Bus fare Babies
Birthworks has special ties to a village in the Peddie district of the Eastern Cape, called Bodium, a village near Hamburg. For many years Karen has wanted to build a rural birth centre in the Eastern Cape that will enable women in the area to give birth to their babies in a safe and comfortable environment near their own villages. The first stage of the birth centre has now begun A.small dwelling in the village of Hamburg has been renovated and to serve as the first birth cottage. Land is still in the process of being purchased for the main site of the birth centre but in the interim, this dwelling will serve for antenatal checkups and for births. The cottage has 2 bedrooms and a small check up room. A bathroom and kitchen / lounge area.
Women from the area can come to the birth centre during their pregnancies for routine check-ups and tests. Women are screened in terms of risk and only low risk women are able to give birth at the birth centre, high risk pregnancies are referred to the appropriate hospital.
In labour, the woman may be collected from her home by a vehicle from the birth centre, or will make her own way to the birth centre where she will stay in one of the birth cottages for her labour and birth and for several days following the birth, until she is feeding her baby well and has recovered and able to cope with her newborn baby at home
Each laboring woman will bring with her 1 or 2 relatives of her choice to support her during her labour, and they may stay with her for the duration of her stay at the birth centre, to look after her, prepare meals for her and help her with the baby.
Initially I am the only attending midwife, and as the need for more midwives grows, more will be employed, preferably from the local community or surrounding areas. Nomvula assists at the birth house. She and I assist during the labour and birth and Nomvula stays with the woman and her baby at the birth house for the duration of her stay
In the event of a complication, the labouring woman or newborn baby are transferred to the appropriate hospital for treatment.
4 Birth Cottages: simple 2 bed roomed cottages, with a bathroom and separate toilet, kitchen and lounge area. Each house would be equipped with all the medical equipment needed for the birthing process: oxygen, suction machine etc
The cottages will be situated a small distance apart from each other, to allow the laboring woman privacy and a home-like environment to give birth in.
To build one birthing cottage. Initially this cottage will serve for antenatal check ups. The cottage will require water and sanitation facilities as well as electricity. There is electricity and piped water along the road through the village of Bodium and the plot is in close proximity to this road.
1 Check-up cottage: Simple 2 bedroomed cottage with bathroom and large lounge area for women to wait in. This could also be used for pregnancy education classes.
Administrative Centre: Office for administration. The building will consist of 2 offices, a lounge area, a toilet and small kitchen.
Vehicle: a vehicle would be part of the birth centre, and would require 2 drivers, from the community who would be on call to collect women in labour as well as to transfer to hospital in the case of an emergency. This would need to be a 4-wheel drive vehicle.
Bus Fare Babies Aims:
- To enable women to have healthy pregnancies by encouraging good diets, by careful monitoring of pregnancies and by early detection and treatment of pregnancy complications.
- To lower the levels of maternal mortality and child mortality in the first year.
- To provide good, quality care in a comfortable environment to the women of Hamburg, Bodium and Bell during their pregnancies, during the labour and birth and in the week following the birth.
- To reduce the incidence of HIV infection in the area by prevention through education, through PMTCT and by promoting safe infant feeding.
- To facilitate the screening process for HIV and to provide anti-retroviral therapy to women in labour to prevent mother to child transmission (we have linked with the Umtha Welanga Health Care Centre). To inform women about and to encourage safe infant feeding.
- To look after women during this special time as they give birth to their babies, to make it a pleasant experience so that they can go into motherhood feeling strong, cared for and empowered after their births.
- To set up an efficient referral network between the Birth Centre and the relevant hospitals for high-risk pregnancies and complications in labour and postnatally.
- To help the government to reach millennium goals 4 (reduce child mortality), 5 (improve maternal health)and 6 (combat HIV/AIDS, malaria and other diseases)
- 2 Drivers
- Cleaning Staff
- Administration Staff
I am Karen Clark, my Xhosa name is Nomzamo, I am 42 years old. My family comes from Cathcart, Eastern Cape, but I was born in Durban and grew up in Pietermaritzburg, Kwa Zulu Natal. I studied Nursing and Midwifery at Carinus Nursing College in Cape Town and qualified as a Nurse and Midwife in 1994, I worked in the U.K for 4 years as a nurse, worked in Khayelitsha at Michael Mapangwana MOU as a midwife and studied a further 18 months to obtain a diploma in Advanced Midwifery through Napier University in Edinburgh, Scotland. I then worked a further 2 years in London hospitals as a midwife. I have been working as an independent midwife for 8 years.
