In our series, Beauty with Brains, we focus on a healthcare practitioner who has come up with a simple idea with revolutionary potential in the maternal health sector. Her innovation tracks pastoralist expectant mothers for crucial pre antenatal care services. Her idea is currently being piloted by Ministry of Health, Marsabit County in collaboration with Strategic of Northern Development (SND) in 10 hard to reach villages in Moyale Sub- County. She is a Grand Challenge Africa grantee, Under Africa Academy of Science.
Tell me about yourself?
I am Dahabo Adi Galgallo, a resident of Marsabit County currently residing in Moyale Sub – County, Marsabit County. I am the only daughter in a family of seven born to late Adi Galgallo (Godho) and Mama Jillo Adi, married and a mother of one. I began my primary school education at Saku primary school Marsabit County and completed in Gil, Nakuru County. I started my secondary education at Manuga girls in Nyandarua and finished at Moi Girls high school, Marsabit. I have a Diploma and degree in Medical laboratory science from Kenya Medical Training College (KMTC) and Kenya Methodist University respectively. I recently obtained a Master of Science degree in Field Epidemiology at Moi University under the Kenya Field Epidemiology and Laboratory Training Program (K-FELTP).
Your innovation has won you accolades both in Kenya and elsewhere, tell me in simple way, how it works?
Our innovation of tracking expectant pastoralist mothers is being implemented as Integrated Maternal Mobile Health (IMMH) programme in partnership with the Strategies for Northern Development (SND) – Kenya. The innovation entails a coin sized, water proof solar powered GPS gadget fitted in a culturally accepted, bead bracelets. The GPS gadget is linked to a satellite that communicates to us the location of the tracked expectant mothers through a computer and an android application, allowing us to reach our mothers within and without cellular network zones. Through this we are able to pin point the mother’s locations prior to our outreach service delivery. This helps in identifying strategic point to where we can set up our outreach camps in ten designated sites where health services, more so, lab services (a critical component of ANC services) are inaccessible and inadequate, within Moyale Sub-County. By utilizing this gadget, we are able to ensure the four mandatory ANC visits as recommended by the WHO are met.
ANC profiling which is at the heart of our project is an important component in reducing infant and maternal mortality. ANC laboratory profile simply entails the following basic tests; Blood, Stool for Ova and cyst, HIV, Hemoglobin level, Blood grouping, VDRL (syphilis screening), and Urinalysis, in addition we do Hepatitis B and C tests. Most of our mothers miss this test due to factors including illiteracy, inaccessibility of health facilities and inadequate laboratory services. In the course of the project implementation, IMMH has expanded its services to include post natal services i.e. immunization up to nine months and nutrition screening.
Where did this passion to deal with prenatal care come from?
I am a mother of one who has also has experienced miscarriages. I have lost friends through pregnancy related complications which has had a great impact in my life. This in turn pushed my zeal towards resolving infant and maternal deaths and has continued to be my drive.
In 2016, I was the sub county lab coordinator at Moyale where I had access to data and with basic training in epidemiology I could collect, analyze, interpret data and give recommendations. I put systems in place, like computers where data can be stored. I then became interested in maternal health.
I looked at the number of mothers coming for ANC tests at our lab, after this analyzing I saw that most mothers who came for the tests were only those within Moyale Township. And I asked myself where the other mothers were going to? I went to collect the maternity register and looked at the outcome of the deliveries, whether mothers and babies were both alive. The 2016 data at Moyale general hospital showed that out of 1047 mother who delivered there were no record of the status of maternal mortality. Record of infants deaths revealed that out of 1047 babies 116 died at birth. This led me to another question. Where did the mothers who lost their children come from? and I realized that quite a number of them came from far away villages .That out of the 116 mothers who lost their babies, about 50% had not received any antenatal care profiling, even the other 50% received less than 2 ANC lab visits during their pregnancy. This was alarming, the World Health Organization recommends that all expectant mothers need to receive at least four antenatal care profiling. I then looked at the DHIS- District Health Information System which gives the number of ANC visits made by expectant mothers and this too showed very low figures. Our mothers were missing out on antenatal care during pregnancy. The Burden of Maternal and Infant Mortality in Marsabit County: Infant mortality rate in Marsabit County stands at 47 deaths for every 1,000 births against the National rate of 40 deaths for every 1000 Births (KDHS 2014). Maternal mortality stands at 1,200 for every 100,000 against the National average of 488 maternal deaths for every 100,000(KDHS 2014)
Those were quite high figures. What did you do with this revelation?
