WHEN a baby is born in the Maasai village of Sitoka, Kenya, the
women in attendance shout the news as far as their voices will
travel across the Mara. It is the sound the men have been waiting
for, and the cue for the father to serve up the goat he has
prepared for slaughter.
But when death rather than life arrives, there is silence.
Stories of birth - even those that are close to tragedy - can be
spoken of in the open, under the shade of a tree. Death, on the
other hand, is spoken about quietly, hesitantly, at a safe distance
from the centre of the village.
"Even talking about it is taboo," Tom Opee explains. He is a
community field-officer for the Transmara Rural Development
Programme (TRDP), Christian Aid's partner in the region, run by the
diocese of Kericho, in the Anglican Church of Kenya. "If you ask
for someone who has died, they will say 'I'm sorry, he is gone.' If
you ask 'Where?' they will walk away."
It is an act of courage and sacrifice when Nashoro Ndayia, aged
43, agrees to tell us what happened to her daughter Semeyian.
Seated on a broken chair under a tree outside her home in the
village of Pusangi near by, she looks defeated. A mother of eight
children (the youngest is ten, the oldest 31), she is currently
looking after six. The youngest, Liaram, playing in front of us,
was born to Semeyian two years and five months ago.
"She was in labour for two days," Mrs Ndayia recalls. "By the
time she delivered she was exhausted and weak, but the placenta was
retained. Around 6 p.m. she tried to deliver the placenta, and was
bleeding very much. Around 8 p.m. we looked for a vehicle, and our
neighbour had one and took our girl to hospital, but she never made
it because of the bleeding."
SEMEYIAN was 19 years old. Her two other children have been
taken in by her sisters. Mrs Ndayia, since the death of her husband
in November - he was 67 and had been suffering from TB - has become
the family's breadwinner, burning charcoal to sell, milking and
grazing the cows, and now looking after a toddler. She looks
exhausted, and Liaram looks hungry. The TRDP team are visibly
Although her husband was reluctant to sell a cow to raise the
money to transport their daughter to hospital, Mrs Ndayia does not
blame him for her death: "Many have delivered at home, and we hoped
she would deliver well. He never meant anything by it." She agrees,
however, that an ambulance would have made a difference. "Other
people demand money. If an ambulance had been here, even if my
husband had refused, I would have done it myself."
In Sitoka village, 18 kilometres away, an ambulance, funded by
TRDP, is a mobile-phone call away. The women are conscious of their
relative good fortune. "A spot of light is being shone on Sitoka,"
Elizabeth, a 28-year-old mother of four, says. "But it is not broad
daylight. Please look for other vulnerable places."
Two months ago, the ambulance came to the rescue of a friend of
Noorkitoip Joyce Julius. Her friend was a 34-year-old mother of
eight who was suffering her third consecutive miscarriage. "I
thought she could bleed to death," Mrs Julius tells us. "We called
the ambulance, and she was taken to Kilgoris - she was very weak,
but conscious. She lost the baby. But she could have died
AN EMERGENCY journey to Kilgoris is one that Mrs Julius made
herself, several years ago, after delivering her third child.
Dizzy, and eventually unconscious, she was carried on a blanket by
six men for the entire 48-kilometre journey. Like Semeyia Ndayia,
she had retained the placenta - a significant cause of maternal
mortality throughout the developing world. Only after it had been
removed did she regain consciousness. She went on to deliver four
more children - the youngest four hover shyly in the doorway to the
hut - at home.
"It's totally different now," she says. "I advocate for all
mothers, where possible, to give birth in a health facility."
This position represents a revolution in Maasai culture, where
women, starting as early as 12, give birth to an average of seven
to nine children over the course of a lifetime. They are assisted
by traditional birth attendants (TBAs).
Clustered under a large tree, in brightly coloured shawls, the
TBAs in Sitoka were the first people we met on arrival in the
village. They were hesitant to speak at first, hands clasped in
their laps, heads cocked, curious, rising above the many hoops of
beads on their necks. They were incredulous that the three British
women interviewing them had only one child between them.
The chief skill of a TBA is massage, one explained,
demonstrating on the thigh of her neighbour. She can discern
whether all is well - "it is a God-given skill" - and, if the baby
is not in the right position for delivery, she can move it into
Later, in the sub-district hospital at Lolgorian, a nurse
explains that "external turning" used to be standard practice in
the health service in Kenya until it was found to rupture the
uterus. In Sitoka, however, the skill is revered.
THE Ministry of Health in Kenya is keen to "rebrand" TBAs as
birth companions who will refer women to hospital. But, although
those in Sitoka admit that they see signs of their work ending, the
journey from the village to the hospital means that their
assistance remains in demand. Just recently, one recalls, a woman
gave birth in the doorway.
Getting women to give birth in hospital is a main aim of TRDP.
