The test interview

I felt the test interview went well. Alusine worked well as an interpreter, and it was clear that he had done this before. His familiarity with Limba meant it was quite easy, and he was quite proficient in English (I'll be paying him £30 for the week). There is still the problem with accent, but this didn’t pose too much of a problem when I transcribed the interview. The transcription of the 20 minute interview took about 1.5 hours, so for 4 interviews each day, I imagine I would have to do 5-6 hours of transcription. This may be speeded up more as I get a bit slicker.

The interviewee was a male from a village, so not quite the perspective from the town that I need, but I still got some good data. This was only a practice run so it will not be taken into consideration.

Some of the knowledge about OF appeared to be correct. He knew that prolonged labour was a cause, and also attributed poor TBA (traditional birth attendant) practices to be a cause too. This is interesting as some TBAs (traditional birth attendants) have been trained to refer quickly if the labour is prolonged. On the whole though, they remain relatively untrained, and cannot deal with big problems. I will ask a more explicit question regarding TBAs involvement in some of the factors that cause delay in women reaching hospitals.

Some of the data supported the understanding that most women are ‘divorced’. Pressure is put onto them to leave the village, and are shunned by people due to their bad odour. I wonder how this affects the children she may already have. This is not a part of my study, but may be an interesting question. He also said that the pressure to leave the village and the stress experienced by the women drove some to suicide.
Although the interviewee knew that repair was possible, he felt sorrow and sympathy. I think this is fair enough. I would also feel the same.

Asked why women still give birth at home, he answered because TBAs are in their village, so they will seek their help first. This is quite logical as a part of the referral system that has been put in place. However, I wonder how long this can continue for. This sort of referral system in the UK does not exist, where women try to give birth at home first. However, for now, this seems to be the best option, to refer to hospital only if necessary, due to resource constraints. Inadequate referral is something that is troubling. Whether TBAs refer quickly enough… it may be a matter of pride or reputation to try to deliver in the home, rather than incurring costs for the family and community to send a woman to hospital, or the peripheral health units. Through informal discussions, I have learned that PHU staff may not refer onto hospital because they will not be paid for doing the work. A system of incentives must be provided to encourage them to refer, but then there is the problem of excessive, unnecessary referral to hospital which would threaten to over-burden stretched resources.

The ambulance that has been provided by Health Unlimited to the hospital has been very useful, and has dramatically shortened travelling times. In the past, they relied on hammocks to carry women, which required many men, and would have required a lot of community organising.

Interestingly, and something which I half expected, the power to decide where to give birth does not lie with the woman. The village leader and elders may decree that all births take place with TBAs, or in the hospital. The husbands, in-laws and womans relatives may all have a hand in deciding where childbirth occurs, but when asked if the woman had any power, the interviewee answered “no”.

The answer to the last question supported what is known to be widespread across West Africa. The belief that if a woman is in prolonged labour, it may be because she and her husband had an argument, or disagreement. The husband would be called to ask his wife to ask for forgiveness. The ritual itself would not last long apparently, but still something of note.