NAIROBI, 18 March 2011 (IRIN) - A go-slow by nurses at Pumwani Maternity Hospital in Nairobi's Eastleigh area has exposed serious challenges at Kenya's largest maternity hospital, with officials calling for urgent intervention to improve services.

"Working conditions at the hospital remain deplorable," Festus Ngare, secretary-general of the Kenya Local Government Workers' Union, which represents the nurses, told IRIN on 17 March. "Although we have reached agreement with the hospital's management on some of the issues and others are still pending, the working environment at the hospital is a major concern for all."

The 180 nurses at the hospital staged the go-slow on 16 March to protest at being overworked and the withholding of their uniform and other allowances by the hospital's management.

Ngare said: "As a matter of urgency, the [Nairobi City] Council should have not less than 30 doctors and not less than 100 nurses posted to the hospital immediately to help ease the workload. At the moment, some nurses find that after working a 6pm to 8am shift, there is no one to relieve them. They find themselves working for many more hours and this is not only a danger to the mothers and their newborn babies but a danger to the nurse herself."

According to Pumwani's chief executive officer, Fridah Govedi, the hospital delivers an average of 80-100 babies daily, 20 of them by Caesarian sections. Ideally, she said, there should be one nurse for four patients but in Pumwani one nurse can serve up to 20 patients.

She said the hospital had two full-time doctors. Doctors from the Nairobi City Council's district-level hospitals are often called in to help, Govedi added.

"What we need is support to boost personnel so we can improve the work environment," Govedi said. "We lack specialized reproductive health delivery equipment such as foetal monitors; there is poor laboratory support and we rely on old equipment most of the time. The hospital started operations in 1926 and relies on donations for any new equipment."

She said there was only one resuscitation machine for newborns. "Although we encourage skin-to-skin contact as soon as possible, it is sometimes difficult when up to three babies need resuscitation at the same time."

Govedi said although there were three operating theatres, only one ran effectively because Pumwani lacked comprehensive obstetric care facilities, such as a blood transfusion unit. "We rely on the National Transfusion Unit and we sometimes lose mothers because it can take time to get the blood to a patient."

She said besides support for personnel, infrastructure development and a blood transfusion unit, the hospital required support for its midwifery school to enable the hospital to become a comprehensive reproductive healthcare one-stop facility.

"We are willing to partner with any donor organization to improve Pumwani," she said. "We have the city council's go-ahead to engage one-on-one with donors and we have even launched the Babies of Pumwani Initiative, with the aim of getting all those who were born in Pumwani to come back and see that standards at the maternity hospital have improved."

Pumwani, run by the Nairobi City Council, is a public health facility, and often waives the Ksh3,400 (US$42) charge for normal delivery and Ksh6,000 ($75) for Caesarian sections for the most vulnerable.

Ultimatum

Govedi said the allowances issue raised by the nurses would be solved at month-end when they would receive their arrears with their salaries.

Achieng*, who delivered her baby on the day of the nurses' go-slow, told IRIN: "I gave birth at 8.25am with the help of trainee nurses; things were really bad for many of us on that day. Whenever I called out to a nurse, they would refuse to attend to me. It is only later that I learnt that they were on strike.

"Although my delivery was normal, I don't know yet when I will go home, I have been in the hospital now for four days; I don't know whether this has anything to do with the action by the nurses but I am glad that today they are back at work."

Ngare, the unionist, said the nurses had resumed work but the union had given the hospital's management until 24 March to solve their grievances. "If they have not done anything, then we'll issue a proper strike notice and this won't be good for the poor women who seek to deliver their babies at Pumwani."

According to the 2008-2009 Kenya Demographic and Health Survey, Kenya's maternal mortality ratio for the 10-year period before the survey is 488 maternal deaths per 100,000 live births.

Source: The Integrated Regional Information Networks (http://www.irinnews.org )