Cycles of powerlessness: How can we improve the health system?
By Dr. Hamisi Kigwangalla
I woke up today reeling from nightmares of what is happening to poor people in Tanzania. I was recently in Tabora conducting research on reproductive health, where I had an opportunity to interview a man who consented to participate in our research. He willingly agreed to share his experiences on the barriers to accessing reproductive health services. His distressing story illustrates the experience of many people across the country.
The whole story starts with this beautiful young lady who got married to this fine young man. The woman got pregnant after some time. She went to the nearby antenatal clinic for care and was advised by the health workers there to go to Kitete general hospital for delivery. But due to lack of finances the family decided not to go to Kitete and rather to go to a traditional birth attendant.
Unfortunately, when the day came the woman didn’t immediately notice that she was in labour. When she finally realized and told her mother-in-law, she was told to just wait and be strong, because she is a woman. So she waited. At night, the pain became aggravating and grew stronger and stronger. She woke her husband, who was fast asleep and drunk, but he assured her everything was alright and that she should wait as his mother had earlier said, because she knows better.
Finally, he noticed his wife groaning and struggling. They quickly awoke the whole family and took her in a cow-pulled cart to the traditional birth attendant, where they were confident that they will receive delivery services. When the traditional birth attendant came and examined the lady in the cart, she quickly noticed that the head of the baby could easily be seen. Upon further examination, she noticed that the woman had twins and that she had lost a lot of blood. Realizing she could not help, the birth attendant told them to rush to the nearby dispensary. It was very late at night and not even a single car passed that way. Suddenly the woman became too tired even to cry. Her movement decreased. The situation was desperate. The husband was sobbing and his cheeks were full of tears. Everyone was quiet, perhaps begging mercy from God. When the midwife was awakened, she quickly jumped off her bed and went to examine the woman. She noticed the woman had twins, had lost a lot of blood and that both the mother and babies were distressed. She opted to call the ambulance from Kitete and at the same time to infuse the patient. She knew she could not be of any further assistance.The poor woman struggled to wait for the ambulance to no avail. The husband sat beside his wife, weeping calmly, his heart full of guilt. As minutes passed, he became aware of the reality that his wife was dying. No sooner than the ambulance arrived, the woman passed away. This is a testimony from the husband.
To this moment, he still cries for his dead wife and twin children. He lost the three most important people in his life in one day. I listened to the story with a chill, as I became aware of the multiple barriers that so many people in this country have to face. These barriers contribute to “cycles of powerlessness.”
The first cycle is within the individual; he or she has to be liberated and enabled to demand for his or her rights. This entails a person who is confident and can make decisions about his or her life and his or her children. Unfortunately many people – especially women – remain trapped in this cycle by a lack of information and autonomy.
Second, a person must overcome barriers imposed by people who have the most direct influence over their lives; i.e. their in-laws and their own families.
Third, there are barriers imposed by the social environment (community) and fourth by the health system. All these barriers create a cycle that is difficult to break – particularly for poor women.
These barriers reflect the obstacles to achieving health equity for women and children in Tanzania. The fact that about 80 percent of Tanzanians live in rural areas, and that more than half of all births occur outside health facilities, compels a strong case towards reforming the health system. We must target improvements in primary health care in order to improve the security of the poor majority living in rural areas. The Government should direct more resources to strengthening primary health care services bringing them closer to the people. Will the budget that is going to be tabled next month in Parliament reflect this?
Dr. Hamisi Kigwangalla is an independent public health consultant and social justice activist. Call 0715636963 or Email
By Dr. Hamisi Kigwangalla
I woke up today reeling from nightmares of what is happening to poor people in Tanzania. I was recently in Tabora conducting research on reproductive health, where I had an opportunity to interview a man who consented to participate in our research. He willingly agreed to share his experiences on the barriers to accessing reproductive health services. His distressing story illustrates the experience of many people across the country.
The whole story starts with this beautiful young lady who got married to this fine young man. The woman got pregnant after some time. She went to the nearby antenatal clinic for care and was advised by the health workers there to go to Kitete general hospital for delivery. But due to lack of finances the family decided not to go to Kitete and rather to go to a traditional birth attendant.
Unfortunately, when the day came the woman didn’t immediately notice that she was in labour. When she finally realized and told her mother-in-law, she was told to just wait and be strong, because she is a woman. So she waited. At night, the pain became aggravating and grew stronger and stronger. She woke her husband, who was fast asleep and drunk, but he assured her everything was alright and that she should wait as his mother had earlier said, because she knows better.
Finally, he noticed his wife groaning and struggling. They quickly awoke the whole family and took her in a cow-pulled cart to the traditional birth attendant, where they were confident that they will receive delivery services. When the traditional birth attendant came and examined the lady in the cart, she quickly noticed that the head of the baby could easily be seen. Upon further examination, she noticed that the woman had twins and that she had lost a lot of blood. Realizing she could not help, the birth attendant told them to rush to the nearby dispensary. It was very late at night and not even a single car passed that way. Suddenly the woman became too tired even to cry. Her movement decreased. The situation was desperate. The husband was sobbing and his cheeks were full of tears. Everyone was quiet, perhaps begging mercy from God. When the midwife was awakened, she quickly jumped off her bed and went to examine the woman. She noticed the woman had twins, had lost a lot of blood and that both the mother and babies were distressed. She opted to call the ambulance from Kitete and at the same time to infuse the patient. She knew she could not be of any further assistance.The poor woman struggled to wait for the ambulance to no avail. The husband sat beside his wife, weeping calmly, his heart full of guilt. As minutes passed, he became aware of the reality that his wife was dying. No sooner than the ambulance arrived, the woman passed away. This is a testimony from the husband.
To this moment, he still cries for his dead wife and twin children. He lost the three most important people in his life in one day. I listened to the story with a chill, as I became aware of the multiple barriers that so many people in this country have to face. These barriers contribute to “cycles of powerlessness.”
The first cycle is within the individual; he or she has to be liberated and enabled to demand for his or her rights. This entails a person who is confident and can make decisions about his or her life and his or her children. Unfortunately many people – especially women – remain trapped in this cycle by a lack of information and autonomy.
Second, a person must overcome barriers imposed by people who have the most direct influence over their lives; i.e. their in-laws and their own families.
Third, there are barriers imposed by the social environment (community) and fourth by the health system. All these barriers create a cycle that is difficult to break – particularly for poor women.
These barriers reflect the obstacles to achieving health equity for women and children in Tanzania. The fact that about 80 percent of Tanzanians live in rural areas, and that more than half of all births occur outside health facilities, compels a strong case towards reforming the health system. We must target improvements in primary health care in order to improve the security of the poor majority living in rural areas. The Government should direct more resources to strengthening primary health care services bringing them closer to the people. Will the budget that is going to be tabled next month in Parliament reflect this?
Dr. Hamisi Kigwangalla is an independent public health consultant and social justice activist. Call 0715636963 or Email
