Midwives at the Forefront of the Fight Against Climate Change: The Case of Ijara Sub County Hospital, Garissa

Blog 3 May 2024
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Community efforts to rescue Garissa County Ambulance stranded on a flooded passage between Ijara Sub-county Hospital and Garissa County Referral Hospital/credit: Matthew Ongoro, Nurse Midwife in Garissa

Authors

Irene Nyaoke, Senior Technical Officer - Liverpool School of Tropical Medicine (LSTM) Kenya
Rael Mutai, Regional Technical Advisor- Liverpool School of Tropical Medicine (LSTM) Kenya
Lucy Nyaga, Country Director – Liverpool School of Tropical Medicine (LSTM) Kenya
Martin Eyinda, Technical Officer – Liverpool School of Tropical Medicine (LSTM) Kenya
Onesmus Muchemi, Technical Officer – Liverpool School of Tropical Medicine (LSTM) Kenya
Charles Ameh, Professor Global Health, Head Emergency Obstetric and Quality of Care Unit, Liverpool School of Tropical Medicine (LSTM) United Kingdom

Midwives, with their unique blend of courage and indispensability, play a crucial role in the face of climate change. They provide culturally sensitive health care, serve as leaders in their communities, and act as emergency responders in times of crisis. When disasters such as climate events or conflict strike, midwives are often the first to respond to pregnant women, making them the single most effective way to prevent maternal deaths.

The effects of climate change are not just a distant threat but a real and urgent one to human health. Besides directly causing illness and deaths, climate change also indirectly impacts health by lowering the outcomes of other social determinants of health (WHO framework). Climate-sensitive health risks have a disproportionate impact on vulnerable and disadvantaged populations who often reside in areas with inadequate health infrastructure, making it difficult for them to cope.

The climate crisis carries specific threats for women and girls. Research shows that hotter temperatures can lead to pregnancy complications and can cause or worsen maternal health issues, including premature births and miscarriages.

As we commemorate this year’s International Day of the Midwife on May 5th, under the global theme of Midwives: A Vital Climate Solution, the Midwives Association of Kenya is rallying midwives country-wide under the theme “Sustainable Midwifery Care: Midwives at the Centre of GreenBeginnings.”

Kenya is among the countries most at risk of climate change, and women and girls remain vulnerable to preventable maternal deathschild marriage and gender-based violence.  

Garissa County, located in Kenya’s Northeastern arid and semi-arid lands (ASAL) region and bordering Somalia to the East, is no stranger to the effects of climate change. It is prone to drought, floods, and high temperatures, significantly impacting productivity, incomes, and food security. With the increasing severity of these climate events, the challenges the County faces are only expected to grow. With a population of over 480,000 (2019), Garissa county has only 328 midwives (Source - Garissa County Health Department). Further, the county has a Maternal Mortality Ratio (MMR) of 641 per 100,000 live births (KNBS 2019), almost twice the national average of 355/100,000 live births, underscoring the urgent need for sustainable action. “The county also faces other challenges in regard to nurse midwives including inadequate capacity building, staff attrition, inadequate MNH infrastructure and equipment at health facilities; the uptake for specialisation in midwifery is also very low” reported Fatuma Ibrahim the County Reproductive Health Coordinator for Garissa.

Against this backdrop, the Liverpool School of Tropical Medicine (LSTM), in collaboration with Kenya’s Ministry of Health (MoH), has been implementing Maternal and Newborn Health (MNH) program in Garissa County. Funded by the Takeda CSR program through Global Fund, the program aims to contribute to reducing maternal and perinatal deaths in Garissa (and Kenya) through the capacity strengthening of frontline health care providers, who are predominantly nurse midwives in Emergency Obstetrics and Neonatal Care, Integrated Antenatal and Postnatal care, and Quality of Care (QoC). In addition, 20 health facilities in Garissa received basic essential equipment to facilitate quality care for mothers and babies.

However, these health systems strengthening efforts are being undermined by climate change effects, including flooding, which disrupts transport systems and bars mothers and babies from accessing the lifesaving care they need.

I had escorted a post-partum mother to Garissa County Referral Hospital located 200 kilometres from my station. The mother of two children had developed chest complications 5 days after discharge from the hospital following a normal birth of a bouncing baby girl.” Matthew Ongoro, a midwife at Ijara Sub-county Hospital in Garissa County, narrates his first-hand experience where the county ambulance (see picture below) in which he was travelling was stranded for hours due to floods that had caused the seasonal roads to become impassable (see photo at the top).

In his eleven-year experience working in Garissa, Matthew Ongoro has seen these scenarios of flooding become more frequent, an incidence he attributes to the negative effects of climate change on the environment. 

“Besides affecting efficient patient referrals between hospitals, the flooding has often rendered roads impassable and communities completely cut- off from the hospital for long periods, even months. In the case of obstetric emergencies, mothers are not able to access health care, which can result in fatal outcomes for mothers, babies or even both increasing maternal and perinatal mortalities,” adds Matthew Ongoro.  

Mitigating the Effects of Climate Change

Tree planting is one of the simplest and most effective ways of addressing climate change. The County Government of Garissa is cognisant of the risks of climate. It has led several initiatives in the county to mitigate the impact of climate change on the livelihoods of the people (including midwives). In November 2023, Kenya observed a public holiday dedicated to planting trees nationwide. Garissa County, led by the Office of the County Commander, participated in a widespread tree planting exercise, an initiative by the Presidential Programme for the Accelerated Restoration of Forests and Rangelands to plant 15 billion trees in Kenya by 2032.

“Yes, Ijara Subcounty Hospital staff actively participated in the tree planting activity. Starting from the Office of the Deputy County Commander (DCC), we planted over 100 trees in just one day, including at the hospital and in residences,” recalls midwife Matthew Ongoro, who is also an award-winner of the 2023 Best EmONC Mentor in Garissa County.

 Staff of Ijara Subcounty Hospital in Garissa plant trees along the hospital fence during the national tree-planting day in November 2023/credit: Matthew Ongoro, Nurse Midwife in Garissa

Investment in the midwifery workforce has been shown to yield significant returns in terms of improved health and social outcomes. For example, a recent study concluded that universal coverage of midwife-delivered interventions would reduce mortality rates by two-thirds. This translates to 1.2 million lives saved annually by 2035 in the ESA region.

Midwives are the primary healthcare providers for mothers and newborns, and they are critical in averting a significant proportion of maternal and perinatal deaths (Lancet Global Health 2020). They are societal role models and influencers who can advocate for a safer and sustainable environment; thus, midwives are a vital climate solution.

As we mark the 2024 International Day Of The Midwife, LSTM Kenya honours and appreciates midwives in Kenya and around the world and calls on the government and all stakeholders to urgently invest in creating an environment that enables midwives to do their important work by establishing pathways to quality education, providing necessary resources, and empowering them to act as full partners across health systems everywhere.

Follow the conversation online #MidwivesAndClimate and #IDM2024