Today, the story has changed. Years ago, there was a form of midwifery called Domiciliary Midwifery. This involves midwives who are attached to health posts, and who go from home to home, to encourage rural women to come for treatment and care that have been provided for them in specific places.
Margaret Olubunmi Akinsola - National Vice President, National Association of Nigeria Nurses and Midwives (NANNM)Rural means the very remote part of the city where civilization and education are hard to come by. When we talk about rural women, we are referring to women living in places where social amenities are not enjoyed.A rural woman finds it very difficult to access medical care. Many years ago, there was a form of midwifery called Domiciliary Midwifery. This involves midwives who are attached to health posts, and who go from home to home, to encourage these rural women to come for treatment and care that have been provided for them in specific places. Despite the many taboos and beliefs held by many of these women regarding certain diseases, these nurses/midwives were still able to persuade some of them to leave the perceived comfort of their homes and visit provided health centers, while also educating them on the dangers and complications of their ailments, and doing their best to allay whatever fears they might have.These days however, most of the hospitals in the rural areas cannot even be described - in quality of service delivery - as at par with the health posts and dispensaries of the olden days. This is mostly because of personal biases by certain people in the location and siting of these health posts.Also, untoward attitude of suppliers of equipment and drugs contributes to the decay. While it is recorded on paper that the supply has been commissioned, suppliers would refuse to supply said equipment and drugs for reasons best known to them, thus limiting easy access of these rural women to medical care. In those days, pregnant women came to health posts for routine checks because they were assured of some free drugs and consultation. What happened to that setup? Where are these health posts now?I could recollect vividly how we had to some times leave our duty posts to meet with these women in their hamlets and villages, allay their fears, and somehow create a trust-based relationship. We also educated them to dispel myths, taboos and beliefs attached to some diseases/illnesses, and brought them to realise that our job was to take care of them.Back then, the relationship between midwives and pregnant women was so strong that, it was difficult for them to miss one session of ante-natal care. All of these have however dwindled over the last decade or so.I think the problem is - like most social amenities (like pipe borne water, good roads etc) - the quality of midwifery has fallen drastically. Training schools are not what they used to be and as such, the quality or delivery has continued to dwindle. This is also very evident in the fall in the quality and quantity of equipment and facilities available for the use of these midwives.Many things have gone wrong these days. We now hear of midwives getting assaulted by the people they care for, health workers getting attacked at their various posts, rural immunization officials getting waylaid and sometimes killed while going about their duties, as well as mismanagement of funds meant for the provision of quality healthcare services by administrators at various levels.These days, midwives, for the most part, get little or no encouragement. There is also no training and retraining mechanism for midwives in order to enable them keep abreast of latest developments in the midwifery profession.Administrators and people generally, now show little or no interest in the quality of the service delivery given by health posts. Even patients have lost faith in hospitals - especially public hospitals - as many of them now see it as a waste of time because, for the most part these days, even public health workers in hospitals are more concerned about their own private practice.A sick patient in an equally 'sick' health post is not likely to get the quality of healthcare delivery required for him/her to get better.A sick rural woman prefers to go to the roadside chemists, because she thinks she'll spend less, than to go to hospital for proper diagnosis and treatment.Even more saddening is the fact that some of the pregnant women go to religious and traditional homes to deliver their babies because they can't afford the treatment and medication, only to be referred to the hospital when complications arise.In those days, pregnant women were given everything they needed in the hospitals at the point of giving birth, including sanitary towels, unlike now that every pregnant woman has to purchase every material she needs.Where are the boxes of vaccines that were once taken to villages so that the rural dwellers could be vaccinated against illnesses? Where are those health posts that once delivered quality healthcare in the rural areas at almost no cost to the patient? Where is the dedication and love; the passion for the profession that were once exhibited by nurses and midwives?Why is there such a huge disparity between health workers in rural areas and those in the urban areas? Why are the rural health workers not carried along in developmental ideas and initiatives targeted at health workers?These and many more, are some of the questions begging for answers, as we seek to figure out - and solve - some of the problems militating against proper healthcare delivery in rural areas.As we commemorate the International Day of the Rural Woman, government and other stakeholders need to motivate health workers, especially those in the rural areas, to improve quality of healthcare delivery available to rural women.Government should make sure that the best hands are employed and deployed to these areas to ensure higher and better quality of healthcare delivery. It should also provide uniform welfare for caregivers at all levels.There should be no disparity between a health worker at either primary, secondary or tertiary health institution either in remuneration or welfare.Government should also make these rural areas accessible, the health posts top quality, and make health care materials and equipment available.Health workers also need to take their jobs more seriously, and strive for ways to better themselves in the administration of their skills. These will ensure that the quality of healthcare received in these areas improves drastically, and the rural dwellers, both men and women alike, will be the better for it.