they don’t.
Even in hospital sometime we get maternal death. But the issue is that they are not empowered with the skills, with the ways on identifying danger signs, you see, all those things early enough for them to do that. So we kinda get the TBAs on board, get what we call, I think it’s abaya. Abaya is like the most — I miss the English word, but most recognized, most vocal women in the community — get to explain to them why we are doing this. We got religious leaders on board get to them to know why it is important for us to do this and without forgetting the area chief like we have a very active and robust chief area in Pate, who really helps us a lot in these issues. We even use his office to make agreements between the health workers and the traditional birth attendants on how they can collaborate and work with each other to improve maternal and child health care. The best person to do this, I think everyone is the best person to do this. Everyone needs to be responsible in issues of maternal and child health care. In our community, if we can have combination of both men and women because this is something else that men tends to be far away from, issues of maternal services.
You know, everyone knows that when you’re pregnant this is now I’m going to deliver is a period of joy. But it’s not that feelings in Lamu. When you’re pregnant you’ll find that the community comes and surround the house or … How is the going? Is everything okay? Is she fine? How is the child? You see that feeling of joy comes when the child is out, but not anyone now get the chance to enjoy that feeling of joy. Yes and when we were doing our own assessment we found that most of the household, most of them — I don’t have percentage, I don’t have record — but anytime when you go to the house you won’t miss a mother who has had stillbirth, be it fresh stillbirth or macerated stillbirth, you will always find that, and cerebral palsy is very common.
DR. BAASBA: Lamu Against Maternal Mortality, we started it in … we had the idea in October 2013 and ideas that four of my colleague. So we just sat in my room with double deckers, we didn’t have even good table, so we just sat on the floor, start talking about it. Hey guys, we saw this clip, we know there was a clip, a program from KTN, so it was just like a wake-up call: Guys, there is this problem. I really thank KTN for that. But we knew there was this problem, but we were not doing anything. So, guys, yesterday we saw this program, so what do you think about it? We just started to chat about it and then here comes, LAMAM was delivered. We said, Hey guys, let’s form an organization and let’s see how we can help. That’s what we started. We didn’t know where to start, how to start, what to do. We didn’t know. So let’s just form LAMAM, then let’s see what we can do about it.
So in January 2014 we got registered by the Ministry of Gender and Social Service and now what we decided now, now we have our child, we need to make him breathe now. Because already delivered so we need to make him breathe. So what we did we said we need to find out is he breathing? So we went to the community, we did assessment, we got to interact with the TBAs, we got to interact with the community, we got to interact with the religious leaders, just to kinda get the feeling of what is going on. We put — I can remember one of my favorite discussion we had is we decided let’s put both the health workers and the traditional birth attendants and the village elders and the chief together, now let’s discuss. It was really interesting. We got really interesting points and after getting to know exactly that one of the major reasons is there is poor health service seeking behavior among our community, and very few people are doing something about it to bring the community and health workers together. And an idea came that we need to do something so that we get these people together.
So one of the project that we are doing currently is to improve collaboration between traditional birth attendants and health workers. So we provide trainings to the traditional birth attendants to transform them from traditional birth attendants to birth companion. So we’ve created kind of a curriculum or a program on what you are going to teach them putting in mind the traditional belief but also, importantly, the policies that we have for maternal and child health service in our government. So we make them to be agent of referrals. So we teach them on danger signs, for example. We teach them when they get someone who is pregnant, even if it’s two months, one month pregnant, they should bring to the hospital. We teach them on how to … what to do when they bring the patient to hospital, be it during antenatal period, during delivery, what they need to do with the mother in the delivery room. We teach them on what to do after the delivery.
The first one is agent of referral, now the second one is nutritional advocate. There are lot of beliefs on what a mother can eat or should eat when they are pregnant. So we make them understand that there are things that the mother needs to have. A complete triangle nutrition, I’ve forgotten its name. The important things that a mother should have.
As a nutrition advocate, we also teach them on how to breastfeed the position the mother. So we use them to teach the mothers on how to breastfeed and what have you. We also teach them to be hygiene promoters. We teach them on waste disposal, how to keep the house clean, cord care for the child, ’cause neonatal sepsis is one of the major thing that we have and it all starts from the cord.