My husband, Garvey, is a coffee roaster and we have 2 children. Our first-born is Kei, a boy, aged 10 and our second born is Che, a girl, aged 8.
The idea of building a rural Birth Centre first came to me in 1993 whilst I was working in Khayelitsha and Guguletu as a student midwife, and it has been in the planning phase ever since. Whilst working in the overcrowded informal settlement, I was struck by how many women moved to the city in order to have their babies. Many of these women came from the rural areas, were very young and had had very little antenatal care during their pregnancies and little or no support through their labours, births and as they became mothers living in overcrowded circumstances.
We have chosen the Hamburg/Bodium/Bell area as the location for a Birth Centre as it is located a reasonable distance from East London, the roads are relatively good and transferring in an emergency situation would be manageable. The Bus Fare Babies Birth Centre is to be located in the village of Bodium 5km inland from Hamburg, which lies at the mouth of the Keiskamma River in the South Eastern corner of Peddie district. This district comprises of 112 widely dispersed rural villages all together.
The Peddie district of Eastern Cape has approximately 100,000 people mostly living in rural villages in an area of approximately 3600 square miles. The rate of unemployment is close to 90% and majority of people live off government grants or old age pensions of grandparents. There is one hospital in the area Nompumelelo in Peddie, this is approximately 60km from where the birth centre will be.
Access to medical facilities in pregnancy and birth is severely restricted by poverty and the inability to travel to sites offering care. Although ambulances do travel to these areas, there can be a 5-6 hour wait for the ambulance to arrive. Such long waiting intervals are a danger to mother and baby at birth.
A letter from a resident of one of the Peddie villages describes why such a centre is needed:
“In 2002 I fall pregnant and I was expecting my child on the 5th of August but I had the baby on the 31st of July unexpectedly.
My husband call an ambulance, early around 5 o’ clock, but the ambulance arrive at 11 o’clock.
It took me to the hospital. At the hospital there were so busy there
with renovations of the old buildings, so the midwifery told me they
going to sent me to East London to the referral hospital, there came
the ambulance took me to the hospital, The first thing in the
ambulance. There were 3 people. 1 lady and two men the lady was
driving. Those two men they were drunk especial the one who was with me
in the back.
Labor pains were serious and he was shouting at me not to deliver my baby. I was expecting twins, one boy and one girl.
I gave birth in the ambulance. One twin came out, the boy.
I think we were not too far from the hospital.
The drunk man cried very loudly and call for the lady to stop to drive to come and help me.
My baby boy was alive and he cried but later stopped, there was no oxygen in the ambulance, my boy died on the way.
When I arrived there, the girl came but I think she was tired. A sister put her in oxygen, I loose the boy I was in need of.
It was the first time for me to have a baby boy. But I loose him, I
will never forget that in my whole life so we really need a safe baby
birth place in our area. Because the hospital is far away.”
HIV and ARV’s
The hospital central to the district has been accredited to supply ARV’s but due to staff shortages and lack of training it is lagging very far behind the need and demand of the population of the district for support and treatment of HIV/AIDS. The ante-natal infection rate is currently 30%.
Linking with the existing government clinics and NGO's in the area, Busfare babies encourages HIV screening for all pregnant women, encourages ARV treatment in pregnancy and appropriate treatment during labor and birth. In the post natal period, mothers and babies are referred back into the existing systems for continued ARV treatment. As their midwife, I advise and support careful and safe infant feeding choices and assist women in the first month of feeding with advise and support.With government clinics now providing ARV treatment, continued care in terms of women who have been diagnosed with HIV during their pregnancies can then be referred to these clinics for treatment postnatally.
Justice Hoffmeyer is an expert on many aspects of obstetrics and is a wealth of knowledge and experience. His presence in Hamburg is also a great asset.
What’s happened so far
The community of Bodium have welcomed this project in their village. Their letter dated 5th September 2007 reads:
RE: Request and agreement
The community of Bodium came to an agreement to request you to please establish a maternity service in our village, which is the neighboring village, the farms around and even Hamburg village.
