Lenche Vasilevska (left) and a UNICEF representative walk through "Hatidje's" neighborhood. / Photo: Gretel Schueller
A Day in the Life: Hatidje
A young mother confronts perinatal mortality in MacedoniaNurse Lenche Vasilevska walks briskly from the Bit Pazar Policlinic, a health center in Skopje, the capital of the Former Yugoslav Republic of Macedonia, where she and six other community nurses met to discuss their plans for the day. She’s on her way to visit Hatidje*, an ethnic Roma mother living in Topaana, one of Skopje’s poorest neighborhoods.
“Without me, many of these people would not get medical care,” notes Vasilevska, who meets regularly with pregnant women and new mothers, providing advice on everything from breastfeeding to social support. The nurse opens a gate to a yard, where Hatidje is squatting in the mud, washing dishes with cold water from a small spigot at her feet—her family’s only source of water. She beckons Vaslievska inside their home: one room furnished with a single mattress, a bare bulb, and an electric stove—all shared by seven people.
Despite their circumstances, Hatidje is all smiles, proudly holding her daughter, seven-month-old Suella. She says she is 20 years old. (This is the answer most Roma girls give to avoid trouble. She’s probably 14 or 15, according to Vasilevska.) When Hatidje found out she was pregnant, she went immediately to the Policlinic. During her pregnancy she had three appointments there—thanks in part to prodding from Vasilevska, who nods in approval, adding, “Some don’t go at all.”
Failure to seek prenatal care is a major reason Macedonia has one of the highest rates of perinatal mortality—defined by the World Health Organization as deaths that take place between 22 completed weeks of gestation to 7 days after birth—in Europe, with 14.6 per 1,000 births against the European Union average of six. They’re often the result of poorly managed pregnancies or botched deliveries. “Antenatal healthcare is relatively underutilized here,” notes Sheldon Yett, director of the Macedonian branch of the United Nations Children’s Fund. Yett says that pregnant women in Macedonia only seek healthcare consultations an average of 2.8 times before giving birth. “WHO recommends a minimum of four, so that’s a significant difference,” he says. In fact, about 10% of Macedonian women don’t see a doctor until the day of delivery.
Fortunately, Hatidje had a complication-free pregnancy and delivery. “It wasn’t difficult,” she says. But Suella is on her fourth course of antibiotics. Thick yellow mucus runs from her nose. Suella has been sick so often, she still has not received any immunizations.
According to most doctors in Macedonia, a significant cause of perinatal death is untreated infection in the mother, predominantly urinary tract and genital infections. These often cause preterm delivery, explains Elizabeta Petrovska, chief of the NICU at Skopje’s State University Hospital’s Clinic of Gynecology and Obstetrics. “Those infections have begun in utero. After delivery, we see signs of sepsis [in the baby],” she says. If they survive, these babies are fragile and especially prone to infection.
In 2004, researchers found that more than half of the neonates at the hospital came down with a hospital-acquired infection. For many, it’s fatal. “We have to support these babies with fluid, food, antibiotics, blood, oxygen,” Petrovska says. “Prevention has to start at the primary level.”
Vaslievska examines Suella and asks to see her health booklet, a passport-like document that lists the baby’s medical history and proof of vitamins, shots, and medicines received. Vasilevska makes sure Suella is getting formula because Hatidje stopped producing milk at four months. When the nurse asks to see what else they are feeding Suella, Hatidje’s mother-in-law pulls out a package of butter cookies. The family can afford little more. “This is the hardest part for me, the saddest part,” says Vasilevska. “All I can do is give advice.” She tells them to put warmer clothes on Suella.
As part of its Safe Motherhood Program, UNICEF and the Ministry of Health are working to improve healthcare. Indeed, perinatal mortality is decreasing. After a World Bank–funded doctor training project, for example, rates in Macedonia dropped from 31.2 in 1999 to 21.5 in 2002, and now to 14.6. “It’s important to recognize strides have been made,” Yett stresses. “But there’s a lot more work to be done. Community nurses are one of the most important parts of the system. They are the gatekeepers.”
In Topaana, Vasilevska’s visit has attracted attention. Sandra, also “20,” is six months pregnant. Earlier in the month she began having contractions and spotting. She went to a doctor, who gave her the calcium-channel blocker verapamil to stop the contractions. He also prescribed cefexamine, an antibiotic used to combat urinary infections, gonorrhea and ear infections, but the pharmacist wouldn’t fill the prescription, telling Sandra that it could cause a miscarriage. With little explanation from her doctor, she’s confused and worried: “I’ve lost weight, I’m vomiting a lot. My back hurts.” Vasilevska writes notes and asks questions. “You’ve got to go back to the doctor right away,” she urges. “I’ll be back soon.”
Hatidje goes back to washing dishes. Asked if she wants another baby, her mother-in-law answers for her: “No. One is enough. Look how we live.” Hatidje smiles but says nothing. Vasilevska says she’ll be back to talk about contraception.
*All names of patients and their family members have been changed to protect their privacy.
Author Bio:
Normally based in the Adirondacks of New York, journalist Gretel H. Schueller is in Skopje until 2011, where she is writing about the plight of the Roma, Balkan lynx, rare birds, and more.
Photo: Lenche Vasilevska (left) and a UNICEF representative walk through "Hatidje's" neighborhood. / Photo: Gretel Schueller
