Tuesday, 7 December 2010


We were fortunate to have Human Rights Watch pay us a visit in November. This visit was part of research that HRW are conducting, looking to examine gaps, challenges and failures in emergency obstetric referrals, as well as health system accountability deficits that contribute to maternal mortality. They are also looking into whether certain groups of women face any specific barriers and whether emergency obstetric care is provided to all women on a non-discriminatory basis.

Their visit was welcomed at the Birth House, where Agnes and Tozama from Human Rights Watch spoke with women from Hamburg village as well as other health care workers. Women spoke about difficulties that they had encountered previously in obtaining transport to hospitals in labour, about having to assist other women in labour as ambulances had failed to arrive, about drunk ambulance staff and tragedies that could have been avoided with better infrastructure in place.

The Busfare Baby concept was discussed and the women were very enthusiastic about the presence of the birth centre and how it is a benefit to the community.

We ended the occasion with a home visit to one of the Busfare Babies who is now 6 months old, and to speak to his mum who knows from personal loss and experience what a difference it can make to have good access to care.

In rural areas many women suffer much loss in and around pregnancy and childbirth and during the first year after birth. Many of the women that I care for have lost a child previously, due to mostly avoidable causes. With HIV affecting at least 30% of the pregnant women in the Hamburg / Bodium area, it is high time we prioritise women and their access to care.
Busfare Babies aims to roll out an effective prevention program and to help to stem the tide of the HIV epidemic in this area, whilst at the same time giving women access to good care particularly during pregnancy and childbirth when it is possible to prevent mother to child transmission of HIV. Women having to wait 8 hours for an ambulance and not having anti retro virals in labour significantly increases the risk of the child contracting HIV.

In the words of Nelson Mandela : "We are all affected by the AIDS pandemic. But more than others, this epidemic carries the face of women. For it is women who bear the most significant burden of HIV and AIDS. As daughters, mothers, sisters, and grandmothers, every day they experience and live out the reality of this epidemic…we must proclaim that the women of Africa cannot continue to bear the burden of HIV and AIDS alone. For every woman and girl violently attacked, we reduce our humanity. For every woman forced into unprotected sex because men demand this, we destroy dignity and pride. Every woman who has to sell her life for sex we condemn to a lifetime in prison. For every moment we remain silent, we conspire against our women. For every woman infected by HIV, we destroy a generation.”

Sunday, 7 November 2010

Busfare Babies Opening Ceremony-Thank you BREADLINE AFRICA

Although the first Busfare Babies cottage  has been in use for a while, we wanted to have an official opening ceremony to let the community know that the centre was open. Due to my having been in the UK and not too much time in between babies being born and completing the finishing touches on the cottage, invitations were created and sent out late. My apologies to all who could not make it for this reason.

Last minute preparations turned into a festive week with a birth cottage full of women peeling vegetables, cupboards being fitted (thank you Garvey), roofs being painted (thank you Sam), guest book being hand made (thank you Kay) grandmothers beading (thank you Mama Nora and Margy) and sewing garments. Friday was baking bread day, dough was kneaded in the morning (thank you Mum, Nondiliseko and Nopeddi) and then fires lit and bread baked in pots on the fire in the afternoon.

In true Xhosa fashion, the catering went off without a hitch. On the day, huge pots adorned the garden and women with long spoons stirred the stews and other dishes on the fire in the cooking area. Unathi MC'd the occasion with style. Nomvula Ghaka was introduced to the community as the woman who will be assisting me at the centre. Some of the women who had had babies at the centre brought their babies to join in the celebrations and gave speeches about their experiences. When speeches were over and translations made thanks to Mama Zita, the Bell "Culture" choir performed on the lawn followed by the young traditional dancers from Hamburg.

A cue of young girls lined up at the cooking area after the dancers had finished. Here Lungelwa and Nomvula sat as matriachs dishing up the food. Every one was served with traditional food and delicious ginger beer, with a deliberate absence of traditional Xhosa beer, as we preferred a more sober occasion.

The day was a celebration as well as a feast. Ntando from the Dispatch newspaper, with her colleague photographer, summed it up in the article published the next day in the Dispatch. To read the article please click here

We are really grateful for the financial assistance from BREADLINE AFRICA who have financed the renovation of the first birth cottage. Thank you too to Frik from Something Old, Gonubie Main Road, East London for the contributions of disposable nappies and blankets to the Birth Centre. Thank you to Johnson and Johnson for the donation of the hamper. Thank you to Collette Driessel for being the conduit for sweet little knitted baby goods to the birth centre from the  Damant Lodge ladies in Port Alfred and Elsebe Cresbe. All the mums and babies are going home with a special bag of goodies thanks to your generous donations. A big thank you must also go to 25:40 for their generous donation of beautiful, handmade baby quilts, they are proudly worn by the mothers as they take their babies to clinic and are being much loved.