I began asking questions on why mothers were not coming to the hospital for ANC care. A larger number of the mothers said distance was a big issue and as a result transportation to the hospitals was quite high. There were a host of related issues, from illiteracy, ignorance, costs and time involved. I presented my findings to the Sub County Health Management team but they could not help me much due to lack of resources. I then went to the County for the Quarterly maternal review meeting where I presented the data and gave recommendations that instead of asking expectant mothers to come to the hospital a lab outreach should be started. As a result we started an outreach program including Laboratory service.
Did this immediately solve the problem?
It revealed other existing challenges because with our lab outreach campaign. We saw that about 55% of the 815 mothers from our laboratory ANC analysis were anemic. And most of the delivery emergencies were as a result of blood loss. When such an emergency happens, because of the lack of a blood bank, we almost always referred them to Marsabit. Even Marsabit had no blood bank and the patient had to be rushed to Meru and Isiolo for blood transfusion. Crucial time was lost in saving the mother. So we started sourcing for blood locally. Before I left for studies in September 2016, we had sourced over 200 pints of blood which could easily save 200 mothers. This saved a lot of lives.
How did your ideas evolve from these challenges to the provision of GPS as a solution?
The solution to reducing child and maternal death was ANC care and we had data backed evidence over this but our lab outreach to the villages to give the simple ANC to expectant mothers ran into another challenge. While we had the full support of the County Government and NGOs like concern and committed personnel in visiting the villages after every one month. We would visit the sites and find new mothers and the next time we would visit the place, they were a no show. This was disappointing and really frustrated me and I thought that it was an end to the lab outreach program.
Luckily Center for Disease Control (CDC) in conjunction with Kenya Government gave me a scholarship to study Epidemiology at Kenya Field Epidemiology and Laboratory Training Program (FELTP). During this training I started to look for grants to ideas on how to reduce maternal and infant mortality. With my data and experience in Moyale and the lab outreach, I did a two page concept while working with my Mentor Dr James Ransom.
Again while we had a data backed challenge we had no workable solution in my concept. Dr James Ransom asked me to think about the solution to the challenge. One evening while watching a movie with my son I saw something on tracking and the idea immediately clicked! What if we used GPS to track our expectant mothers for the ANC profile visits? What if we made culturally acceptable GPS bracelets? I knew that with this we would know where our expectant mothers were at any given moment and we would target them for our monthly ANC Lab outreach without missing them.
I shared the idea and finished the concept, submitted to the Grand Africa Challenge from the Bill and Melinda Gates Foundation. Our idea was successful and we were given the fund to go ahead with the project, we received 10 million for a 2 year research phase which is how our project begun. We designed the GPS bracelet and deployed it to 10 far to reach villages within Moyale targeting people who really needed the service. We enrolled 168 expectant mothers by February, 2018
According to statistics Marsabit County leads in maternal deaths due to birth related complications. What can be done about this?
Most maternal deaths in Marsabit County are due to PPH- Post Partum Hemorrhage, which is basically blood loss during delivery. In Marsabit county there is no single blood bank. Blood can’t be bought. Our mothers are dying because of lack of blood transfusion. The establishment of a blood bank and a vibrant antenatal and post natal care program that includes lab services is recommended as a matter of urgency.
