News — Black Female

Leparua, Isiolo County, Kenya – it takes three hours to snake downhill on a motorbike, skirting gingerly around mud puddles, but for Salome, it feels like days.

Riding side-saddle, she exhales sharply over each bump on the track and rubs her heavily pregnant belly protectively.

In the driver’s seat is traditional birth attendant, or TBA, Afro. He squints through the monsoon rainclouds, carefully inching the motorbike forward. His gaze remains fixed on the horizon until, at last, the hospital comes into view.

Deep in Kenya’s interior, health facilities are sparse, with some located up to 100 kilometres from the communities they service. For pregnant women like Salome, reaching it can be perilous, particularly during the rainy season, when dirt roads flood and bridges become submerged.

“I know many women who went into labour and started to walk to the hospital alone,” she says, slumping down on a plastic stool at the hospital entrance. “But it is too far to walk with labour pains, so they had to deliver the baby in a bush.”

Fortunately, Salome is in safe hands, thanks to birth attendant Afro and his motorbike, or piki-piki, as it is known locally.

As she goes in to register, Afro leans heavily on a curved crook outside, exhausted. He explains why traditional birth attendants continue to play a central role within the Masai’s tribal structure.

“It is a great honour for us to deliver the new members of our tribe. This role gives us status within our communities.”

But with the arrival of the motorbike, he says, the role of the traditional birth attendant may be changing.

“In the past, I had to deliver the baby at the woman’s home with no medical knowledge. When there were complications, there was nothing I could do. Now I can bring the mothers here on my piki-piki and take the tiny babies back home when they arrive. So, we still play a significant role.”

Unfortunately, many women in Kenya do not have access to the same level of medical care as Salome. According to the latest figures from the World Health Organisation, more than 6,300 women died in childbirth last year, one of the highest in East Africa. It is estimated that more than 800 of those deaths occurred in Isiolo County.

Traditional birth attendant Afro, Leparua, Isiolo County, Kenya, 2016 Photograph: Nicola Kelly

With long distances, poor infrastructure and no licenced medical professionals nearby, women in this part of the country have relied on TBAs for generations.

In 2005, Kenya’s Ministry of Health banned traditional midwifery practices, saying TBAs had adopted increasingly risky methods of delivery. They focused their investment instead on training and equipment.

Nurse Julia describes how the ban further entrenched high-risk practices in Masai culture. “Many TBAs felt abandoned at that time. They felt they had no choice, so they continue to use these natural remedies. For example, they take a part of a tree commonly found here, boil the root and give the liquid to the pregnant woman to encourage the uterus to contract.

“But many midwives give the mother too much of the liquid. Sometimes, the ladies overdose, start fainting during labour and even lose their babies. It is traditions like this that we must prevent.”

She points to a small plastic bag filled with blood on a tray nearby and explains that this had been extracted from a goat by another TBA to increase the haemoglobin levels of an 18-year-old mother.

“Clearly, she needed a blood transfusion, but the TBA saw no alternative,” she adds. “This is how tetanus, hepatitis B, HIV and many other infections are being spread.” Afro says that, while these traditions will endure, he encourages his fellow TBAs to integrate their practices with skilled medical care.

“We used to deliver the babies with no protective gloves, but a lot of birth attendants contracted HIV. Now we know that it is not safe to do this. We have agreed not to assist women at home anymore.”

International development agencies believe that providing funding for motorbikes as part of the Rural Transport Network scheme, rates of maternal mortality in Isiolo County will improve. “By giving motorbikes to rural communities, we can ensure emergencies are quickly referred for specialised obstetric care,” Samuel Nyutu, Health Programme Officer for Christian Aid in Kenya, says.

“They allow TBAs to reach areas it would be difficult for an ambulance to get to and they are easy and cheap to run.”

Alongside the health benefits for the mother, there are a number of other incentives for the traditional birth attendants. They receive a small stipend, protective clothing and some also undergo midwifery training, working alongside nurses like Julia.

