Would you rather die or undergo a caesarian section without anaesthesia? Fatuma Ismail, an expectant mother of four in Watiti village of Wajir North, would choose the later.
But medical ethics in Kenya do not allow such surgeries without anaesthesia.
Fatuma has seen several of her friends die during childbirth because of complications that could have been avoided through C-section.
“When you're pregnant, then you're not sure of your life,” Fatuma, 30, says.
Wajir County is the second most dangerous place in Kenya for pregnant women. The latest demographic and health survey shows that nearly 700 women die every year from pregnancy-related complications. The situation is only worse in neighbouring Mandera.
The county government has moved to arrest the situation by refurbishing maternity wards in the four sub-county hospitals and equipping them with caesarian section sets.
But Governor Ahmed Abdullahi faces one problem: there are no anaesthetists. Without these experts no major surgery can take place, including c-sections for pregnant mothers.
Anaesthetists are qualified doctors or specialist nurses who provide anaesthetics (drugs which cause loss of sensation) to patients before, during and after surgery. This is to make sure that they do not feel pain. They also monitor patients closely after surgery to make sure that they recover comfortably.
“We have four district hospitals with fully equipped maternity theatres and clinical officers, but only one (Wajir County Referral Hospital) has anaesthetists,” he says.
Wajir County is the size of Rwanda and Burundi put together (roughly 10 per cent of Kenya). It often becomes unforgivably hot, borders Ethiopia and Somalia, and is not connected to any other county with tarmac road.
Some women in far-flung areas usually trek to shelters near Wajir Referral Hospital during the last stages of pregnancy to avoid certain death in case of complications.
Bute and Habaswein sub county hospitals - hundreds of kilometres far apart – have proper maternity theatre sets and clinical officers, but no anaesthetist as yet.
Governor Abdullahi is visibly frustrated by the situation. He devotes at least 25 per cent of the county's budget to health and has offered generous packages to retired anaesthetists to come to Wajir.
“We are ready to pay them well and provide housing,” he told the Star. Officials are crossing fingers after one retired specialist agreed to move to Bute, near the Ethiopian border, in a fortnight.
Health Permanent Secretary Dr Nicholas Muraguri says anaesthesia providers are an integral part of the delivery of safe and effective surgical care, and ethics do not allow clinical officers to carry out c-sections without them.
“This is a very specialised skill and not so many Kenyans are qualified,” he says.
He promises to check whether some nurses from the AIC Kijabe Centre anesthetist training programme can agree to move to Wajir when they graduate this year.
But only slightly more than 50 nurses have graduated since the programme began in 2007 and some come from neighbouring countries.
Anaesthetists are scarce across the world and in Britain, for instance, the National Health Services employs 21 for every 100,000 people.
The World Journal of Surgery reported in 2010 that only 13 of approximately 120 anaesthesiologists in Kenya worked in public hospitals. The rest are in private hospitals in major towns.
The county is now offering scholarships to some of its 600 health workers to train in anaesthetics and other specialised skills in Nairobi but they must return to Wajir after the training.
The three working in the referral hospital in Wajir Town were trained in this system. Another one has been posted Habaswein sub county hospital after the training.
Secretary General of the Kenya Medical Practitioners and Dentists Union Dr Ouma Oluga says all counties could attract specialised staff if only they compensated them well.
“It's all about pay. The problem that county governments are not ready to pay specialised staff competitively. Would you come to work in the counties for Sh40,000 or remain in Nairobi where you can make Sh200,000?”
Wajir has also built a Sh200 million Kenya Medical Training College (KMTC) in Wajir Town from where it hopes to easily lure health workers in future.
Dr Muraguri praises the initiative, saying it demonstrates how counties and the national government can cooperate to strengthen health.
“We will have to inspect the facility to ensure it meets relevant standards before students are admitted,” says KMTC national deputy director John Anyira, who also visited the facility last week.
The first 200 students could be admitted this year. “We hope some of them could be trained in these rare medical skills,” says Abdullahi.
The students will be enrolled through the KMTC admission system but the governor hopes they can choose to work in Wajir when they graduate.
“We believe if Kenyans from other areas come to train here, they can get used to the environment and can easily accept jobs here,” he says.
Dr Muraguri says the Wajir KMTC will also be considered for the Beyond Zero scholarships.
The World Bank and Beyond Zero Trust supported programme sponsors 400 students to train in community health nursing at KMTCs in Loitokitok, Kabarnet and Garissa.
“We give people scholarships to train in the environments where they are likely to work. The condition is that they are trained outside the city and those trained here will work here. We hope to sign an MoU with the counties so that some of them can be hired in those counties immediately they graduate,” says Dr Muraguri.