Almost!!! I almost missed the story just like you did, but for proximity. I wonder if she could have made it to the national figures. Because of Covid -19 pandemic, attention is off other causes of death in Nigeria but sadly while the world is in lockdown to contain the spread of the Corona Virus Disease, pregnant women are still dying in the country.
Like nearly every pregnant mother in Nigeria, Mrs Humihani Yahaya took pictures of baby bump, kept them possibly to publish, after the delivery of her baby. This pregnancy was her sixth and she has five live children, all under the age of 12. The plan would have been to bring the sleepy, slow paced life in Ohueta district of Ihima town in Okehi Local Government Area of Kogi State alive during naming ceremony.
Multiple sources told me that the mother of five other children had left her house on March 17, 2020 to the home of one of the many nurses in the neighbourhood to have her baby. It is common practice in Ihima and most communities to have nurses both serving and retired, open their doors to saving lives all round the clock, often times at no cost.
They act as dispensaries, they take deliveries, check BP and give advices to patients. It was initially a safe delivery and there was jubilation. Her husband, Mallam Salawu Yahaya who works in Kano was over 300 kilometers away when the baby was born but he said he got a call immediately.
According to Yahaya, ‘after the baby was born, she called me and told me I won. That was how I knew the baby was a girl. In fact she told me she was sitting down, she told me she liked the chairs in the sitting room of the nurse and reminded me that we could contract the carpenter who made the chairs to replace our own since we have been planning to do so. She was even the one that chose the dress the baby would wear after the new baby was cleaned up. Just a few minutes later, they called me that she was sick. Before I could even say anything, she was no longer picking her call.”
She began to bleed, I was told the nurse did what she could to arrest the bleeding, when it dawned on her that it was getting out of hand, she ran out and raised the alarm. Neighbours struggled to get a vehicle with which to take her to the hospital. By the time they got to the hospital, there was nothing anyone could do. She died just at the entrance of the hospital. She had bled to death.
Good news is that the beautiful newborn is doing very well, she has been handed over to her late mother’s friend, who had a child 5 days earlier. So she is raising two babies now.
Now let’s look at the circumstances.
She lived in a house very close to a Primary HealthCare Centre PHC. The Ohueta Primary Health care center was built sometime in 1979 by the then Adamu Attah regime as governor of Kwara State. That PHC has oscillated between coming alive, comatose, being resuscitated and at some point given a lifeline, through funding from World Bank Assisted Health Systems Development Project –II.
As at press time, that PHC which is supposed to be functional is under lock and key and desolate. I asked my cousin who is a senior midwife Mrs Rekiya Idris, in one other PHC in Ihima what exactly the situation was with the PHCs. According to Rekiya government has in the past years been focusing attention on primary health care delivery especially to reduce maternal mortality. She told me that the PHC in Ohueta as it is in other PHCs, has a resident midwife whose emolument comes directly from the state government. If government has committed so much, why is it still under lock? She explained that ‘giving birth in the PHC is very cheap, because the government insists that we cannot charge money. The basics are usually provided so there is no need. However the cost of giving birth there is between N2,000 and N3,000.” I also called Mrs Serah Oveka the head of another PHC in Obeiba district, that PHC is about 30 minutes’ walk from the Ohueta PHC. It’s actually much convenient to gauge the distance by foot than to talk about drive time, because the difference between walk and drive time could not be more than 5 minutes, because of state of the link roads. The districts are interconnected and it’s a very closely knit community so everyone is aware of the death of Mrs Humihani so I also asked Mrs Serah Oveka what she thought of the incident and she said “…it is sad but unfortunately there is nothing we can do because she is already dead.”
“In our PHC, we take deliveries at all times, since I joined that PHC in 2017, we have not recorded any single death. On the average we record 20 deliveries every month and we pleased that the outcomes are successful. So I really did not come to our facility”, she said
Could there be confidence issues with the setting? Was she just visiting a “nurse” friend and then went into premature labour? Sadly, no one has been able to understand why she did that. Could it be the user fees charged at the PHCs? Midwife Rekiya disagrees. “The homes charge more than the PHCs. If she had come to the PHC, there are more personnel there who could come up with practical ideas on how to arrest the bleeding. But the nurse was alone, what could she have done?” this is happening more than 13 years after the Nigerian ministry of health identified behavioral change as a great factor in helping women make informed decisions about hospital birthing. It launched in 2007. The Situation Analysis And Action Plan For Newborn Health in the context of the Integrated Maternal, Newborn and Child Health Strategy in which it says “Campaigns should highlight positive deviance in addition to addressing the various factors that prevent mothers from attending ANC, delivering in the health facilities and seeking early postnatal care for themselves and their newborn.”