Reasons for this request:
1. Our village is central to the mentioned village
2. There is no such service in the entire area except the local hospital, which is 50km away.
3. It is very difficult when a woman becomes in labor especially at night there is no transport except for one teacher who in most cases visiting his wife in Grahamstown.
4. Stillbirths are not uncommon, ambulances takes five to six hours to respond.
5. Such a facility could bring relief to the community at all the villages mentioned above.
Hoping for a favorable consideration
Chair person: Mr T. Yona
Secrertary: Mrs Nokwanda Makubalo
Since this time, we have opened a Busfare Babies bank account in South Africa and we have registered as an NPO.
Myself and my family moved to Hamburg in January 2008. The past year has been spent fixing up suitable accommodation for ourselves and trying to arrange a suitable site for the birth centre.
In terms of the site of the Birth Centre, we felt that a 4ha piece of land would be suitable. The community offered land to start the project, we were however advised that in the interest of securing funding, we would have more success if the land was either leases formally for a long-term period or purchased as this would afford the project more security. We have identified an appropriate site in the village and are in the process of purchasing the land required. The community has been involved in the decision of location and have agreed on the proposed site as being suitable. The site is well situated in the village at a walkable distance, and close to the road and will be suitably private for laboring women.
Although the community is impatient for the project to begin.
The securing of land has been a necessary but protracted process and we are awaiting transfer on the afore mentioned piece of land.
Our first requirements of funding will be for the building of a fence around the entire property. This is necessary to keep the meandering cows, goats, sheep and pigs away from the trees and vegetables that will be planted in the vegetable garden that will later feed staff, women and support people that stay at the birth centre.
After fencing the property, we will need to build the first birth cottage.
The village of Bodium has many people skilled in building. traditional dwellings made from mud bricks, wattle and daub and other similar methods have been used for many years. Roofing skills using thatch and zinc are also available. In the building of the birth centre we aim to use affordable and enviromentally friendly building techniques for the building of the birth centre and more sophisticated screeds and finishes. There is little knowledge of plumbing and electricity installation, these skills will need to be sourced from neighbouring towns and hopefully skills workshops will be able to be arranged to allow local artisans to learn these skills.
Plans have changed and in 2010 this first 2 bedroomed birth cottage opened. Antenatal visits were able to be done and births became possible from July 2010. Although I have attended births in the area up until this point, there is a need for a house that has running water and that offers women some privacy which is difficult to find at home where rooms are shared.
Funding and sustainability
In order to make the Birth Centre sustainable, women will be required to pay the cost of their bus fare that they would have had to pay to go to a government hospital in a large city to have their baby at the Birth Centre, hence the name Bus Fare Babies. The majority of funds will be obtained from donations, both nationally and overseas sources.
Once the birth centre is fully operational, we will begin offering courses for midwives and nurses around the country. The NALS (Neonatal Advanced Life Support course) will offer refresher courses for Neonatal resuscitation. And ALSO (Advanced Life Support in Obstetrics) courses for midwives and obstetricians.
We hope to be able to accommodate those attending the courses in cottages near the birth centre. The attendees would then pay for accommodation and course fees all funds of which will go to the birth centre.
Private individuals from outside the area who wish to give birth at the birth centre are welcome, they are required to pay private rates, these fees also go into the birth centre to keep it sustainable.
Bus fare Babies has approached NARM (North American Registry of Midwives) and have obtained accreditation as a clinical facility where student midwives can come for training, as well as being able to train our own rural midwives. Student midwives in the USA have great difficulty obtaining sufficient experience We would aim to also allow local women interested in midwifery to be able to train using the NARM training programme. Foreign midwives coming to work in the centre are required pay for accommodation and training and placements are a minimum of 6 months in length.
The state of birth in the public sector in South Africa is far from ideal. Women are neglected, treated harshly and there is a lack of care and compassion. The majority of women labor alone without friend or family support.
Busfare babies proposes that there is another way. That without excessive cost, women can be cared for gently and their babies welcomed into the world in a safe, soft and nurturing environment. We plan to care for women throughout their pregnancies, as they give birth to their babies and for the early weeks following birth. In South Africa there has been a severe increase in maternal mortality associated with pregnancy in 2005-2007 when compared with 2003-2005. By providing this type of care it is our belief that the statistics that are associated with maternal and child care will be greatly improved for the women that we serve.