January 21, 2015
SAKE, DEMOCRATIC REPUBLIC OF THE CONGO – Soft rays of morning sun light up the walls of Sabina Kitambala’s home in Sake, a town at the edge of lava plains in eastern Democratic Republic of the Congo. Children play in the neatly swept courtyard. A goat is hitched to an avocado tree out front.
Inside, the home is small and simply furnished. A mattress lies on the floor alongside a table and two chairs.
Women have given birth in this room for 60 years.
Kitambala says God pushed her to become a midwife to Pygmy and internally displaced women, who have few other health care options here, in the eastern DRC province of North Kivu. Kitambala learned midwifery from her mother and assumed her mother’s role in their community when she died.
“Women who were about to give birth continued to come to [our] home because they knew that I had already learned something from my mother,” says Kitambala, 74.
She attended her first delivery when she was 14.
“On one blessed day, I helped a woman give birth without complication,” she says.
She admits she was terrified.
“I heard a voice inside me telling me: ‘Why do you have fear? There is the baby you are looking for.’”
Unable to count, Kitambala does not know how many babies she has delivered. Her daughter Naim Lughendo, who often assists her, says Kitambala usually delivers 12 to 16 babies a month.
Kitambala is an important figure in the community, Lughendo says. She is known for her calm bedside manner and for helping women from marginalized populations, including Pygmies and people displaced by regional violence. Both groups lack access to medical care.
Kitambala rarely charges for her services, Lughendo says.
“She’s friendly, courageous and requires almost nothing,” Lughendo says.
If a client can pay, Kitambala says she will accept 2,000 or 3,000 Congolese francs (about $2 to $3).
“I like this work – it leads to new creatures,” she says. “It is a voice that came from God. Therefore, I couldn’t tax my beneficiaries.”
Like most midwives in DRC, Kitambala has no formal training. When a woman arrives in labor, Kitambala first aims to soothe her.
“I caress them with soft words,” she says. “Then, I give them a very sugary tea as I bind a strip over their stomachs. And then I begin my work.”
Lacking medical equipment and supplies as well as formal training, she cannot provide emergency care.
Kitambala sees many kinds of complications, including heavy bleeding and breech births. Sometimes she discovers the fetus has died in the womb.
Kitambala directs women with complications to the Sake Afia health care center, about 2 kilometers (1.24 miles) from her home. Most women in DRC must travel much farther to get medical care.
According to the United Nations Population Fund, there is just one doctor for every 10,000 DRC inhabitants, and most of them work in the larger cities. As a result, even women who can afford medical delivery often must walk miles to a health center.
Despite her limited range of ability, Kitambala is often the only resource for poor indigenous and displaced women in Sake. Some men forbid their wives to go to medical professionals, while others say they would never allow their wives to deliver with an untrained woman like Kitambala.
A woman dies in childbirth every 25 minutes in DRC, according to the World Health Organization. Almost 5 percent of the country’s newborns die at birth or immediately after.
A woman’s lifetime risk of dying in childbirth is 1 in 24 in DRC, a 2013 Population Fund study reported. DRC is one of six nations that account for half of all maternal deaths in the world.
According to a 2012 article in “BMC Pregnancy & Childbirth,” an open-access, peer-reviewed journal on global pregnancy and childbirth, nearly half of the world’s babies are born at home.
In research that spanned six countries, including DRC, the study found that less than half of birth attendants were literate and 80 percent had no more than one month of formal training. Most rural midwives lack even the most basic equipment, including blood pressure apparatuses, stethoscopes and manual resuscitators.
Most women in eastern DRC do not deliver in traditional health facilities, says Omer Paluku Mbusa, president of the Association pour la Promotion de la Sage Femme (“Association for the Promotion of the Wise Woman”), a nongovernmental organization that works with “wise women” – traditional midwives.
Outside of Goma, a large city in the eastern DRC, as many as 80 percent of babies are born in homes like Kitambala’s, Mbusa says.
