Defining Moments: Jacob Kioko’s Experience as a Midwife


Any patient or client who walks into Kasikeu Dispensary in Mukaa, Makeuni County, Kenya, will inquire if this young gentleman is on duty. His charisma and dedication to his work at this far-flung dispensary located in one of Kenya’s remotest areas makes him stand out. Meet Jacob Kioko, a 28 year old nurse.

However, his experience as a midwife has not been an easy task. The turning point in his career dates back to 2004 when he was a first year student in nursing school. That which would have been an exciting experience in midwifery turned out to be a distressing one for him.

It was his first time to assist the nursing officer to conduct a delivery. The mother in labour had just been admitted but was experiencing prolonged labour; the foetus was in distress, and would not descend, and there was a slight delay in referral to the hospital. As fate would have it, the baby died but the mother survived. This disconcerting experience haunted Jacob for days.

It was at this point that I made a promise to myself; that I would work zealously to avoid the death of any baby or mother under my care.

When Jacob was posted to Kasikeu dispensary in Makueni County, he had mastered his skill as a nurse and midwife and was very passionate about conducting deliveries. But ironically, community members shunned attending the dispensary for delivery; a majority of them gave birth at home under the watch of Traditional Birth Attendants (TBAs) and relatives. The local administration recorded an average of 14 home deliveries a month, while the dispensary recorded only 2 to 3 deliveries a month. Jacob considered this a major challenge and pondered how he would convince the community to utilise their services and skilled attendants during delivery; but nothing seemed to succeed.

In June, 2010, Jacob experienced another difficult delivery; but this time he had to make the decisions on his own.

It was 6pm and he had just arrived on night duty. A mother in labour had been admitted 6 hours earlier and was at 8cm dilation when he arrived. He examined her, and to his shock, she had breach presentation of a multiple pregnancy- twins. The District Hospital was about 200 kilometres away and there was no ambulance to refer the patient. Jacob and his team put the mother on intravenous fluids.  

By the time he called for help, the first twin was almost out; Jacob had to conduct the delivery. Thirty minutes later, the second twin was born. However, none of them was breathing well; Jacob felt very light heartbeats. The promise he had made to himself five years ago drove him to desperately attempt to save their lives at all costs. Without any resuscitation kits and equipment at this remote dispensary, he administered mouth-to-mouth resuscitation, oblivious of any infection and danger to his health. After 40 minutes of tireless exertion, the babies finally started breathing comfortably and were out of danger. A problem half solved.

The mother was bleeding profusely. Jacob’s colleague had delivered the first placenta and bits of the second. Efforts to manually remove the remaining bits were futile, due to heavy bleeding. By this time, a local resident had sourced for a vehicle; a matatu (local minibus), but the mother had no money to pay for this service. They had to raise Kshs 7,000 ($80) within minutes for the matatu hire. At this point, the mother had lost consciousness; she was given adrenalin, and more IV fluids administered through both hands and through her neck.

The two-hour journey was the longest of Jacob’s life. He held the mother in his arms all the way.

“I knew that if I just let her lay on the matatu seat, she would die. So I held on.” By the time they got to the hospital, Jacob and the accompanying nurse were literally covered in blood. The mother was rushed to theatre; had the clot removed. She survived.

Jacob knew that this experience would have been prevented; if only the mother had been correctly examined on admission, they would have referred her sooner; and if only they had access to appropriate means of transport, she would have had access to better services much earlier. The woman had only attended two Antenatal Care (ANC) clinic visits during her pregnancy, and thus there were no proper records of her pregnancy. It was then that the gravity of the situation in this community dawned on him.

Two years later, things are looking up. When the Mama na Mtoto wa Afrika project came knocking, a glimmer of hope filled this remote region. “We now have an average of 20 deliveries per month!” says an elated Jacob.  Jacob indicates that the Community Health Workers (CHWs) trained by the project have been doing an excellent job of referring mothers to the dispensary. The facility now has basic obstetric and neonatal care equipment and new labour wards have just been completed by the Mama na Mtoto wa Afrika project.

In addition, the skills of the health workers have tremendously improved. Jacob is one of the beneficiaries of the project, and has been trained on Basic Emergency Obstetric Care, Focused Antenatal Care and Integrated Management of Childhood Illness. “We are able to conduct deliveries and make timely decisions on referral,” states Jacob. All mothers who come for delivery have records of not less than four ANC visits. “Amazingly, is that where we have community units rarely will you find home deliveries. Life in this community is changing for the better,” concludes Jacob proudly.