Again, understanding that women are continually giving birth outside hospital facilities, the WHO in 2015, came up a recommendation on working with Traditional Birth Attendants TBAs to help reduce mortality by equipping them with skills required to save the lives of mother and child, ostensibly to ensure every woman has access to skilled birth attendant. Nigeria’s National Demographic Health Survey 2018 says “Still, 59% of births are delivered at home” that is outside a hospital facility.
Now, this case is about a ‘nurse’ who has some skills. However, emergency response, linkages with other facilities are not available. Since the news of her death came to me, I have been searching for information about nurses and home deliveries to no avail. There has to be a network and certification as well as documentation of who is providing services, the types of services they provide and the resources they would require. Even in the most advanced societies today, many women are opting to deliver their babies in home setting but this is often guided by rules.
That brings us to emergency response and why home delivery could just be a death sentence in Ihima. Within Ihima, the community road networks have gone so bad that the only memory residents have of any work on the roads was in the 1990s. Mr. Yusuf Obosi The chairman of the Ihima Elites Initiative, a social media pressure group told me the group had in 2017 requested to support the Local authorities to rehabilitate some of the community linking roads. That request was not accepted because the then leadership of the local authorities said they already had the rehabilitation on their table for implementation. Now the roads from the PHC in Ohueta linking to any part of the main road would still have been a nightmare for emergency evacuation as all the roads are no longer motor able.
I went through the road in December 2019 during the yuletide. At some point, we asked people to alight from the car otherwise it would be unable to move in the deep gullies that had been created over the years by erosion leaving huge sharp stones and edges, capable of destroying a car. Even if there was a vehicle to convey Humihani, valuable time would have been lost before she got to the hospital. What should be a five minute drive on a good road takes at least 20 minutes of meandering. Either way, the prospects are not very good.
In 2007 the Nigerian ministry of health identified behavioral change as a great factor in helping women make informed decisions about hospital birthing. It launched The Situation Analysis and Action Plan for Newborn Health in the context of the Integrated Maternal, Newborn and Child Health Strategy in which it says “Campaigns should highlight positive deviance in addition to addressing the various factors that prevent mothers from attending ANC, delivering in the health facilities and seeking early postnatal care for themselves and their newborn.”
In communities like Ihima, the availability of a Non-Pneumatic Anti-Shock Garment, could have been a life changer. I remember that a Professor Ojengbede and his colleagues had conducted a pilot test on the cost effectiveness of the NASG in four referral facilities between 2004 and 2008 and they reported that “The NASG significantly reduced mortality even among women who were in severe shock, which is very encouraging. … This reinforces our message that the NASG is first aid only; while it can resuscitate women in shock, it is not definitive treatment.” The World Health Organization (WHO) recommends it as a temporary measure until appropriate care is available (2012).
Like this and all the other deaths from child birth, it is a stark reminder of the societal failures that have continued to make pregnancy in Nigeria a huge risk. Currently, Nigeria is the highest contributor to maternal mortality in Central and Western Africa and contributes 14% to the global maternal mortality rate. “According to UNICEF, a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13”,, the 2018 National Demographic Health Survey says The pregnancy-related maternal mortality ratio for the is 556 deaths per 100,000 live births.”
Science vs Spiritual
That is the science behind the death, now let’s get to the spin.
The community was nearly crippled by news that Humihani’s death was more spiritual than physical. The talk was that this was not her first child, this was her 6th so why would she die in her 6th delivery? The thinking here is every birth makes you better prepared for the next birth so incrementally, you are better prepared than someone having a first child. The more, the better. This is grossly at variance with science.
Not only that, she is said to have had quarrels with her landlady who gave her quit notice so her landlady must have cursed or threw some concoctions at her, this in turn caused her death.
Moving on still, she was said to have not told anyone where she was going, on the fateful day she had her child, and she was said to have worn white dress. My source asked me “have you ever seen a woman going to have a baby wearing all white”? I had no answer.
The ‘nurse’ in whose house she had the baby is said to be a very good person, very helpful and friendly and they all attest to her effort in resuscitating her, meanwhile, they were not there. So in their view, if evil hands were not involved, she could have survived.
With these spins to the death, this is potentially debilitating and has the ability to stall any investigation into her death not only to find out the culpability of the actors but also to issue a preventive guide to other women.
Credit: Voice of Nigeria