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Thandeka Moyo
IN a brightly lit sitting room in Bulawayo’s Cowdray Park suburb sits a worried father, clad in his worksuit after a long day’s work.

Minutes go by and still Chamunorwa Makombe cannot get enough of the woman in the big picture frame in front of him.

Samantha Sungirai Mutungwazi’s smile reminds him of the happy home he had before her unfortunate demise. She died while giving birth at Mpilo Central Hospital on April 14, 2012.

Not only did his wife add to Zimbabwe’s high maternal mortality rate statistics, but to him she stands as proof of a growing trend — women who die due to negligence.

“Her death cost me all I had. I pray that one day I find strength to forgive the Mpilo staff for denying my daughter a chance to have a mother in her lifetime,” said Makombe, his breaking voice betraying his bravado.

“My heavily pregnant wife bled for more than seven hours on that fateful day. We went to Mpilo at around 10AM and although doctors and midwives recommended an urgent operation, she only went into theatre at around 6PM.”

Makombe said he knew that most maternal deaths in Zimbabwe were caused by lack of trained personnel. “After doing everything by the book and avoiding backyard delivery rooms, my wife still died at the hands of professionals.”

“I miss her every day and the trauma her death caused me and the family will be forever felt. It’s been three years and I still can’t stomach the pain. I wonder what I’ll tell my daughter when she starts demanding the truth”.

Makombe’s misfortune was taken to court, an inquest into his wife’s death was opened as he sought answers which he did not get from the medical staff that attended to Mutungwazi.

After the five-month enquiry, the coroner Magistrate Chrispen Mberewere concluded that Mutungwazi’s death could have been avoided.

“It’s the excessive loss of blood prior to the operation that stands out as the major cause of Sungirai’s death. The cause of delay was the system of prioritising emergencies being done at Mpilo,” said magistrate Mberewere in his ruling.

“The system itself is a result of deficiencies in the health sector, both at Mpilo and in the national health delivery system. She was a victim of systematic failure and the system must take responsibility for such tragedies.”

Acting Mpilo chief executive officer Dr Leonard Mabandi confirmed that in the hospital, just like any other government run medical institution, most theatres were dysfunctional.

Dr Partson Maphosa, who attended to Mutungwazi, was one of the witnesses during the inquest and he said Mutungwazi died due to negligence.

“I was called in to help her deliver at around 6PM and by then we had already lost the battle. In an ideal situation or in a medical system functioning normally and in terms of World Health Organisation (WHO) guidelines, she was supposed to be taken into theatre in about 10 minutes or at most an hour after she came into the hospital.”

A post mortem document submitted before the court shows that Mutungwazi died due to a C-section operation, hemorrhage and pregnancy induced hypertension.

“We would like to apologise to the family and the rest of the country for Mutungwazi’s death as I believe a lot could’ve been done to save her life,” said Dr Maphosa during the inquest.

He added that there was only one theatre room in the maternity ward where they vet the conditions of women to determine who will get in first.

Samantha’s inquest is not the only case of negligence-related maternal deaths at Mpilo Central Hospital, a referral hospital which caters for three provinces in the Southern region of Zimbabwe-Bulawayo and Matabeleland North and South provinces.

The World Health Organisation defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

According to the 2014 Multiple Indicator Cluster Survey (MICS), Zimbabwe’s maternal mortality rate stands at 614 deaths per every 100,000 live births and hemorrhage has been identified as the leading cause of maternal death.

Zimbabwe’s maternal mortality rate stood at 960 deaths per 100,000 live births in 2010, according to the World Bank.

In The Trends in Maternal Mortality Study: 1990 to 2013 by the United Nations Population Fund, the United Nations considers a maternal mortality ratio of less than 100 as low, between 100 and 299 as moderately low, and high when it is 300 to 499.

A local activist, Thandiwe Ndlovu blasted the hospital for conducting a lot of Cesarean-section operations without the capacity to sustain the lives of the pregnant women.

“I was talking to some teenagers who are alleging that the hospital is forcing them to give birth through the C-Section so they pay more money. It’s scary to think one can survive lack of proper equipment, blood shortages and unavailability of theatre rooms at Mpilo.”

Ndlovu added that the government must ban the hospital from conducting C-Sections till it acquires standard equipment to cater for women.

Dr Mabandi, however denied that Mpilo is cashing in on C-sections saying it is a health institution for the poor.

“Mpilo is for the poor and how would one get rich by targeting the poor. In most cases the condition would be life threatening where both the mother and the child could be lost.”

A midwife employed at Mpilo who spoke on condition of anonymity said they are forced to work with what they have as the government is failing to sustain the maternity ward.

“Nothing seems to be properly working in the maternity ward. It’s either the ventilator or some other machinery is down, or there is no blood set aside for emergencies. We’ve accepted these conditions and the least we can do with limited resources is to save lives,” she added.

She said a normal delivery costs about $50 while giving birth through C-section at Mpilo costs an average of $350.

Caleb Mutandwa from Justice for Children Trust, said children who grow up without mothers show signs of having lacked proper guidance as they grow up.

“Such a child who is deprived of the right to a family that cares and loves her, faces challenges in accessing birth registration, and may be subject of family disputes for instance in custody matters,” he said.

Mutandwa added, “Many in African culture would prefer that such a child be taken by the maternal relatives yet the law on custody now prefers the father to retain or have custody”.

In July 2009, Margaret Chiduku, the then permanent secretary in the Ministry of Constitutional and Parliamentary Affairs, died after giving birth at the Avenues Clinic.

Preliminary investigations suggested she could have died due to negligence by hospital staff, her gynaecologist or both.

Parliamentary Portfolio Committee on Health chairperson, Dr Ruth Labode said losing one’s mother during birth is disastrous for children.

“Mothers are an essential part of every human being and no one can sacrifice for a child’s well-being like mothers do. Babies need to breastfeed for two years and that means the loss of a mother jeopardises one’s health development,” said Dr Labode.

She said hospitals must thoroughly investigate maternal deaths and take tough action on negligent professionals to deter likeminded health personnel.

“Notable is the fact that children who grow up without mothers may be subjected to some form of abuse later when the father remarries. We need to ensure all mothers live to see their babies grow.”

Dr Mabandi said the hospital does 11 C-sections and 30 normal deliveries daily.

Zimbabwe is signatory to a number of international instruments that obligate the State to halve maternal mortality by this year but still 15 women die every day while giving birth.

Dr Mabandi said of the 3,253 births recorded at Mpilo Central Hospital since the beginning of 2015, only four women had died.

“Theatres are just standard with ordinary equipment like anaesthetic machines, monitoring and suction machines. Obviously like any other institution in the country not all our theatres are working and we’re making efforts to make them work to reduce the pressure,” he said.

The Director of Family Health in the Ministry of Health and Child Care, Dr Bernard Madzima said the Ministry investigated every maternal death though he could not readily give the outcome of investigations into Mutungwazi’s death.

“As for health professionals who cause the death of patients, the Ministry has guidelines in place that deal with such cases.”

However, contrary to what Dr Mabandi said, Dr Madzima maintained that there had been no maternal deaths recorded at Mpilo Central Hospital since the beginning of the year.

“Health workers are also continuously receiving on job mentorship to ensure that they deliver quality services. It’s the Ministry’s position that preventable maternal deaths should be reduced to zero,” said Dr Madzima.