© UNICEF Rwanda/Muellenmeister
RUBAVU, Rwanda, HONG KONG – Several years ago, when Asterie Nyirabatware was giving birth to her third child, she was suddenly faced with a terrifying scenario: she was bleeding uncontrollably and she was nowhere near the care of trained doctors and nurses.
Like her two previous deliveries, and like many other women in her community, Asterie had decided to give birth at home, unaware of the extensive risks.
She rushed to a health centre, and luckily she and her baby survived. But the experience stuck with her.
“I was shocked by the dangers of home delivery,” she says. “I realized that I was endangering my own life and my unborn child.”
Now a 64-year-old mother of five and grandmother of 11, Asterie has channelled her trauma into a career helping others. For the past 10 years, she has worked as a community health volunteer in Rwanda’s Rubavu district on the northern edge of Lake Kivu.
“I strive to improve the health of my whole village,” she says.
One of Asterie’s main goals is getting other mothers to deliver in health centres, instead of at home. For this, she uses RapidSMS, a mobile phone-based system for community health workers, which tracks the health of pregnant mothers, newborns and young children. Asterie uses RapidSMS to register women as soon as she learns of their pregnancies, and sends short text message reports through the system, which are sent on to the Ministry of Health. Asterie then receives SMS reminders to make sure these women visit the health centre regularly before giving birth. She also makes weekly home visits to discuss good nutrition and more with families, and continues following up after the women have given birth.
“I am proud of my contributions,” she said. “I am happy to be responsible for my community.”
Since it was piloted in 2009, RapidSMS has helped over 730,000 pregnant women and about one million newborns access life-saving health and nutrition services. Among these, over 25,000 women had life-threatening conditions, but community health workers using RapidSMS helped them reach health centres, saving many lives in the process.
RapidSMS has also helped significantly reduce the number of maternal and child deaths across Rwanda. In 2005, 750 mothers died for every 100,000 live births, but in 2015, this number had declined to 210. Infant deaths also declined, from 86 per 1,000 live births in 2005 to 32 per 1,000 live births in 2015. Since its introduction, RapidSMS has been upgraded to cover the critical first 1,000 days from pregnancy to a child’s second birthday.
Recognizing warning signs
Across town, at the Rubavu District Hospital, 22-year-old Claudette sits in the hallway outside of the maternity ward. She gave birth to a healthy baby just last week.
“RapidSMS helped me and my baby survive,” she says. Claudette’s first child, delivered at home, did not survive.
When she was 16 weeks pregnant with her second child, a community health worker registered Claudette in the RapidSMS system, and continued to visit her regularly during her pregnancy. Encouraged by these visits and the messages relayed through RapidSMS, Claudette went for regular check-ups at the health centre. She learned about breastfeeding, and discussed what she learned with her husband.
“I learned about the danger signs during pregnancy, too,” she says.
When Claudette experienced early labour contractions during her most recent pregnancy, she recognized the warning signs and knew who to call.
“My water broke too early. I called my community health worker, and she used RapidSMS to bring an ambulance.”
Her health worker used the ‘Red Alert’ feature in RapidSMS, which sends an automated message if something goes wrong during pregnancy or delivery. In addition to dispatching an ambulance, Red Alerts inform nearby health facilities of the incoming emergency, and tell the community health worker how to help in the interim.
Claudette was taken to Rubavu District Hospital, where she delivered her second child safely.
Smiling with her newborn girl held tightly in her arms, Claudette is grateful.
“My husband and my whole family were happy to see me and my baby come home healthy. During my pregnancy, I was always confident that I had support.”