And most of all a thank you to all the women who have trusted me to be with them as they give birth to their babies. To the mothers who have trusted me to take care of their daughters as they labour and give birth, and to the fathers who have been willing for the mothers of their children to try out this new style of having babies. Thank you to the women that are working with and supporting me, particularly Nomvula, Unathi, Noluvo, Noluntu, Nosisa,Totyiwe, Mama Zita and Mama Nora for their confidence and support.

Without the support of the community and without the confidence and start up funding from Breadline Africa there would be no birth centre.

Wednesday, 22 September 2010

Returning home

Despite initial lack of finances, the UK trip served to be a wonderful visit on many fronts. Having managed to do the neonatal resuscitation course and the breech workshop with Jane Evans, I also was fortunate to be able to attend Michel Odent and Liliana's doula course just before returning to South Africa. I returned inspired and having met many special people.

I need to thank Odette and her family in particular for their generosity in sharing their home with me. It was a gift to spend time with such a warm and welcoming family and to talk not stop (as I fear many midwives do) about birth and midwifery. The generosity of Odette and Regina in donating equipment to Busfare Babies was also completely unexpected and welcomed, thank you both.

Being in the UK also presented the opportunity to meet with a group from the Netherlands who is interested in sponsoring a vehicle for Busfare Babies in order to facilitate accessible care to women and to enable early pregnancy screening to be done in rural areas.  Thank you to Jan and Peter  and all others involved for generously paying for me to travel to Amsterdam to meet with them. It is refreshing and inspiring to realize how many people there are, who are interested in changing things for the better for women, babies and birth.

Fund raising ideas at present involve arranging an event in London next summer.  So we have a moment or two to decide what exactly that will be. I will keep this updated on the blog too as we go forward in planning the event.

 Since my return, I have visited some of the babies that were born just before I left. It brings me joy to see how they have grown and how their mothers are carefully, exclusively breast feeding their babies despite this not being the cultural norm in the area.

Thank you to 25/40, who in my absence, have donated more blankets from the industrious and generous seamstresses in the USA. I will be doing the rounds soon to hand out these new blankets to the latest babies, and will post some photos here of those occasions.

Wednesday, 4 August 2010

what the women say

“She rushed me to hospital when I went into labour and helped me through an easy and memorable birth,” third-time mother  said.

First-time mother 23, said the ante-natal treatment, constant updating and explanations which the midwife provided, left her confident that giving birth would not be difficult.
“Even as I sit here I know the exact position my baby is in, and I know ... how to go about making the process an easy one,” she said.

And some photos need no words to say how they feel:

Taking good birth rural

"Garage" birth centre helps rural expectant mothers

 In most parts of the world, good birth seems to be available only to the elite. In Britain woman need to pay in the region of 4000 pounds to have a midwife that they know come to their home for a home birth. In Europe and New Zealand perhaps this kind of care is more available to those are not very wealthy. In most countries, however, during birth a woman is assisted by a midwife that is a stranger to her and most times birth is not a pleasant experience for woman or midwife.
Why is this so?

It has not always been like this. My mother was welcomed into the world by her Aunty Teen who was a midwife. In those days midwives attended the births of the babies in their town or village. In some areas, the midwife actually moved in with the family for the last month of the pregnancy and would cook meals, darn clothes and generally help out...wouldn't that be nice.

Then the world got more people and life got busier and everything got more expensive. As a result, not only did they close down all the little cottage hospitals where women used to have their babies with midwives that they knew, in many countries they also took away the community midwife too.
Although the community midwife does still exist in some countries, she now works in a large team and most times the woman is unclear who she will be having attend her when she goes into labour. This is often as unsatisfactory for the midwife as it is for the woman. Midwives like to know their clients and feel a connection with them and want to attend their births. Similarly, a woman may like a certain midwife and would like her to attend the birth too.

Because of the lack of finance and lack of midwives, we have now shifted care to be neither woman nor midwife friendly. Is this necessary? Is good care unaffordable?
Perhaps we need to look at it from a different angle, to find a new way.

This article describes the start of finding a way to bring back something old in a new way.

Tuesday, 3 August 2010

Why women and babies die

In a recent study published June 21, 2010, Kinney et al state "According to the most recent World Health Organization (WHO) analysis, most maternal deaths in Africa are related to direct obstetric complications that occur around the time of childbirth (mainly hemorrhage, hypertension, sepsis, and obstructed labor, which combined account for 64% of all maternal deaths.) Non-pregnancy related infections, such as HIV/AIDS and pneumonia, account for 23% of the deaths and unsafe abortion accounts for 4% of maternal deaths in Africa. More than half of maternal deaths take place within one day of birth. Malnutrition, including maternal anemia, iodine deficiency, and poor-quality diet, also contribute to maternal mortality and the high incidence of stillbirths and congenital abnormalities. HIV-infected mothers' risk of dying is ten times higher than that of HIV-negative mothers. (Sub-Saharan Africa's Mothers, Newborns, and Children: Where and Why Do They Die?)

