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Rutendo Rori
Mash East Correspondent
It is midday in remote, impoverished and secluded Gwashavanhu Village in Uzumba-Maramba-Pfungwe (UMP) District in north-eastern of Zimbabwe.
Gloria (18) sits restlessly on a filthy rug spread inside a makeshift plastic structure serving as a maternity ward. She feels strong cramps in the abdomen, groin and back.
She endures the pain which gradually intensifies. She is in labour.
Standing besides her, the father-to-be is apprehensive as his wife goes from screaming in agony to quietness. He stands up and tries to walk towards the exit point but Gloria grabs his hand and cries out in pain: “Don’t leave! Don’t leave! It’s terrible! I’ll die!”
The husband calls for help and an elderly woman attends to his wife.
Madzimai Lydia Gwashavanhu, the attendant, aggressively feels Gloria’s swollen belly and instructs her to “push”.
No one knows whether or not Gloria will make it. Her life is in danger and her unborn child is equally at risk. She is exposed to poor medical care and any serious pregnancy complications will almost certainly result in death.
Gloria is one of Johane Marange Apostolic sect women who have delivered in makeshift maternity rooms, with the help of untrained but experienced elderly women who claim to be guided by the Holy Spirit.
The expecting mothers risk transmitting HIV to their newly-born babies since they are not administered with drug regimens to prevent mother-to-child HIV transmission.
At a makeshift maternity “clinic” made of plastic tents (Chitsidzo) in Gwashavanhu Village under chief Janhi in UMP, The Herald found 13 pregnant women waiting to deliver.
Madzimai Lydia, who is the delivery attendant, says she has been doing the job for more than 14 years with the guidance of the Holy Spirit. She boasts of not having experienced maternal and neonatal deaths when assisting women during labour.
“Pregnant women are supposed to receive health services only from the church. We help them in the form of prayers, prophecy and use of symbols which are directed towards the protection of the mother and child from evil that may attack them during pregnancy,” says Mbuya Gwashavanhu.
“I have been a delivery attendant for more than 14 years. I was never trained to do that. I get guidance from the Holy Spirit. We don’t give drugs like they do in hospitals. There’s no such thing as Caesarean delivery at our hospital. The only thing that we use is holy water.
“Pregnant women from this church do not go for ultrasound scan. I can predict through the Holy Spirit, the gender of an unborn child.”
Asked how they get birth records, Mbuya Gwashavanhu said: “We record their names in a book and we take it to the Registrar General’s office at Mutawatawa for the babies to get birth certificates.
“There is nothing like maternal or neonatal deaths here. We actually target first pregnancies. The ones that are referred to your major hospitals. After delivery, no one is stitched because the wounds caused during labour are healed by God,” she said.
Witness Nyamambo (30) who is one of the 13 women staying at the Chitsidzo waiting to deliver, says Mbuya Gwashavanhu was her midwife when she gave birth to her two children.
She is currently nine months pregnant and is expecting to deliver soon.
“My first born child is now nine years old, followed by a seven-year. Currently I’m nine months pregnant and I’m expecting to deliver any time soon,” she says.
Another patient who identifies herself as Elizabeth Mangwende says Mbuya Gwashavanhu treated her when she had severe wounds on her breasts, something which looked like breast cancer.
“After four years of barrenness, I sought help from Mbuya Gwashavanhu who helped me to conceive. Two weeks after giving birth, I started developing wounds on my breasts and stopped breastfeeding.
“My breasts are back to normal. I gave birth last year at this same place and I’m nine months pregnant now.”
Sect leader declined to be interviewed and were hostile towards The Herald news crew.
A skilled delivery attendant is defined by the World Health Organisation as an accredited health professional for instance midwife, doctor or nurse who has been equipped with the skills needed to manage normal uncomplicated pregnancies, child birth and immediate post-natal period and in the identification, management and referral of complications in women and new-borns.
This is different from the Johane Marange Apostolic makeshift hospitals where there are no records on neonatal deaths. How they deal with deaths that occur during labour, has remained a mystery.
Legislator for Uzumba constituency Cde Simbaneuta Mudarikwa says there is need for professionally assisted deliveries by pregnant women to avoid pregnancy related deaths.
“The problem with the Johane Marange apostolic sect is that they are not being honest with you. It’s impossible not to have maternal deaths without professionally assisted delivery.
“There is no accountability of maternal deaths and they take advantage of that,” said Cde Mudarikwa.
Mashonaland East Provincial Epidemiologist Dr Paul Matsvimbo said the Ministry of Health and Child Care was trying to account for deaths and complications caused during labour through village health workers.
He said the Ministry could not force the apostolic members to seek medical treatment since it did not have the powers.
“These practices have been there for a long time. The Ministry once tried to use force during a measles outbreak and there was a backlash from the Apostolic members.
“We have village health workers who sometimes alert us on community deaths and we then carry out a community death audit. This helps us to account for deaths that are linked to religious activities. However, the community might not be willing to engage which becomes a challenge,” says Dr Matsvimbo.
UMP district health promotions officer Mr Godwin Takaniwa said: “There is need for capacity assessment and building of apostolic midwives to ensure that acceptable minimum health standards are practiced to minimise risks to mothers and children.”
The Johane Marange apostolic sect is among apostolic groups that have strict religious moral codes and tend to emphasize strong adherence to religious teachings , church doctrines and regulations. They steadfastly object to the uptake of modern healthcare services and immunisation.
In Zimbabwe, approximately 95 percent of the paediatrics cases of HIV in children are from mother-to-child transmission during pregnancy, childbirth or breastfeeding.
According to the United Nations Development Programme (UNDP), reducing child mortality is one of the eight Millennium Development Goals (MDG4) and Zimbabwe has since committed to reducing under-five child mortality by two-thirds.
UNDP notes that refusal of medical treatment or advice on the basis of religious beliefs has a strong bearing on the child mortality rate in Zimbabwe, since some groups do not allow their children to be immunised or using modern drugs.
The apostolic movement in Zimbabwe can be traced to Johane Marange and Johane Masowe groups which started in the 1930s in Marange and Makoni areas and have since paved way for other formations of the dominant apostolic groups to crop up.
Apostolic leaders teach faith healing and regard sickness and use of medical services as signs of weakness of faith.
They emphasize strict adherence to religious teachings and practices, compliance with normative values and impose penalties on those who violate church regulations and religious teachings.
Failure to embrace modern maternal health services has contributed to maternal morbidity and mortality, mother to child HIV transmission when a mother is not aware of her HIV status, post-partum haemorrhaging, complications and hypertension.
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