It is in line with the provision of a vibrant free pre and post natal services with complete lab services that IMMH is undertaking this research project with the purpose of analyzing and describing ANC profiles, laboratory outcomes and delivery status in the ten disadvantaged sites in Moyale Sub-County with the hope of sharing the research findings to influence decision and policy makers at the county and national governments
What successes and challenges did you encounter with your idea?
In the one and a half year since the projects implementation, the project has been able to reach about 250 expectant mothers ensuring the recommended 4 ANC visits were met with comprehensive lab services. More than 100 successful deliveries were made from these mothers and immunization of the infants ongoing with the rest still receiving ANC services. We have also expanded our services to the larger community members by providing them with free consultation, diagnosis and treatment in addition to important nutrition and critical health talks courtesy of the Marsabit County government.
The project has also been able to undertake emergency responses to distress calls among our mothers including but not limited to referrals and emergency evacuation.
Mobility to the sites due to poor road networks, intertribal skirmishes and cross border movements by our mothers prohibits us from delivering services to the enrolled mothers are some of the major challenges experienced in the projects goals.
How many people have benefited from your innovation so far?
This being a pilot project, we have 51 mothers identified as the sample size and fitted with the GPS. However, it might not be possible to quantify all the indirect beneficiaries given the diverse platforms the project has used to designate the idea within and outside the country.
What’s the scaling up potential for this innovation in this region?
There is potential for up scaling the project within Marsabit County, to other pastoral counties in Kenya and outside the country to remote regions with similar challenges. However, this being a research project much is dependent on data generation to indicate the project’s success. We are getting impressive results, majority of the mothers with GPS bracelets have safely delivered with proper ANC care women can safely deliver with very few complications. The GPS idea offers unlimited possibilities. So far it has shown us where women gather during water shortages we have seen them gather at water points, during the Moyale war our tracking devices shows the mothers along the road. Information of this kind is important and can inform development practitioners and policy makers where to invest. If you want to build a new health facility you can draw on these kinds of data analysis to show where to best locate the facility. With the right kind of strategic vision we can make this county zero maternal death by simply taking ANC profiling to each village and to every expectant mother. In other sectors too, for instance livestock, can be tracked to curtail cattle rustling.
Marsabit County Government often speaks about huge investment in the health sector, state of the art maternity, we have seen plans for a medical training college, perimeter walls around hospitals etc etc. Are such huge investments the solution to the challenges in the health sector?
While the huge investments in the county’s health sector might be true, that does not necessarily translate to immediate solutions to the pressing health needs. Simple solutions and embracing of innovations like the GPS tracking devices would go a long way in enhancing accessibility to quality health service delivery. As we move forward, we need to continue to focus on both long term, medium and short term solutions to the pressing health needs. Importantly, we need to focus on research to provide solutions to our health care management. We should never shy to challenge existing conventional wisdom to try new ways and strategies to tackle the perennial health challenges. Small kitties to support locally based research would generate knowledge and solutions of the health challenges within the context of our county.
In the short term what can the county government/Ministry of Health do to reduce the high child and maternal mortality rates in Marsabit County?
There is need to identify the vulnerable groups and areas so as to have tailor made solutions to fit their situations. There is need to scale up both Ante and Prenatal services to reach the most marginalized and the poor with the critical ANC services. However, it is important to note that ANC services alone would not reduce infant and maternal deaths. There is need to have other support services like blood banks and to centralize this to serve other areas in the peripheral.
Any parting messages for Marsabit residents?
Problems bedeviling Marsabit County can only be solved by people of Marsabit and no one else. It is time we put our deference’s and embrace our diversity for the wellbeing of our county. It is time that health is given the seriousness that it deserves. One life lost is too many lives lost. It is time for our elites to come home and build our county in whichever field they have expertise on.
“HORRA, BULAA, DEEBANA”
Do you know someone doing some good work for the communities in Marsabit county? Do you want their stories shared with the world? Share their their names and contacts with us.