Paulo is going to conceive an offspring for the fourth time in the most fundamental healing center conditions possible. The dispensary is made out of two unassuming square structures in a jacaranda brush most of the way up a slope. While the staff will put forth a valiant effort, Paulo will get no agony help, no fetal observing and no therapeutic mediations. The absence of specialists implies cesarean areas are not performed here.
Without water, the conveyance room can’t be legitimately cleaned between conveyances, of which there are a few every day. Tanzania has made incredible walks in bringing down newborn child mortality lately, yet its rate is still relatively high. While just 3.6 out of 1,000 British infants will bite the dust before their first birthday celebration, in Tanzania that number is 51. One noteworthy reason is the predominance of bacterial contamination and sepsis.
Each morning, staff at the clinic buy 20 jerry cans of water from a local vendor for 500 shillings (about 16p) each, for basic cleaning. The money comes out of their own pockets, which is significant for nurses who earn less than £200 a month. Because of this, pregnant women are required to arrive with their own water.
Paulo’s water sits in the birthing room – three large vats of murky liquid purchased from a shallow well near her house an hour’s walk away.
The water in these buckets will sterilise any implements used in her birth and make the sweet tea she will drink in the late stages of labour. Finally, it will be used to hand-wash the bloodied linens and rubber sheet on which she gave birth. A new mother cannot be discharged until she or her relative has done so.
Paulo’s experience is very much the norm. In Tanzania, only 44% of healthcare facilities that deliver babies have access to water, decent toilets and hand-washing with soap. Of these, only 24% have these facilities in the delivery room. The situation is similar across the region, with 42% of healthcare centers in sub-Saharan Africa having no water source within 500 metes.
By 8am each day, the dispensary’s open-air waiting area is packed with mothers, pregnant women and infants, most of whom have walked miles to get here. This is an area known for foreign-owned gold mines. What little employment there is here is back-breaking and poorly paid. Although healthcare is free in Tanzania, patients have to buy their own drugs.
The medical staff at the dispensary – three registered nurse/midwives, two trainee nurses, an office manager and a lab technician – are clearly overworked. Clad in white smocks, they rush about with clipboards, weighing and immunizing dozens of babies, testing sick patients for malaria, tuberculosis and HIV, often working 24-hour shifts for no overtime, trying to get ahead of the stream of patients, which can number 500 a day.
In the birthing room, Pendo, 27, has just given birth to a healthy son called Amos. She lives in a village 10 miles away and went into labour in the middle of the night. She set off for the dispensary with her “aunty” (her mother-in-law’s youngest sister) on a motorbike taxi at first light. After 20 minutes, she felt the need to push and told the driver to stop. Pendo then lay down by the side of the road and gave birth to her son. Her aunt cut the cord with a razor blade from her bag. Pendo and her aunty, with Amos in a bundle, then got back on the bike and drove the rest of the way to the dispensary. When they arrived, the midwife put a clip on the umbilical stump. That was about an hour ago. Now Pendo is resting under a white sheet while her aunt, who wears a Chelsea FC T-shirt and a traditional kitenge wrap skirt, cradles the baby.
Asked if Amos has been bathed, Pendo shakes her head. They will do it at home later. “We didn’t have time to get water,” she says.
Childbirth without water is unpleasant for all the obvious reasons but it’s also dangerous. If a labouring woman comes in without her jerry cans and needs an episiotomy, for instance, the midwives must simply wipe down the instruments with bleach, instead of sterilising before cutting. The same goes for the scissors used to cut the umbilical cord.