Clinging to tradition, Turkana mothers shun maternity clinic

(This story was originally published for Journalism Without Walls on February 1, 2013.)

LORENG’ELUP, Kenya – Joyce Apus, a birth aide from Turkana, sat outside of a clay-colored maternity clinic in this remote village with a child on her lap and her feet in the dirt. It was mid-January 2013, one month shy of the clinic’s first birthday.

The birthing room was empty – no mothers waiting for an epidural, no babies crying – but Apus sat in case someone came.

The newly-built building had only just begun to show wear from the desert sun and the persistent winds of the Great Rift Valley. Four metal bedframes supporting stiff, new green mattresses had been placed in the two rooms; they looked barely used. The birthing chair was covered in a light layer of grey dust.

“This clinic saves mothers,” said Apus, holding her 6-month-old child. She had never been formally trained but was hired with the hopes of encouraging locals to use the clinic.

Still, very few women have come to give birth here. Despite the high risk of death – the death rate of mothers in rural Kenya is approximately 600 per 100,000 live births, three times the global average according to the Health Demographic Surveillance System – the clinic has only seen 11 children born inside its walls. By contrast, a traditional birth attendant from the nearby village of Nachukule claimed to deliver 10 babies per month.

It’s an irony public health officials wrestle with worldwide: medical attention is not eagerly sought in places where people embrace traditional medicine, even when that medicine proves ineffective. In this corner of northern Kenya, between the district capital of Lodwar and Lake Turkana, medical care is hard to come by. People regularly walk hours through 100-degree heat to receive basic care such as stitches or vaccinations. But that determination does not yet extend to maternity care, and the clinic where Apus works has struggled with this obstacle.

“It’s not uncommon for women to feel as if giving birth in a hospital is a sign of weakness,” said a spokesperson for Merlin, a British international health charity that sends aid and doctors to 16 countries worldwide.

Traditionally, women in this area give birth at home, in huts made of dried palm fronds, with little to no help from other women. The women ask for help only if there is a complication or if their homestead has a traditional birth attendant. Even then, a woman is unlikely to seek help. As Wilkista Ebuya Ehkai, a local Turkana mother, put it: “all you need for birth is a razor, some string and a mat.”

“[The Turkana] don’t typically like change even though it’s good for them,” said Dr. Craig Lehmann, dean of the School of Health Technology and Management at Stony Brook University. “They would rather go to the woman they know and is nice to them than someone who comes into the community and tries to change things.”

The challenge according to Lehmann, who has been working to bring medical innovation to rural Kenya for the past five years, is that change cannot be made unless people understand why it is good for them. If they don’t, they will continue doing what they know, such as giving birth at home instead of going to a clinic.

The maternity clinic where Apus spends her days waiting for mothers was built and funded by the Turkana Basin Institute, a research facility co-founded byRichard Leakey and Stony Brook University. The institute also had hopes of implementing programs that would benefit the village of Loreng’elup and a 20-year-old medical dispensary nearby.

The institute built a machine to process goat dung into methane, which would power an electrical generator, a renewable source of energy that would make both the clinic and dispensary self-sufficient. But, according to Acacia Leakey, Richard Leakey’s grand-niece and a manager at the facility, the plan quickly fell apart: the clinic couldn’t get the community to supply the goat dung needed to run the machine.

Then the people hired to run the clinic slowly disappeared. According to Leakey, the clinic recruited a trained nurse from another area of Kenya because it could not find a qualified Turkana woman. But the nurse, who came from a more populated and developed area of the country, would get bored and escape the village for the livelihood of the closest provincial city.

“There was so much effort put into it from [the institute],” said Leakey. “And there was no effort received from the Turkana.”

As the vision began to disintegrate, less people came to the clinic, leaving Apus sitting outside, waiting. With a culture and tradition that has survived for hundreds of years, change does not come as quickly as building a clinic. Still, Apus said she remained hopeful.

“They try birth at home, they bleed, some die,” said Apus. “Then they want to be monitored. They come.”