MARION KAPLAN / CAMERA PRESS

On call 24 hours a day at a maternity clinic in a Ghanaian village,
Alice Oppong is a busy woman. She found time to talk to Ajoa Yeboah-Afari.

It is a quiet Saturday morning at the maternity section of the Prampram Kotoka Health Post. Prampram – population about 8,000 – is a small fishing town on the Atlantic coast in the Greater Accra Region of the West African country of Ghana.

Sheep are grazing in the Outpatients Hall, which is empty except for a couple of women who sit chatting on one of the wooden benches. Neither of the women shows any sign of pregnancy so they must be relatives come to visit, if the unmistakable crying of a new-born baby from inside the building is anything to go by.

A visitor who asks for the midwife is told she’s just popped home but is expected soon. Minutes later she bustles in, all smiles and apologies, and goes to check on the new mother, who has been delivered of a baby girl at dawn. Since this is a Saturday the baby’s ‘day’ name will be Ama. In almost every part of Ghana there are female and male names for children for each day of the week, to which other names and a surname are later added.

The midwife, Alice Oppong, invites the visitor into her small consulting room to talk about her work. She has been a midwife for five years, and was transferred to Prampram only six months ago. Her husband and three children living in the nearby harbour town of Tema cannot move to Prampram – instead, they visit every weekend. She can’t go to see them because at present she is the only midwife at the health post, and so is on call 24 hours a day. There should be at least two midwives, even three, but unfortunately the others are on sick leave. She originally trained as an Enrolled Nurse, but after working for 15 years she was eligible to apply to train as a midwife. ‘With my background it means I’m able to lend a hand at the clinic when necessary.’

Blessed with electricity
Although Prampram is only an hour’s drive from the capital Accra, and blessed with electricity, it is still a rural community with its share of rural problems. Two of these are poverty and a high birth rate – which are also national problems. Ghana’s population is currently estimated at 17 million, of which some 70 per cent is rural. Official sources put the population growth rate at 2.6 per cent, but other sources believe it is over 3 per cent, with the highest rates in the villages.

‘They really like having babies here,’ Oppong says, ‘which means a lot of work for me. But I don’t mind because that’s the best way for me to get more experience.’ Sometimes there are three or four births a day – this includes patients from the surrounding villages which make up the 17,000 population of the Prampram health district. She has no explanation as to why so many babies are born in Prampram, but considers unemployment to be quite important.

Few of the women have sources of income other than being dependent on a man. ‘It’s basically a fishing community,’ continues Oppong. ‘In the past education was not a priority. Thus they marry at an early age and start having children immediately. Also, the incidence of divorce is high and the women habitually have children as soon as they enter a new relationship.’ Perhaps this reflects the women’s strategy of ‘cementing’ a new relationship to guarantee the man’s financial support. Oppong adds that in some polygamous marriages there is rivalry between wives to see who can bear more children for the husband.

photo by AJOA YEBOAH-AFARI

In her view the traditional birth ceremonies and practices also serve as an incentive. According to local custom, two weeks after the birth the baby is ‘outdoored’, brought outside for the naming ceremony. This is when the husband gives his wife presents – including, in some cases, a substantial sum of money – to show his love. The ceremony is sometimes given a touch of carnival, the family processing through the town with the husband’s gifts on proud display. The flip-side is that this is usually the last time the wife will receive any significant sum of money from her partner, until she has another baby.

Oppong says it’s not strange to find a 25-year-old woman with six children, particularly among those who are illiterate. Only educated women tend to come for family-planning advice and service. ‘However, we’re doing our best. The Community Health Nurses also visit people at home and talk to them about it. We tell them that even if they don’t want to stop having more children, they should consult us on how to space births.’

A woman brings a week-old baby with an infected umbilical cord. Oppong explains, as she applies medication, that new mothers are given medication for dressing the cord when they’re discharged, and normally the cord stump falls off within two weeks. However, because of their anxiety to ensure that it will fall off and heal before the all-important ‘outdooring’ ceremony, the women apply their own herbal preparations, or a home-made salt solution, which often leads to infection.

There’s the sound of laughter outside, shouts; a voice calling the midwife. She goes out and returns followed by a very pregnant, sheepish-looking middle-aged woman in a shapeless outfit – obviously charity clothing from Europe. ‘Kwaale,’ Oppong says to her (this is not her real name), ‘go and lie on the bed and I’ll check how the baby is doing. You were trying to avoid me but God has shown you up. I’ve told you that you won’t be asked to pay any money, so why are you running away from me?’ Kwaale had been stealthily walking past the clinic when she was noticed by someone who knew that the midwife had been looking out for her. ‘This should be your last delivery, Kwaale, you’re not strong enough to have another baby.’

Kwaale agrees. ‘I feel so tired, I’m tired all the time, and when I walk my heart pounds so.’ She has borne eleven children but only five have survived. There’s a Safe Motherhood programme in place in Ghana which seeks to reduce child- and maternal-mortality rates by half. Every year the Ministry of Health organizes nationwide campaigns to vaccinate children against childhood diseases.

Kwaale is given some tablets. After telling her the dosage Oppong makes some marks on the envelope with a pen to help her remember: two vertical lines, a dash and two more lines mean two tablets twice a day.

The standard charge for delivering at the health post is 2,200 Ghana cedis (about two US dollars). Generally the patients pay, even if some of them have to wait until their men return from their fishing trips. There are a few like Kwaale who simply cannot pay, even though they continue to have children by ‘invisible’ men. Oppong says she has no information at all about Kwaale’s husband. ‘Such people have to be given free treatment to ensure a safe delivery, because if they have a difficult labour the problem will land on my doorstep just the same.’

But the standard fee applies only to normal delivery. If extra treatment is required, patients pay extra. ‘And sometimes we don’t have all the drugs they need,’ says Oppong, ‘so we give them prescriptions and they go to the nearest big town to buy the medicine’.

Intimidated
Serious cases are referred to the Tema General Hospital. But Prampram patients hate going to Tema since they feel intimidated there, not to mention the expense of hiring a taxi for about 5,000 cedis. ‘They usually insist I should do my best to treat them here,’ says Oppong. The clinic once had a vehicle, supplied by the ministry, but it has been broken down for months. ‘Lack of transport is one of the biggest problems we face,’ she says.

What does she do in her spare time? She laughs. ‘I have no spare time; I have to be on call all the time. When I get some breathing space I rush home to do my household chores...’ Does she enjoy her work? She smiles. ‘Oh yes; I’m happy. In any case I don’t think I can learn something else now; I can’t go back to school!’

At this point one of the women comes to tell her that the new mother is feeling cold. Before she can go inside a young woman comes for ante-natal advice, but minus her clinic card which she has forgotten, and has to be helped to remember her last visit... The visitor decides that it is time to go.

Ajoa Yeboah-Afari is a freelance journalist based in Accra. A former Deputy Editor of the Ghanaian national weekly, The Mirror, she reports, among others, for the BBC African Service and West Africa magazine.