The maternity award in a rural health unit

Written by Harriet Howells 

I volunteered within the rural health unit (RHU) each day. This is open 24 hours a day and works like a general practice, but also has organised sessions such as TB and vaccination clinics which run once a week. There is also a small maternity ward. The Head of the RHU told us of what she believed to be the most significant health challenges in the area, among the list was teenage pregnancy. Young mothers often experience birthing complications meaning that maternal deaths are more common for teenagers. Furthermore, younger first-time mothers often go on to have larger families which can be difficult to support, particularly in fishing villages, where food availability often relies on the catch of the fishermen. Unfortunately, much larger competing fishing vessels mean that local fishermen are finding this hard to achieve. A smaller catch means that less is able to be kept by the fishermen as a larger percentage must be sold to get by.

It is not uncommon for mothers who have moved away for work, often to Manilla where they find domestic jobs, to travel all the way back to their village to deliver at the local RHU. Despite there being many larger and more modern hospitals in the city these women come back so that they can give birth with the help of their mother. However, I was told by the midwives that they try to avoid family from entering the delivery room as they often try to take over, thinking that they know best. I witnessed the value and respect that pregnant daughters have for their mother’s opinions when I met a woman who had just given birth and did not want to have any more children however, she would not have a coil fitted as her mother did not agree with this. She continued to decline despite nurses encouraging other forms of contraception. The nurses explained that she will likely have several more children and that this will be common as long as older generations continue to have these beliefs. Unfortunately, the combination of large families and low income often means that illnesses such as pneumonia and TB are commonly seen in the RHU.

In the back yard of the RHU there was a tall mound of bricks and crumbled concrete next to a homely, white building with red windows. However, the windows were smashed and there were holes in the roof. I was told that the building had been left derelict after it had been damaged beyond use by a typhoon several years ago. It had once been the maternity ward, and offered a safe place for women to stay for several nights before and during labour. Lack of funding means that it can take several years for the damage to be fixed, by which time there will probably be more damage by subsequent typhoons.

maternityward1

Damage by typhoons is a common problem to infrastructure

A small room that had previously been used as the TB clinic now acts as the maternity ward and the TB clinic is now held within the corridor, without any privacy. However, after sitting in a few clinics within the corridor, there did not seem to be much concern with this. People willingly spoke about what I considered intimate problems in front of the queue of patients waiting behind. One man admitted to drinking alcohol daily and the doctor involved the waiting patients in his consultation, asking what they thought of it! Everyone laughed and he was encouraged to stop. I could not help but wonder what the patient was thinking at this time and the light heartedness of the situation made it hard for me to believe that he understood the true risks to his alcohol intake.

The TB clinic at the Rural Health Unit

There are two beds in the maternity ward and a third is kept in storage to be retrieved when needed. Opposite the beds are a set of sliding, frosted glass doors that connect the ward to the delivery room. Like the maternity ward, the delivery room has also been moved from the back of the hospital following weather damage.

Maternityward4.JPG

The original delivery room windows are boarded up and the room is unusable

The new delivery room has two couches, similar to those seen in general practices. Next to these is a large medicine cabinet holding medications needed during birth however, I later found out that pain relief was not included amongst these. There was an incubator in the far corner with posters instructing what to do in emergency scenarios above. Compared to a maternity theatre in the United Kingdom this was extremely basic. However, this was the main maternity ward for several surrounding barangays (villages) and if birthing complications arise, mothers must travel by tricycle to the nearest hospital. There were holes in the ceiling and the rain pours in when it starts, however the work doesn’t stop. The staff were proud of the RHU and were always happy and enthusiastic. It was humbling to witness two births, but I could not help but think how I would feel in the mother’s position after having witnessed the privileges the National Health Service in the United Kingdom offers.