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Preparing for childbirth in rural Ghana, where clinics are scarce and ill-equipped, and roads are often pot-holed mud paths, is a frightening prospect. Mary Issaka should know. She’s a midwife in northeast Ghana, near the town of Bolatanga. Issaka has received the Midwife of the Year award from the Johns Hopkins affiliated group Jhpiego because of the innovative ways she’s helped pregnant women. She says home births are often unsafe in Ghana, but that getting women to a clinic or hospital is no easy feat.

• Jhpiego

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MARCO WERMAN:  Preparing for childbirth in rural Ghana can be a frightening prospect.  Clinics are scarce and ill equipped and roads are often pot holed mud paths.  Mary Issaka should know, she’s a midwife in northeast Ghana, near the town of Bolatanga.  Issaka has received the midwife of the year award from the Johns Hopkins affiliated group Jpiego.  It cites the innovative ways in which Issaka helps women.  Issaka came to the U.S. to accept the award.  She says in northeast Ghana getting pregnant women to a clinic or hospital is no easy feat.

MARY ISSAKA:  There are some areas where there is no car for referral.  You have to ring the hospital for them to bring an ambulance.  Now the ambulance is even down.  Or you have to ring the national ambulance which is only one for the region.  So if somebody has already called the national ambulance and you are also calling the national ambulance, it means you are not going to get access to that service.  So it is also a challenge, means of transport.  It is a challenge for us.

WERMAN: And you’re going to visit these women and getting them on a motorcycle to get them to a place where they can deliver safely.  How safe is that getting these pregnant women who are already to term on a motorcycle?

ISSAKA: It’s safe.  Where a lorrie cannot go, that is where we use motorbikes.  At times we will even use the motorbikes, you still have to pack the motorbikes because there are certain areas the motorbikes cannot even go.  That is during rainy season, you have to pack the moto and then walk by foot to the community where you can bring the woman to where the motorbike is and then bring her to the health facility to deliver.

WERMAN: What are the factors that prevent women in rural areas from getting to those clinics at the key moment of childbirth?

ISSAKA: The problems is their distance to the health facility and then there may be the family members also making decision for the woman before she goes to the health facility.  You know we have our family heads, no woman cannot just get up and say I’m going to the health facility to deliver unless she seeks permission from the opinion leader and it is given for her to go.  So we met with the opinion leaders and made them understand that it is good, immediately a woman is pregnant you make the decision that anytime the woman is in labor and I’m not even around, the woman should be sent to the health facility.

WERMAN: Why would the elders not want to let the pregnant woman go to a safe clinic at their own speed?

ISSAKA: Just as I was saying, you know its ignorance.  In the – - areas they have TV’s they give- – they see everything.  But in the rural areas they don’t see these things and then they also believe that if you also deliver by yourself in the house it means you are brave.  And they are happy about it.  You see?  So we need them to understand that it is not good for you to say you are brave and then at the end of the day you lose your life or your lose your baby.

WERMAN: As you’ve described it seems surely one of the big challenges you face is just dealing with the roads in northern Ghana and the time it takes to get pregnant women to clinics and to get to them in the first place.  Compare the roads here in the United States, this is your first visit here, with those you regularly travel in Ghana.

ISSAKA: We cannot compare our roads to these roads at all.

WERMAN: How many paved roads do you have in northeast Ghana?

ISSAKA: About two roads.  Just two.  Here you have so many roads.  If you don’t take care you can even get lost.

WERMAN: Mary, what was your most difficult delivery ever?

ISSAKA: So there was a day this woman called me from a community telling me she was in labor.  So we went there with the car, picked up this woman from the community, brought her to the health facility and this woman, she was pushing.  I said no, she would wait, no she will not understand.  She was pushing because maybe the first delivery, she doesn’t know how to maybe hold on.  So she delivered through an undilated cervix and had a cervical tear.

WERMAN: A cervical tear?  Yeah.

ISSAKA: Yes, she had a cervical tear, we just had to set up an I.V. line, put this woman in the lorrie and she was bleeding.  I mobilized doing this.  I rang the Bolatanga Regional Hospital and told them about the woman.  She has cervical tear, I’m bringing her.  We rang the laboratory, we took her blood for grouping and cross matching and then we got there, they just sent the blood.  While we were doing the suturing, the blood was brought up, it was set up on the woman and then we also finished with the suturing of the cervix and they were able to save the woman’s life.  Because such – - she had delivered in the house, she would have lost her life because the way she was bleeding, it was not easy at all.  So if we have enough midwives and they are able to send them to all the communities and they are nearer to the community members, we can actually help to save so many lives.

WERMAN: Well, I surely see why you were named Midwife of the Year.  Thank you very much for speaking with us Mary.

ISSAKA: Thank you very much.

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