Answering those Questions: DR. LORRAINE MULUKA

By JACKIE MBITHE

Pregnancy is a challenging and often lonely journey for women in Sub-Saharan Africa. Access to qualified experts in case of an issue is burdensome, high-quality information often misses, and aspects such as pregnancy-related depression are neglected. To make the whole process a lot easier, Dr Lorraine Muluka, an obstetrician and gynecologist, founded Malaica; a startup that supports pregnant mums in Kenya. The startup takes a holistic approach to the pregnancy journey to help reduce maternal mortality.

“Women have a lot of questions during pregnancy and sometimes don't have the person to ask. We provide moms with their own remotely accessible personal nurse/midwife throughout the pregnancy journey and this nurse/midwife would be the person who would act as their guide during the pregnancy,” Dr Muluka says.

Dr Muluka has been in the medical field for 13 years now. She has a wealth of experience having worked in various hospitals including Kenya’s largest referral hospital, the Kenyatta National Hospital. From her experience in the public sector, referrals happen too late. “By the time the mom is getting to Kenyatta you realize that there's a lot more that could have been done by the peripheral center that was taking care of her.”

Through research, she found there was a gap in information sharing, and the lack of it was costing so lives of many mothers. Her daily motivation is the need to bring quality care to maternal health care. Her being able to make a difference in the sense that she not only treats her patients but also empowers them so that they can take charge of their health gives her the most satisfaction.

Enhancing Maternal Healthcare

The maternal mortality ratio in Kenya is 355 in 100,000 meaning, 355 women lose their lives, per 100,000 live births. A look at West Europe, for example, the figure is 6 per 100,000 live births. “It clearly shows that there's something broken in our system,” she says.

A couple of years ago there was a model focused on antenatal care, which was targeting to reduce maternal mortality by encouraging mothers to have four antenatal clinic visits. Dr. Muluka reveals that the guidelines have since been updated by WHO to eight. This means that expectant mothers need to have contact with the healthcare giver eight times during the pregnancy journey. “At least a mom needs to have these eight touchpoints, and this has been shown to improve the outcomes for the mother as well as the babies. Four can happen physically as they visit for antenatal care, four can happen online or all eight happen physically,” Dr Muluka explains.

Malaica provides midwives who help an expecting mom to achieve the touchpoints through online conversation. “What we are offering is this partner, this trusted guide during your pregnancy journey,” Dr Muluka adds. The nurse/Midwife acts as a coach to make sure that this mom, who has become her trusted all the tests that require to be done. They will guide the mothers on having the right kind of behaviours during their pregnancy like exercising and nutrition. She will also be able to identify risk factors early like a complicated pregnancy due to a medical condition or whether she has a twin pregnancy or a higher older pregnancy.

“We're trying to fill in those gaps and also provide support in terms of mental health. Other things come up in pregnancy that honestly cannot be covered in our very short consultation to make a decision. At Malaica we feel that if we can fill in these gaps. Not replace what is currently going on in terms of the antenatal care, but working together with that to ensure that moms are well educated about what's happening in their pregnancy and encouraged with behavioural changes,” Dr Muluka reiterates.

Limited By Technology

companion during the journey, is attending or having these eight touchpoints and during the touchpoints, they are going to the right facility.

The Midwife also ensures that the mother is having the ultrasound done in time and has done

Malaica’s main platform of interaction is WhatsApp. “We realized that more and more people are now using WhatsApp to communicate with their friends, family and even with people from work,” Dr Muluka says. She however highlights that not all mothers have access to a smartphone. According to the latest statistics from the Communications Authority of Kenya, one out of every five Kenyans has a smartphone. But she is optimistic that this will soon change because smartphone manufacturing is increasing globally. “If you've been in this Kenyan market, for example, ten years ago, it was difficult to access a smartphone let alone affording one. But right now, the price of those smartphones is coming down.”

Then there is the issue of network coverage and rates. In the case of a rural setup, there is the issue of electricity and due to poverty, most mothers cannot afford internet bundles.

“We believe that in the coming years there will probably be a phase-out of the feature phones with time. And so, we're leveraging on this as we continue advancing.”

For a mom who wants to join the program, they first signup on their website. Once signed up, she gets a three-week trial to test the product and see whether it resonates with her because there are various elements. They get access to a Midwife, educational content that comes to their phone every day about what to expect in the pregnancy journey, and educational forums with health experts. She can also join a support group with other pregnant mums. All this at a monthly fee of KSh 250 (US$2.03) or a one-time fee of KSh1900 (US$15.39) for the rest of the timefrom the point she discovers she is pregnant, which is at around five weeks, up until the baby's born.

Scaling Impact Through Collaboration

To scale its impact on maternal healthcare in Kenya, Malaica joined hands with MumsVillage, one of the largest pregnancy communities in Kenya with more than 100,000 women. With the new collaboration, Founder and Chair of MumsVillage, joined Malaica as a board member and Co-Founder. “We look at Mums Village as a source of resources for basically walking the pregnancy journey and up to parenting. We felt that our missions are aligned in that we want to make the pregnancy journey safe and convenient for women in Kenya,” Dr Muluka says.

With the merger, Dr. Miluka now leads a team of young professionals, doctors and people from different nationalities. Collaboration has been key for her and the company’s success post merger. “I think it's having an approach of leadership whereby you can listen to your team. Those are the key things that can build out this team because they also feel as part of the team.”

People with the same goal and mission as her are what Dr Muluka is looking for in future partnerships. She looks forward to partnering with more hospital facilities where the mothers get to visit physically. Also with labs, which can be able to provide testing services and ultrasound providers. Emergency referrals and services are a partnership that she is eager to explore in order to reduce the delays that lead to maternal mortality.

In the next five years, Dr Muluka wants to see Malaica being a one-stop place for pregnant moms and also for Malaica to be incorporated into Kenya’s universal healthcare program. She dreams of expanding to the rest of Sub-Saharan Africa to make the pregnancy journey of more mothers safe and convenient. “Nigeria has one of the highest maternal mortality ratios in Africa. We would like to expand there and also in other spaces, not only in Kenya. If this is something that would be able to have an impact in terms of maternal mortality, we are hoping to help achieve it,” she says.