When one looks within the existing health care system in South Africa, it is evident that care is not optimal. Why is this so? Is it because midwives are human? Is it perhaps that working conditions are overwhelming?  That when responsibilities are beyond human capabilities, in order to survive emotionally and work every day, the midwife withdraws? Is it possible for one midwife care for 4 women in labour, as well as other demands, simultaneously, without becoming removed and distant? Could it be that she needs to stop caring in order to be able to function on a daily basis?

Perhaps we need to look at creating another way. A way in which we as midwives can maintain our humanity and serve women well that are in our care. But how is this to be achieved? I would suggest with difficulty and with very careful changes. I believe that midwives want to care, they just do not work in environments where this is possible.

Busfare babies is suggesting another way. This is not a new way, in fact it is a very old way. It is a way that can be more beneficial now that we have advanced technologically. Previously all the midwife had was her hands, her little suitcase and no other back up. We now live in an age of gadgets and technology and these really can make childbirth safer when used carefully and when necessary.

The combination of a skilled midwife and the availability of appropriate technology is a formidable force in combating the current statistics that affect women and babies in Sub-Saharan Africa.

The aim of Busfare Babies is to provide good, careful and care-filled care to the woman in the area. It is my belief that within a short space of time, statistics will show that without excessive cost, care can be improved and that less mothers, babies and children will die if we bring back the midwife to the community. This is a system that is being revisited in parts of the developed world with obvious improvements, why not offer it to the developing world and see how simple changes make a big difference.

Saturday, 31 July 2010

fund raising

So, this is the world of fund raising. As I start out on my rather wobbly wheels, I am realizing it is definitely NOT the easiest thing in the world to do.

I am not a big, many-peopled, paper-pushing organization. I am just me, a midwife and a mother with an idea of how things could be shifted from how they are to better. And somehow I am going to wander around and convince people that, although they do not know me, and although I am not a big fancy organization, that they should donate to BUS FARE BABIES.

Its going to be an interesting 6 weeks.

Already I have managed to rope a young job seeking Irish lass (thank you Charlotte) into being my temporary P.A. In between job hunting, she is now making lists and coming up with all sorts of good ideas as to how we could get the word out and the money in. (If anyone has a job for her, please let me know.)

I am convinced that there is money available, its just a matter of finding the right people, explaining the need and having them see what Bus Fare Babies is doing and why they should contribute. I know there is a world recession, but there must still be a way for wealthier individuals to donate money to create better conditions for people living in the rural areas like where I live.

Obviously in my line of work, I think priority should be given to women and babies. In the words of Malcom X: " To educate a man is to educate an individual, but to educate a woman is to educate a nation." It is impossible, however, to look at women and babies in isolation. I am realising that all social issues need to be addressed if women and babies are to be cared for.

I can not just focus on women and their pregnancies and births and ignore the devestating HIV rate. In our area 35% of the pregnant population are HIV positive. In order to serve women well, this HIV level has to be addressed. In order for women and children to be safe, the alcoholism and abuse issues have to be addressed. In order for women and children to be healthy, food issues and growing vegetables has to be addressed.

So, as I said earlier, fundraising is not easy but it is just one of many things that just has to get done for us to move from how things are now to how they could be. Luckily I was born with a permanent silver lining to my clouds. It is this silver lining that I cling onto, and that keeps the impossible feeling possible.

I am in London for 6 weeks and I came here with all of £300 pounds last Sunday. Fortunately I have been accommodated by 2 wonderful midwives and their families (thank you Odette and Nyree and families). I have come to do some courses and to fundraise for the birth centre. The first course in Neonatal life support I completed on Monday and the other in Advanced Life Support in Obstetrics for dealing with emergencies is in September. I am doing these courses as I would like to do workshops for the nurses and midwives in the local clinics and hospitals, current practices with regards to how to resuscitate babies and how to manage emergencies.

Immediately, I am looking to raise enough money to keep the centre going for the rest of this year. To sustain the project i need £2000 pounds a month. This amount will cover all staff (cleaner, gardener, village health worker and HIV education team of 4), materials and transport as well as water and electricity for a month. So I need to somehow fund raise £10 000 for 2010. Once we are more established, it will be easier to generate funding from bigger organizations but in the interim we really are needing individuals who are willing to contribute. To contribute please email me on karen@birthwork.co.za or click the Donate top right of page to donate by Paypal.
Thank you