Mawazo Nyandwi, who lives in a camp for internally displaced people near Sake, came to Kitambala when she delivered each of her 10 children.
Years of fighting between government and rebel troops have displaced 2.7 million DRC citizens. More than 70,000 internally displaced persons, or IDPs, live in the Sake area.
Despite her lack of resources, Nyandwi says the culture looks favorably on women who have large families. So Kitambala’s free assistance has meant a lot to her.
“Especially for us who remain in IDP camps, it helps us a lot,” she says.
Women in IDP camps have serious unattended health problems, according to the United Nations High Commissioner for Refugees. Worldwide, women and children account for about 80 percent of refugees and IDPs.
The average annual income in DRC is just over $400. But many women in the region live outside the formal economy.
In addition to facing limited options and financial resources, Pygmies say discrimination impedes their access to health care.
Josephine Fatu, a member of the local indigenous population, says Kitambala is an important health care provider for the Pygmy community in Sake.
“She welcomes us without discrimination of tribe,” Fatu says. “Here is my third son. She delivered me without difficulty and didn’t require anything.”
Health care conditions are worse for Pygmies than for the rest of the population, according to the International Work Group for Indigenous Affairs.
The government estimates there are 600,000 Pygmies in DRC, making up 1 percent of the total population, but the rights group says there could be as many as 2 million Pygmies in the country.
Pygmies are marginalized in DRC, the rights group says.
“Their participation in the DRC’s social and political affairs is low, and they encounter discrimination in various forms, including racial stereotyping, social exclusion and systematic violations of their rights,” according to the organization’s 2013 report on the human rights of Pygmies in DRC.
The high infant and maternal mortality rates of Pygmies are “alarming healthcare indicators,” according to a 2009 World Bank report on development strategies for Pygmies in DRC. Rejection by health care officials and distance from medical facilities are among the principal causes of those rates.
While many in the local Pygmy and IDP populations regard Kitambala as a vital asset, others say untrained midwives are part of the problem of rural maternal mortality, not the solution.
Kitambala knows that health care workers in her community discourage women from giving birth in her home. But with no financial resources, local women often have no choice.
Police have detained Kitambala twice after patients suffered complications, she says. Relatives of the patients had asked police to make her stop delivering babies.
“They have made me stop twice following the failure of childbirth, but the people and law enforcement officers have always advocated for my release because it happens many times that even women police found relief with me during their deliveries,” she says.
Although untrained individuals are not legally barred from practicing midwifery, the Sake Afia health care center works with community members to identify the patients of untrained midwives so it can steer them to the clinic, Sake Afia Director Josué Baguma says.
“There is an awareness project among the population of Sake to end the home delivery practice and denounce those who practice it because it’s very risky,” Baguma says.
Christian Tumaini says he would never allow his wife to go to Kitambala.
“It is not possible that my wife would give birth with her,” he says. “It is only ignorance that would let some men allow their wives to go to Kitambala for delivery.”
Baguma encourages local women to give birth only with medical assistance.
“We discourage all women from delivering in the home, with midwives or even in prayer rooms, where some women go because people tell them God is going to operate miracles on them,” he says. “We discourage all of this.”
Kitambala acknowledges her inability to treat a woman who is having complications.
“If a woman is bleeding heavily after childbirth and the placenta hasn’t come out, it can be life-threatening,” she says. “I’m aware that this woman needs urgent medical care for her to have a chance of survival.”
While Kitambala has seen both mothers and infants die during birth, she says her work is vital to marginalized communities.
“Health agents try to discourage me, but women in difficult situations encourage me to do this work,” she says.
Aiming to reduce infant and maternal mortality rates, the Association pour la Promotion de la Sage Femme is working with provincial health authorities to identify, train and supervise traditional midwives.
The association has trained more than 100 midwives to deliver properly and to detect risk factors.
Kitambala has not received the training.
GPJ translator Rafiki Nzita King translated interviews from Swahili and French.