Race to save mothers during childbirth

WHEN the wife of the former Commissioner for Health in Kwara State, Dr. Femi Ogunsola, fell into labour some years ago, little did anyone had the premonition that the woman would die as a result of complications arising from childbirth.

Expectedly, Ogunsola who was shattered by the sad news, had petitioned the State House of Assembly calling for the probe of the death, which occurred at the maternity wing of the University of Ilorin Teaching Hospital (UITH), Ilorin Kwara State moments after the woman was placed on admission. But the rest is now history.

This was just one of the numerous cases of deaths in most of the nation’s hospitals linked with childbirth.

Perhaps, this particular case came into prominence due to the calibre of the casualty involved. But how many of such cases go unreported daily in the nation’s media? How many of them under the medical law are actionable in the law court?

However, worried by the unabated alarming statistics of maternal mortality rate in the country, the UITH recently rose up to the challenges posed by the problem, by organising a training programme that cut across health sector providers both in the public and private sectors in the state.

It was contracted to the UITH by the state’s Health System Development Project (HSDP) due to the large number of qualified teaching personnel to handle the intricacies inherent in the programme. The HSDP, according to the officer in charge of maternal health at the state’s Ministry of Health, Mrs. Wule Sanni, was in turn bankrolled by the World Bank.

Held at the School of Midwifery, Ilorin, the programme was organised by the department of Obstetrics and Gynaecology of the UITH. From the facility’s department were pooled experts who formed the resource persons: The Medical Advisory Council of the hospital, Dr. Abdul Waheed Olatinwo; the former Chief Medical Director of the health institution, Prof. Olurotimi Fakeye; Dr. (Mrs.) Irene Durosaro; Dr. B. O. Bolaji of the Department of Anaesthesia, among others.

This does not exclude the role played by the state governor, Dr. Bukola Saraki who through the state’s Commissioner for Health, Alhaji Oladimeji Hassan, declared open the programme amidst great concerns “for our mothers, sisters, wives, and daughters who are daily exposed to the avoidable danger of death resulting from childbirth complications”.

According to Hassan in a chat with The Guardian, “our aim in Kwara especially that of the state’s Governor, Dr. Bukola Saraki, is to reduce to the bearest minimum the issue of maternal mortality. We need to develop the needed manpower. Not all maternal cases are life-threatening. We want to have personnel on standby that can handle life-threatening cases and equally impact the techniques into others. Kwara has one of the best indices on maternal healthcare in Nigeria, but we do not want to rest on our oars.”

UITH, today, remains the only teaching hospital serving the health needs of the citizens of such states as Kwara, Kogi, Niger and Benue.

Olatinwo, while reeling out the aims of the programme described as that requiring the urgent attention of all medical experts, said among others that it will help in training:

• health workers on how to care for women with obstetrics complication and help them monitor women’s labour and identify danger signals hereby reducing maternal mortality and morbidity ratio in Kwara State;

   

• health workers (doctors, nurses/midwives, and CHEW) on emergency obstetrics care and reproductive health life saving skills; and

   

• the trainers on emergency obstetrics care and reproductive health life saving skills for community health officers tutors.

  Under the projected benefit, the course coordinator, Dr. Rabiu Balogun, corroborated the views of Olatinwo thus: “The training shall increase the number of trained personnel on the concept of emergency obstetrics care and reproductive health life-saving skills at both hospital and community setting.

  “This shall improve the health of the beneficiary community and thereby reduce the high maternal morbidity and mortality status of the community and the state in general. We therefore hope that very soon maternal mortality ratio will fall in this state and all other states under the catchment’s zone of the UITH.”

  The reproductive health challenge in Nigeria is indeed great vis-?-vis the recently released statistics of the World Health Organisation (WHO). With a population of about 14 million women in the reproductive age group in Nigeria, it is estimated that about 500,000 of them can become pregnant every 18 months.

  At the United Nations Summit in the year 2000 where one of the three health-related Millennium Development Goals (MDGs) was developed to reduce maternal death by 2015. Evidence shows that motherhood can be safer for all women.

  Reacting to the development, Olatinwo believed that one of the best ways to address serious and life-threatening complications of pregnancy and childbirth is to make sure that women receive skilled care at delivery by ensuring that reproductive health professionals could manage normal deliveries and treat the life-threatening complications of pregnancy and childbirth.