In the UK, where home births for "low-risk" pregnancies were
recommended this month, a mother can swiftly be driven to the
nearest hospital; but, in Sitoka, even when a vehicle can be found,
she faces a journey on roads that are, in many places, just
stretches of grass flattened by previous tyres. The taxi fare is
prohibitively high - vastly inflated above the rate charged in
Although Kenya is set to achieve many of the Millennium
Development Goal targets by next year, its record on maternal and
child health-care is one of the worst in the world. Approximately
one woman dies every hour from causes related to pregnancy and
childbirth. Only 44 per cent of births are assisted by health-care
professionals - well below the target of 90 per cent. The infant
mortality rate is almost ten times that in the UK.
The Kenyan government has not been inactive. This year, the
First Lady, Margaret Kenyatta, launched the Beyond Zero Campaign,
which includes the roll-out of mobile clinics, and a focus on
preventing the transmission of HIV. This year, the Ministry of
Health allocated $US 400 million to prevent the rate of HIV
transmissions, reduce maternal and child death, and increase the
number of skilled health-care workers and facilities in the
BUT there is a long way to go. For women in Sitoka, even with
the arrival of the ambulance, a successful transfer to hospital is
no guarantee of a happy ending. At Lolgorian Sub-district Hospital,
we are told that, in the past two months, two women have died. Once
they arrive with complications, it is too late, Margaret Nyachoka
Omwenga, the matron, observes, sadly. "One lady came here with very
high blood pressure, went into a coma, and died on the way."
Like many of the Kenyans we met during our trip, Mrs Omwenga
speaks not of "problems", but of "challenges". It is the word that
she uses while giving us a tour of the hospital, where we learn
that it is missing a theatre, two extra nurses, and a washing
machine (the laundry is piled high with bed linen that staff will
have to wash by hand). All surgical instruments must be sterilised
with boiling water and bleach, because there is no electric
The labour ward has just two beds; and a lack of incubators
means that, if four mothers give birth prematurely, Mrs Omwenga
must teach one to hold her baby "kangaroo style" to keep it
MRS OMWENGA estimates that about 20 per cent of births result in
complications. There are no scanning facilities or theatre; so
options are limited. A doctor currently away in Nairobi undergoing
training has promised to return, but only if there is a theatre in
which he can practise his new skills. "Truly speaking, we cannot
rely on the Kenyan government, because we are missing a lot of
things," she says.
Waiting for her in the maternal and child-health unit - they
travel early, she explains, to avoid elephants - are about 40
women, many holding tiny babies wrapped in thick blankets and
crowned with woollen bobble hats.
Those we interview are complimentary about the hospital. Large
charts announce that treatments are free of charge, and, within a
couple of hours, the clinic is empty. Children have been weighed,
vaccinations have been completed. In one of the rooms, counselling
takes place before HIV tests are carried out. The prevention of
mother-to-baby transmission is crucial in a country in which AIDS
continues to be the leading cause of death.
Mrs Omwenga has seen children who have been raped - sometimes by
their fathers or uncles - who are seeking post-exposure prophylaxis
two or three months afterwards, when it is too late.
She is encouraged by the uptake of family planning: "A mother
has the right to do family planning; but here you can't," she says.
"I have given women the injection secretly. Gender is a big problem
in this place. To change someone who does not want to be changed is
hard . . . We cannot have perfect people, but we try to change them
IN SITOKA, it is the day of the opening of a new dispensary -
one of three funded, in part, by TRDP. Within minutes of the
cutting of the ribbon, women fill the waiting room, with babies to
be weighed and vaccinated.
Although the building is now complete, and stocked with
medicine, it remains unstaffed. The chief executive of TRDP, the
Archdeacon of Transmara, the Ven. Dominic Santeto, believes that
the community must take ownership of the facility, and announces an
impromptu fund-raiser. While a teenage boy taps out a tune on a
keyboard under a tree, the men make their way up to the front to
throw notes into a plastic baby-bath - part of a kit that is to be
given to all new mothers.
It is the women who lead the celebrations, singing a
call-and-response song in praise of God while gradually gathering
in concentric circles, ululating while performing a dance.
In Pusangi, Mrs Ndayia wishes that healthcare was not so distant
from the village. "Our area is beautiful, and maybe you are saying
it is beautiful," she says, glancing around her. "But it is
meaningless to have cows, and have this beautiful land, and people
are still dying.
"Now you have seen the problem we are going through. If it is
possible to help in any way to have a permanent dispensary around,
God is going to bless you. Our health is the priority."
Madeleine Davies travelled to Kenya with Christian Aid. For
details of the Christian Aid Christmas appeal, visit
www.christianaid.org.uk/deliverhope or phone 0845 7000 300.
Donations made before 6 February 2015 will be matched by the UK
Government up to £5 million.