Born on the lake, the difference a boat makes for island mothers

Written by Otiato Guguyu

Soklo is the remotest part of Mfangano Island in Mbita, perched at the very top of the towering rock formations that make life possible within Africa’s largest freshwater lake, Lake Victoria—known locally as Lake Inyanza. While Mfangano is a picturesque tourist destination, offering safari camping, beach holidays, bird watching, and walking trails, it is also one of the most dangerous places in Kenya to give birth.

According to the 2014 Kenya Demographic Health Survey (KDHS), Homa Bay County, which encompasses Mfangano Island, ranks among the 15 counties with the worst maternal health indicators in Kenya? It has a maternal mortality rate (MMR) of 583 per 100,000 live births, significantly higher than the national average of 355.

One key reason is geography. Mfangano and its neighboring islands are only accessible by boat or waterbus. This isolation severely hinders access to healthcare, especially for expectant mothers. Routine clinic visits and emergency care are often delayed or missed due to limited, costly transportation.

Soklo, located in Suba West Sub County, has a population of 29,278, including 6,852 women of reproductive age. It records around 1,001 pregnancies annually, yet only 14 healthcare facilities serve the area. Of these, two do not offer delivery services, and nearly half lack emergency care equipment.

Take Benta* for example, a teenage girl facing the dual challenge of early motherhood and medical complications. Due to her young age and small stature, she required a Caesarean-section. Initially admitted at Soklo Dispensary, she was referred to Sena Level 4 Hospital at the base of Mfangano Island. But even that facility lacked the surgical capacity for her case.

Elvis Orimba, a healthcare provider at Sena, recognized the urgency and arranged for Benta to be transported to the mainland. “I had to call for the boat. The relatives had nothing and we could not even tell them to look for anything it was a matter of saving lives,” Orimba explains.

Boat maternity

He says that it was critical to have an ambulance or the boat in terms of the time the emergency occurs and the referral takes place in such cases.

Even as they sailed across the tumults of the evening waters of the great lake that always threatens sudden violent thunderstorms, he was anxious his young patient would go into labour right on that simple plank of stretcher on the small wooden boat.

Transporting patients is risky. "I carried delivery gloves and packs in case I had to deliver the baby mid-lake, you have to do it in the lake," Mr. Orimba recalls. On Benta’s trip, they arrived in Mbita by 6 p.m., and she was rushed into theater immediately.

Mr. Orimba, who co-authored a paper on emergency referrals in the area, reported that in 2023, the CBO facilitated 37 patient referrals, including 15 obstetric emergencies. Conditions ranged from prolonged labor (26.7%), pre-eclampsia (20%), to malpresentation (13.3%). All patients survived and were successfully transferred to Mbita Sub County Hospital and Homa Bay Teaching and Referral Hospital.

Without an ambulance boat, families often struggle. Those living inland must hire boats and pay for fuel—a luxury many cannot afford. Fortunately, thanks to a community initiative, Benta’s life was saved.

Community effort

A locally-led effort, driven by Sena Level 4 Hospital and EK FM, a community radio station, launched an emergency boat ambulance operated by the Abakunta Community-Based Organization (CBO). This simple wooden boat, equipped with basic emergency supplies, has become a lifeline for island residents.

Samuel Otieno, Station Manager EK FM, Cyber and community radio says the boat serves residents of Mfangano and Wakula islands, who previously had to travel over an hour to the mainland for specialized treatment.

“Remarkably, this community-run vessel has operated successfully for over seven years, even though government-backed ambulance boat initiatives have repeatedly failed due to the high maintenance and operational costs of water-based services,” Mr. Otieno said.

Maternal mortality remains high in Kenya, with nearly 5,000 deaths annually with a maternal mortality rate of 355 deaths per 100,000 live births according to KDHS. The situation is worse in isolated fishing communities like those on Lake Victoria. Delays in accessing care, lack of transport, and insufficient medical facilities all contribute.

In their 2023 paper titled, “Collaborating with local partners in provision of emergency referral services to minimize poor maternal and neonatal outcomes in Suba West Sub County,” Mr. Orimba and colleagues concluded that community collaboration significantly improves maternal outcomes. In Suba West Sub-County, such partnerships resulted in zero maternal deaths out of 507 deliveries in 2023.

To scale this success, national and county governments must invest in accessible, high-quality maternal healthcare. That includes skilled birth attendants, emergency equipment, and support for community ambulance boats.

In the meantime, the resilience and innovation of island communities like those on Mfangano offer a powerful model for saving lives—one boat ride at a time.

*Benta not her real name as the teenage mother requested anonymity

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