ESTABLISHING A MODEL MATERNITY UNIT AT BOMANI DISPENSARY
A PROJECT OF THE ROTARY CLUBS OF MTWAPA, KILIFI COUNTY, AND BAHARI MOMBASA, KENYA
Founded in 1995, the Bomani-Malde Dispensary is located at the centre of the rural community of Bomani on an approximately 2.5-acre community parcel with perimeter fence. Having started as a community, not-for-profit clinic, the dispensary is now governed by the County of Kilifi. The dispensary is well embedded in the local community. Close co-operation and association exists between the dispensary and the nearby North Coast Medical Training College in the fields of knowledge transfer, equipment and personnel. Both preventive and curative healthcare are offered to the local economically-challenged population. The present focus areas of healthcare at the Dispensary are: family Planning, HIV-care, malaria, chronic diseases, especially diabetes and hypertension, as well as immunizations and maternity care. The Dispensary has a permanent staff of four medical and 3 support personnel; it also works through a group of community health volunteers, it is supported regularly by a group of Dutch doctors. The Bomani Dispensary provides low-threshold care in a very authentic and poor region of Kenya.
PRESENT MATERNITY CARE
Although Bomani Dispensary provides antenatal care and mother-and-child care for many women in the vicinity, care during labour and delivery is barely provided for due to lack of proper facilities and equipment. Kenya ranks among the countries with the highest maternal mortality rates in the world; currently around 500 maternal deaths per 100,000 newborns - about 50 times higher than in many Western countries. The statistics from Kilifi County are even worse and show about 20-25 women dying every month through pregnancy-related problems in a population of only about 1.2 million. Almost all these deaths are preventable with appropriate care. Contributing to this high mortality rate are:
• The inaccessibility of healthcare facilities during labour and delivery in the vast rural areas.
• Low rates of facility deliveries, even among those who attended antenatal care, and many home deliveries
• Many women dying at home or reporting at the health facility very late and when their unborn babies are already very sick or have died from complications
The African population explosion is very visible in the catchment area of the Dispensary. It doesn't take great effort to see very young women, actually girls (between the ages of 14-18), walking around with a young child on their backs and one in their belly.
Bomani Dispensary provides basic antenatal care (history taking, physical examination and provision of preventive medicine for malaria and anaemia) to many of the women in the locality. However, actual deliveries at the facility are very low considering the need. Approximately 5-6 births/month take place at the facility, whereas there are about 90 deliveries every month in the area. The reason is that due to lack of facilities, proper maternal care during delivery cannot be provided. Most of the women stay at home for the delivery whereas some go to other health centres or hospitals much further away. The few deliveries per month are done in a part of the dispensary that is normally used for giving vaccinations and other injections. In addition, the absence of post-natal facilities forces the dispensary to send women home immediately after delivery. It is impossible to conduct a 24 hour 'watch over woman and child' to prevent post-natal complications from becoming dangerous and life threatening.
It is against this background that the Rotary Clubs of Mtwapa and Bahahri-Mombasa wish to support the Dispensary to improve provision of care during labour and delivery by establishing a model maternity unit at Bomani Dispensary to extend its ability to provide more and proper maternity care with up-to-date, dedicated facilities. Projected maternity care should be realized for at least 25-30 women per month and possibly many more. With this project we intend to support the maternity care expansion by:
• Renovating existing buildings to provide a maternity ward, upgraded toilets, duty staff accommodation and power and water connections.
• Equipping the maternity ward for its task
• Providing refresher and advanced training for existing staff
A draft Rotary Foundation Global Grant proposal (GG1982988 - Establishing a model maternity unit at Bomani-Malde Rural Health Centre) with a projected cost of $66,000 has been submitted to The Rotary Foundation
A community needs assessment has been conducted by the North Coast Medical College which clearly established the need for an enhanced 24/7 maternity provision in this rural area in which the government health funding and provision of doctors is extremely low whilst the perinatal deathrate is extremely high.
Rotarians from the Rotary Club of Mtwapa are closely involved with both North Coast Medical College and Bomani Dispensary on a regular often daily basis whilst Rotarians from Uppingham are regular visitors to the area; both clubs are actively committed to the project and are are currently engaged in fund-raising and final project definition.