'AKOM' IN THE MBU - WHEN A MOTHER SUDDENLY BECOMES A PRIESTESS

 

“Boss, you won’t believe what happened today!” Juliet, the indefatigable medical officer for the paediatric unit, exclaimed. I was on leave, but as her senior, she would call me to discuss complex cases. “What happened?” I asked. “One of the mothers at the Mother and Baby Unit (MBU) started dancing around in circles and chanting,” she said. “Really? Why?” I asked.

She then narrated what had happened. The son of this woman had been on admission at the MBU for a while due to the nature of his illness. As is usual in our setting, the relatives at home started asking questions. It was revealed to the mother that her sister-in-law was responsible for the baby’s illness and she needed to bring the baby home for rituals. The baby’s maternal grandfather, a fetish priest was the one going to perform the rituals, so they requested that the baby be discharged.

Unfortunately for the family, but fortunately for the baby, according to our laws, a child who needs medical care cannot be discharged against medical advice even if the parents request that in writing. The law expects the health worker to act in the child's best interest. If discharging a child would be harmful to him/her, the health personnel is to refuse such a request. Thus this mother’s request was refused as the baby still needed inpatient care. When the news got to her, she was livid! A few hours later, she started dancing in circles and chanting some intelligible words as though she was possessed. Who knows perhaps she was. She is her father’s daughter after all. A lot of things followed after the fetish dance, I was told. My Boss said later that she was faking it. We may have to ask him how he knew.

The reality

There are times when relatives would come and demand the discharge of babies. Sometimes, health workers who refuse these requests are verbally or physically assaulted. There have been incidents where mothers have even forcibly disconnected babies from oxygen and intravenous medications, and threatened to curse staff should they dare to come close.

The causes

Physical and emotional exhaustion is one cause. The MBU is one of the units in hospitals where patients can stay for a long time due to the nature of their ailments. When caregivers have to be in an environment that limits them in many ways, it can lead to emotional and physical exhaustion. An emotionally and physically drained person can sometimes act irrationally.

Financial strain is another cause. Even though the national health insurance scheme takes a chunk of the financial burden off parents, there are still times when parents are required to purchase medications not covered by insurance in community pharmacies. Some investigations such as echocardiography and CT scans or MRI may also not be available in the facility and have to be paid for. This takes a toll on their coffers and can affect how they behave.

When relatives lose hope in a ward getting better, they can also act irrationally, especially when asked to make further financial commitments. Many people are used to patients recovering after a few days of admission. When their ward has to do more than a week, they begin to believe that the child may not survive and any effort is a waste of resources.

We cannot overlook cultural norms and traditions. In this part of the world, family leaders and the elderly are respected, and they may be the ones making the decisions, not the parents. Parents also tend to listen to them more than the health workers.

Certain psychiatric conditions become worse or more evident after delivery. Depression, psychosis, and anxiety may become florid after delivery and can also make the mothers act irrationally.

Inadequate counseling or information to caregivers and other stakeholders can also be a factor. There was a time when we requested to speak to the grandmother of a baby whose mother kept pestering us with discharge for the baby. Her reason was that the baby needed to be cared for by his grandmother. After thorough counseling of the grandmother in the presence of the mother, she understood the need to keep the baby on the unit and the mother never bothered us again with requests for discharge and was very cooperative until the baby was finally discharged. I could go on and on.

 

How do we reduce these incidents to the barest minimum?

Communication!!! Health workers must move in the direction of family-centered care. Parents and stakeholders must be adequately involved in the care of their children or wards. They must be given adequate information about their children’s condition. Updates on the condition should also be timely. We must give them a listening ear even if we do not agree with their suggestions. Sometimes the only time we communicate with caregivers is when we are instructing them to buy medication or do something for the baby. This should be a thing of the past. Many a time, the counseling given on a condition should be repeated because they may not have understood it the first time.

We must also pay attention to the health needs of the parents or caregivers and refer them to other health professionals such as physicians, psychologists, and psychiatrists when necessary. 

Though our insurance scheme reduces the financial burden to some extent, more needs to be done. We must start researching sustainable ways of absorbing the entire cost of care for children as a country. We will continue to also call on benevolent groups to continue to make donations in kind and cash to support the care of children. Every health facility should also have a children’s emergency fund where children who require urgent care can still receive it even if they were brought in by a Good Samaritan.

We must keep educating the public on health conditions particularly the ones affecting newborns. Ghanaians love to shroud newborn diseases in mystery. I call on health workers to demystify newborn diseases. Every newborn disease our lay minds cannot explain is “asram” and requires a spiritualist. This has to change. Although certain myths are ingrained, with regular education, people’s mindsets will gradually shift in the right direction.

We can also work towards making our hospitals friendlier for parents. I have worked in some hospitals where mothers of newborns have had to sleep in plastic chairs. They also witness unpleasant procedures being performed on their children. Caregivers are already anxious when their wards become sick because of the fear of the unknown. That in itself causes emotional stress. If the environment is unfriendly and health workers are harsh, it can worsen their state.

Solving these problems may appear daunting, but we can start with the low-hanging fruits. Some of the interventions don’t even require material resources. Take communication for example, it requires an attitude change and training.

Parents and guardians are encouraged to ask questions. They must patronize programs aimed at broadening their understanding of diseases. When a parent/caregiver is on the same page as the health workers, it makes the work easier and more effective. Let us brighten the corners where we are for a collectively brighter world.

Dr Gloria Amponsah-Kodua

Paediatrician specialist

Acknowledgment

Dr Akosua Omenaa Boateng