November 16, 2016

Field Notes: Giving Birth in Togo


Below are field notes from our Maternal and Child Health Program Coordinator, Pernille Hoej. She writes candidly about her encounter with a pregnant woman in one of HTH’s rural sites. The story she tells is both harrowing and hopeful and illustrates the lifesaving nature of Hope Through Health’s work.

When I was significantly younger for a brief moment I considered becoming an ambulance doctor. The excitement of working in an environment with blood and blue lights, where two days are never the same, attracted me a lot. In the end, six years of medical school with subsequent specialization attracted me much less. Luckily, with the job I have today, no two days are the same. Though some days are better than others.

One day I was in the village of Sarakawa for a supervision visit with two regional and district representatives of the Togolese Ministry of Health. We were visiting the Sarakawa health center that serves a population of about 6,000 people with only five staff members. As we were about to leave, we saw a young woman in labor waiting on the steps outside the health center. Her labor had been advancing too slowly and the fetus was in distress. The birth attendant referred her to the regional hospital and the woman was waiting for the local motorcycle taxi to take her there. Since our team had traveled by car, we quickly decided to end our meeting and take the woman by car directly to the regional hospital.

The laboring, 18-year old woman was placed in the back of the car with her elderly mother. They sat among bags of yams and a live chicken, obligatory gifts to the city folk from the Sarakawa village chief. After an hour on dusty, bumpy roads the car stopped in front of the maternity ward of the regional hospital. In the ward it quickly became clear that the woman needed a cesarean – her water had broken and she had started to bleed. A midwife’s assistant stared at us blankly as she told us there was no midwife or doctor available to do the procedure. Much to my dismay, we wheeled the woman on a gurney back to the car, loaded her in (along with the Ministry of Health officials!) and sped through town towards a second regional hospital in the area. At the second hospital we ran into a new issue: the staff necessary were available but they did not have the equipment and medicine necessary to perform a cesarean. The midwife performed a quick ultrasound and found that the baby’s heart had stopped beating.

It was with this disheartening news that we left the hospital – the woman had to give birth to her stillborn baby the natural way. I left my colleague at the hospital to comfort the woman and I drove with the Ministry representatives back to the office. I was definitely not in the mood, but there is always work to be done so I crouched over my computer to write a report. Not more than 40 minutes later, my colleague bursts into our office with a huge grin on his face. He is normally always in a good mood – and hardened to the death of children as it unfortunately happens way too often here in Togo—but now he was completely ecstatic. He explained to me why: the woman had given birth naturally, to a boy, and he was alive!

So on this day, we won the battle despite an extremely challenged health system that lacks the infrastructure, human resources and supplies necessary to insure safe deliveries for mothers and babies. I am proud to be part of an organization that fights to improve this challenged health system, and also who shows up for individual moms and babies when they need us.


A road in the village of Sarakawa in northern Togo
A road in the village of Sarakawa in northern Togo