DR. BAASBA: Changing people, it’s really one of the most difficult thing, but if people don’t want it then it will be useless to have all that. So changing people is really difficult, but I think the model that we have used is we are not changing them. We are improving their lives and we are making them understand the difficult that mothers go through when they are pregnant. And using facts. Being born there knowing how people are when they are pregnant, the worries that they usually, the community, get when someone is pregnant. We used to explain to them that this is not a time for us to be in sorrow or to be sad, this is time for us to celebrate. It’s a time for us to know that somebody is coming, this somebody may do something to this community. So we’re not trying to change them, we are trying to improve them, we’re trying to make them know that there are some things we need to do for us to improve the lives of the pregnant mothers in our community.
There are some things we need to avoid or continue for us to improve the mother’s life. A good example of something that they need to continue as our tradition. Once you deliver, usually we have what we call mkandaj. Mkandaji is someone who does massage. So this thing really helps in protecting thrombi formation. After delivery we have DVT, deep venous thrombosis, one of the major thing that can occur after delivery. But to prevent it you need to walk, you need to massage, you need to exercise, you see? So usually our community do a full body massage after delivery, from the head, actually from the hair to the toe. ’Cause it start with the hair, move around the hair and what have you. Then they go down the whole body, our mothers get massage. That prevents from DVT, deep venous thrombosis. So we cannot say that this is traditional belief, it’s something … it’s past so we need to stop it. No, we don’t look at that, we look at things that will improve the community. So we are not changing the community here, what we are doing is we’re improving the lives of pregnant mothers and the children in our community.
DR. BAASBA: We get so many challenges when we are communicating because the level of education is somehow low and we are working with traditional birth attendants, who most of them have not gone into education or the formal education system and most of them are usually old. So they did not even go to school, most of them. So it becomes really difficult sometime to get them to understand. Let me give practical example that we get. You know, nowadays people use research, use statistic, use numbers to show how good or bad things are. So it is really difficult for us to use statistic to make people understand that this is how the situation is. It is very difficult for us to make people understand that a single maternal death is nothing simple. It’s not just one maternal death, it’s something major and somebody who has been, has gone through education knows the meaning of maternal mortality rate will be easier for them to put that into their mind and come up with something that make them understand that yeah, this is difficult.
However we don’t need to use numbers, you know. We can use the stories that we have. We can use the good and bad stories that we have, and luckily we were born there so we make use of our own native language to explain to them the stories, to explain to them that one maternal death is not just one.
Everybody knows that pregnancy takes nine months, but I can tell you for fact in Lamu, we’ve got mothers, two of them when we were doing our assessment in different areas, one believed to be pregnant for 11 years — that’s the level of illiteracy that we have — sorry, illiteracy sounds bad — level of low education in health service that we have, and another one that we successfully helped her, who believed to be pregnant for seven years. So we made her understand, luckily we had traditional birth attendants there who talked to her, explained to her that this is not pregnancy and later I can show you the picture of the huge fibroid we removed. Yeah. So they believe to be pregnant because the abdomen is distended so they think this is a child inside, but unfortunately it’s not a child, it’s a fibroid.
Some of the ideas that we have is exactly what we are doing to improve the health service. Incorporating traditional belief to the conventional medicine. I understand that current policies, it’s illegal for the traditional birth attendants to conduct deliveries. I think if we will … if we can incorporate them into whatever we are doing in whichever way possible, it will really help. Personally I wish if we could have policies that will upgrade these traditional birth attendants to be more equipped with current skills and current delivery skills, skills on identifying danger signs, like use of partograph in whichever simple way we can make it. So incorporating traditional belief with conventional medicine — I think that is the best thing that we can do to get these mothers’ health improved. Putting … avoiding our traditional belief will make it really, really difficult for us to achieve.
So we’ll start with Lamu and then slowly grow and, to be exact, we will still continue, strengthen, using the experience that I have, the project that we’re doing. So we will continue with empowering or either transforming traditional birth attendants to become birth companions, we will continue with our mobile reproductive and antenatal care service, we will strengthen and get better ways to do it because we were not doing it in the ideal way. But the experience and the training has really helped me a lot.
VOICEOVER: We hope you’ve enjoyed hearing from Dr. Abubakar Baasba, YALI Network member from Lamu, Kenya. Abubakar has big plans for mothers in Kenya. He hopes someday to be able to build a state-of-the-art maternal and child health center in Kenya that will give expectant mothers and their new babies the best chance at survival.
Thanks, Abubakar, and thank you for listening.
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