Selemoi, left, is isolated from her community after delivering a stillborn baby.
EAST POKOT, KENYA – A light rain drizzles down as crowds pass through a crowded shopping center in the village of Akwichatis, a Pokot word meaning swamp.
Akwichatis is 250 miles north of Nairobi, Kenya’s capital city. Like many places in East Pokot, the roads here are poor, the terrain is rocky and the temperatures are high.
Just a few hundred feet to the east of the shopping center, a young woman sits in a structure made of sticks with a small fire burning beside her. Passersby pay no attention to her. Only her husband and mother-in-law surround her frail body.
Chepolughumong Selemoi, 25, is anaemic, dehydrated and weak. She has been isolated in this small, shady spot for three days. As a member of the Pokot tribe, she is not allowed to mingle with other young women or children for one month.
Selemoi gave birth to a stillborn baby just a few days ago. She is now considered bad luck by members of her community. It is widely believed that if she comes into contact with women or children, more people will die.
Paul Kibor, a nurse who operates the mobile clinic in Akwichatis, says the stillbirth was likely the result of delayed labor and rough conditions during the final days of her pregnancy. It took Selemoi three days to reach the mobile clinic. She was carried on a makeshift wooden stretcher by her husband and three other men from her village.
This stillbirth occurred during Selemoi’s seventh pregnancy. Twelve years ago she delivered her first child via caesarean section and has had complications with her pregnancies ever since. Her three living children are 12, eight and six. Four of Selemoi’s pregnancies have ended in stillbirth or death shortly after birth.
“Stillbirths are common here,” says Kibor. He sites financial hardship and long distances to major health facilities as primary reasons. However, he believes the most prominent reason for the poor state of maternal care in Kenya can be attributed to cultural practices and beliefs. Girls in the Pokot community marry when they are very young. Selemoi, he says, is a perfect example—she was married at 13. Kibor confirms that her first child was delivered by caesarean section because she was too small to deliver her baby vaginally.
But there is another reason for Selemoi’s complications. Like many young women, she went through the process of genital mutilation as a young teenager. A practice, Kibor confirms, is common here. Considered by the community to be a right of passage, female genital mutilation involves the partial cutting or complete removal of the clitoris and some parts of the labia. Many pastoral communities, like the Maasai, Samburu and Somali, circumcise their girls between the ages of eight and 13. In Kenya, statistics show that approximately 50 percent of the adult female population has “undergone the cut.” There is strong social stigma against young women who resist the circumcision, but recent studies have shown that women who have been genitally mutilated have a higher rate of stillbirths than women who have not.
Female circumcision, as it is also called, is widely discussed at international and national forums as a violation of human rights and as detrimental to female reproductive health, but Selemoi says she does not resent the process, she says she accepts it as just a part of her culture.
Still, her physical pain and social isolation are trying. Selemoi can hardly sit and says she is in constant pain. She lays on a rag with her husband and mother-in-law—the only people allowed to be near her.
Kibor says cultural beliefs have hampered health services and childbirth delivery options in the Pokot community. The Pokot are known for their nomadic lifestyle in the Northen part of Kenya’s Rift Valley province. Kibor says their nomadic ways and tribal beliefs, like the ones that isolate women after reproductive complications, hinder his ability to care for patients. Even Selemoi rejects his treatment. She does not want nurses to come near her, Kibor says, she believes in the culture that has isolated her.
“I don’t feel bad under this shade because it is culture that advocates for this and everyone else does it when they experience stillbirth,” says Selemoi. Her mother-in-law declined to answer questions, but according to Kibor who translated some of her comments, she was confused why anyone was paying attention to Selemoi’s condition. As she sat next to her dehydrated daughter-in-law, her job was to keep the fire burning and to keep an eye out for hyenas.
Superstition and Isolation are Common
“This culture of isolating women who experience stillbirths is very strong and it might take a long while to disappear,” says Kibor based on his years of experience working in the community. He attributes the practice of these cultural traditions largely to illiteracy. Two-thirds of the population is illiterate here. The only school in the area offers just the first grade. “There is a community school called Akwichatis Primary with only one [building]. [It] hold[s] 150 pupils with two untrained teachers,” says James Teko, the director of currency and branch administration at the Central Bank of Kenya.
“The Pokot, like any other pastoral communities, believe that every death has a reason,” says Albert Panga, an accountant and a member of the Pokot tribe. Panga says that whenever a stillbirth occurs, rituals for cleansing, like the slaughtering of animals and blessings by spiritual leaders, are performed to welcome the isolated woman back to her home after time has passed.
“These traditions are only based on superstitious beliefs, common with the illiterate members in the community,” says Panga. Although Panga believes the community will eventually abandon such practices, he says it will take time because the tradition is deeply entrenched.
Limited Access to Healthcare
Inaccessibility, vast distances and socio-cultural barriers have also contributed to maternal deaths in rural areas like Akwichatis. The international health and development communities have repeatedly called for action to address health-related superstitions. Maternal health also remains one of the World Health Organization’s millennium development goals in order to reduce poverty. But deep in Kenya’s Rift Valley, little has changed. Kibor says he registers the deaths of five pregnant women every month and two to three stillbirths every week.
The mobile clinic, which operates in the village once a week, is supported in part by the African Inland Church and the government. The main health facility in the region is in Kwokwototo, which is more than 150 kilometers away. There are no major roads connecting it to the smaller villages.
Apart from the long distance—villagers say the walk takes three days without stopping—money is the primary factor limiting healthcare. Selemoi’s husband, who refused to disclose his name due to the shame associated with his wife’s stillbirth, says, “I don’t have money to take my wife to hospital.” Kibor continues to treat Selemoi on credit. He fears her health problems are more serious than he and his mobile clinic can handle. “I have a feeling Selemoi could be having internal bleeding,” he says. “I have only been managing the pains and the dehydration. I wish I could be in a position to rule out the bleeding.”
Kibor says this is the worst case scenario, but there is nothing more he can do for her. The small room for the mobile clinic can barely accommodate 10 patients, yet he sees dozens each day. Men, women and children scramble to be treated. Many stand in line and those who are too weak, sit on the wet, earthen floor. Today is a particularly busy day. As Kibor speaks, he attaches an intravenous drip to an elderly woman and then to a little girl.
He says Selemoi’s case has been difficult for him as he will not likely be able to treat the real source of her health problems. Kibor says he worries that Selemoi will become just another statistic.