  An un-cursory studying of the Kwara State’s statistics on the related subject shows that about 64 per cent of maternal death occurred in health facilities alone, and about half of this is associated with avoidable factors.

  For Olatinwo, it could be deduced from the development that even when women with complications arrive at a health facility they may not receive the care they need quickly and enough to save their lives.

  He explained: “This is often due to the inability of the facility staff to recognize obstetrics emergencies. In addition, the facilities are often not equipped with essential equipment and blood required to ensure a safe delivery. Lack of medical protocols to guide health care providers and effective supervision also affects quality of care.”

  Delivering a paper on “Overview of female reproductive health”, Fakeye who is also a Consultant Obstetrician and Gynaecologist of the UITH, said haemorrhage was the major cause of maternal death in the world accounting for 50-60 per cent of all maternal deaths. Besides, he put maternal mortality ratio per 100,000 live births at between 450 to 1,700.

  Defining Sexually Transmitted Infections (STIs) as infections that are spread primarily through person-person sexual contact, the medical expert added that there were more than 30 different sexually transmissible bacteria, viruses and parasites.

  He observed: “The most common conditions they cause are gonorrhoea, chlamydial infection, syphilis, trichomoniasis, chancroid, genital warts, Human Immunodeficiency Virus (HIV) infection and hepatitis B infection. Several, in particular HIV and syphilis, can also be transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer.”

  Fakeye noted at the end of his presentation that the most effective means to avoid becoming infected with or transmitting a sexually transmitted infection was to abstain from sexual intercourse, that is, oral, vaginal, or anal sex. He also advised on the need to have sexual intercourse only within a long-term, mutually monogamous relationship with an uninfected partner.

  For him, male latex condoms, when used consistently and correctly, are highly effective in reducing the transmission of HIV and other sexually transmitted infections, including gonorrhoea, chlamydial infection and trichomoniasis.

  In a joint paper by Durosaro and Mrs. Muslimat Nuhu, both of the UITH, they coined an acronym, NURSE, to explain a point. According to them in the paper entitled: “Attitudinal re-branding among nurses in Nigerian public health institutions”, N (Neatness), U (Understanding/ Upright), R (Reliable/ Responsive/ and Resourceful), S (Sensible, Sensitive and Smart), and E (Educated and Empathic), all should represent effective attitudinal re-branding among Nigerian nurses in the nation’s public health institutions.

  The paper urged the nurses not to deviate from the concept of nursing which among other things include assisting individuals, families, communities, and promoting quality of life from birth to care at the end of life. Besides, they canvassed proper reactions from nurses to their patients as poor reactions could reduce the pace of recoveries.

  “Poor reactions can mar patients recovery, especially laughing when someone is in pains, shouting at/insulting patients instead of empathising with them, should all be shunned in the modern day nursing.”

  Speaking on Cardiopulmonary Resuscitation (CPR), Dr. Bolaji said CPR was required when supply of oxygen to the brain is insufficient, or after a cardiac arrest, respiratory arrest or both.

  He added: “Brain is sensitive to hypoxia. It has limited anaerobic metabolism and cannot store oxygen. In cerebral hypoxia, patients may survive circulatory arrest, permanent impairment of cerebral function may result if oxygen delivery is not restored within 3/4 minutes.”

  He gave several definitions of the term “cardiac arrest”. According to him, it could mean: “Sudden cessation of the circulation in a patient not expected to die at that time”, or “failure of the heart to maintain an adequate cerebral circulation in the absence of a causative or irreversible disease. Cardiac arrest is potentially reversible while death is not.”

  For him, the features of cardiac arrest include among others, sudden deep unconsciousness, apnoea or occasional gasp, absence of pulsation in a large artery, ashen cyanosis and dilated and unresponsive pupils.

  A participant from a private hospital in Ilorin, Dr. A. Omotesho said the programme afforded him a rare opportunity to refresh his memory on most of the things learnt some 13 years ago at the medical school.

  Besides, Omotesho from Olanrewaju Hospital Ilorin said the one week event has added to his knowledge of medicine, promising prompt introduction of the newly acquired concepts to his professional colleagues.

  A post-training examination was conducted at the end of the course which afforded the organisers to assess the success or otherwise of the programme.