Afro hopes that more vehicles will be supplied to TBAs in the surrounding villages to ensure women in rural areas make the arduous journey to their local health facility.

“I see that my motorbike has helped to save lives. It helps the mother and the baby – and it also helps me!” he says, patting the saddle of his piki-piki fondly.

Claudia Gordon was eight years old in rural Jamaica when she suddenly developed severe pain in her middle ears. Her aunt, Mildred Taylor, took her to a small clinic but with no doctor on duty, the nurse couldn’t determine what was wrong. Gordon became deaf.

Her mother at the time had immigrated to the South Bronx, in New York, to make a better living for herself and her family. A domestic servant with only an eighth-grade education, she left Gordon and her two other children in the care of her eldest sister, Mildred, a schoolteacher. Her plan was to reunite with them as soon as possible. Then Gordon’s unfortunate event occurred.

When she suddenly lost her ability to hear, she was taken out of school and made to stay home to perform chores. Healers tried to perform rituals to restore her hearing but to no avail. She also lost her friends gradually and experienced discrimination in a country where deaf and disabled persons are usually stigmatized.

“I thought I was the only deaf person in the world. I did not realize until years later that a woman who everyone in my town knew as ‘dummy,’ and who children my age would incessantly harass with stone throwing, was deaf,” Gordon said in an interview. “Looking back, I wish I knew her real name. What I do know is that the life of this woman – ostracized as ‘dummy’ – almost became my own but for my mother’s triumph in successfully bringing me to America by the time I was eleven years old.”

In the United States, Gordon first attended a public school before moving to the Lexington School and Center for the Deaf in New York. At Lexington, Gordon learned sign language, was engaged in sports and became a top student. In her junior year in high school, she resolved to become a lawyer. People tried to talk her out of it. “Some cited my deafness as an obstacle rendering it impractical if not impossible to pursue a law degree. Thanks to the values that were instilled in me during my formative years, I understood then that those voices of doubt neither dictated my worth nor my capacity,” she recalled.

Defying the odds or simply refusing to see them, Gordon went on to study political science at Howard University and graduated with a Bachelor’s of Arts in 1995. She subsequently became the first deaf student to graduate in 2000, from the American University (AU) Washington College of Law, in Washington, DC, where she specialized in disability rights law and policy. She then won a Skadden Fellowship (for law graduates working with disabled people)for 2000-2002, and worked as a staff attorney at the National Association of the Deaf Law and Advocacy Center, giving her the opportunity to provide “direct representation and advocacy for poor deaf persons with a particular emphasis on outreach to those who are members of minority groups.”

But while working at the Center, the Jamaican immigrant became interested in working for the Federal government. “I confronted the truth that passing legislation is one thing but actual implementation with enforcement is another. I felt that a job with the Federal government would more effectively allow me to affect the actual enforcement of laws such as the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973, thereby alleviating the blatant discrimination that people with disabilities continue to face.”

In time, she started working as Special Assistant to the Director of the Office of Federal Contract Compliance Programs (OFCCP) in the Department of Labor, ensuring that people who do business with the federal government do not discriminate on the basis of race, color, religion, gender, national origin, disability or status as a protected veteran. At Homeland Security in 2005, Gordon, who was also one of former President Barack Obama’s key advisors for disability issues, worked towards enforcing executive orders for people with disabilities in emergency preparedness situations such as Hurricane Katrina in New Orleans, a report noted.

Gordon has also been active in the deaf community, becoming the vice president of the National Black Deaf Advocates in 2004 and receiving the Paul G. Hearne/AAPD leadership award from the American Association of people with disabilities. The Black female attorney is today among many people with disabilities who, instead of resigning to their fate, have chosen to work on their limitations to make something of themselves. Currently, in the U.S., more than 5.6 million African Americans live with a disability. Out of this figure, only 28.7 percent of working-age are employed.

Gordon, who has been mentoring young adults with disabilities, hopes to change the status quo. “I have an innate desire to give back. It is uplifting when you are able to empower another and help someone discover a sense of self-worth and confidence in his or her abilities.”