With a maternal mortality ratio of 388 per 100,000, Kenya is
still abysmally swimming in a very muddy pond. We are way off the mark in
achieving out Sustainable Development Goals (SDGs) despite effort being made in
the same. We are pacing in the right direction but we should be sprinting.
Our top priority is directed at taming the top five causes of
maternal death with a myriad of interventions being put in place. As we
continue to fight the monster, let us focus of the leading cause, hemorrhage.
When one loses blood, they die. It is a simple equation.
Bleeding can be a trickle or can be a catastrophic exsanguination.
Unfortunately, post-partum hemorrhage is a catastrophic event that leaves all
involved shaken. No one gets used to seeing blood pouring out of a living
person.
Pauline* checked into our maternity unit at five o’clock in
the afternoon, apprehensive but hopeful. She was having her first baby at the
age of 25 and had enjoyed an uncomplicated pregnancy. She was already in
established labour and was admitted directly for monitoring in anticipation of
a smooth delivery.
Three hours down the line, Pauline’s labour was nearing the
end. She was ready to meet her baby and the midwife was gloved and waiting. Her
3500 gram baby checked into this world in top form, howling loudly, much to the
pleasure of the mother and midwife. The umbilical cord was clamped and cut and
the baby was put in the warm resuscitaire while the midwife attended to Pauline
in the third stage of labour.
Pauline’s placenta came out whole without any trouble and the
midwife got onto the business of massaging her uterus and ensuring she had not
suffered any injury to the birth canal. In a space of five minutes, celebration
turned into an emergency. Pauline was bleeding like a broken dam. Her uterus
just wouldn’t contract and the site where the placenta had come out of was
literally draining life out of her.
The doctor on duty in the labour ward and four other nurses
convened for emergency resuscitation measures. The overall night nurse in
charge came running to the operating theatre to call for reinforcement. Since
we did not have a surgery going on, we quickly crossed over to the labour ward
to help.
Within minutes, Pauline was on oxygen, her blood had been
taken to the blood transfusion unit to prepare several units to give her, she
had three intravenous access lines in place, rapidly giving her lifesaving
fluids as we awaited the blood for transfusion and her uterus was under manual
compression to try and stem the tide.
Everyone was doing something to keep the new mother alive.
She had not even held her baby. She was awkwardly transferred to the operating
room to institute surgical measures to control the bleeding but she was rapidly
losing consciousness. Her last words to us have haunted me since. She simply
said, “Thank you for your effort but I know I am dying. Thanks for trying.”
She never made it onto the operating table. Twice her heart
stopped and we had to resuscitate her. Despite commencing transfusion of three
units of blood simultaneously, we lost Pauline. The darkness that set in that
night was palpable. The hard reality was biting cruelly. We had just been left
with a brand new orphan who was completely oblivious of his newly acquired
status.
We had done everything humanly possibly but she still slipped
through our fingers. We had blood, staff, operating room, drugs and expertise
but Pauline still left us. It sank home that sometimes, it is possible to do
everything but it still won’t be enough. That mother nature can lift the veil
to her nasty side and we would not be able to stand up to the storm.
While Pauline was in the best possible set up to survive this
tsunami, several of her counterparts are not so lucky. They die in ambulances
in a race against time and chaotic traffic. They die in the hands of
overwhelmed staff with inadequate resources to help. They die in the hands of
unskilled birth attendants because they did not know better. They die alone in
their cattle sheds because culturally it is normal to deliver your third or
fourth baby unassisted.
Maternal health advocacy is not a fad that we engage in when
it is trending. It is a consistent, sustained push to save mothers from the
expected and the unexpected. It is the art of never slacking on the job when
things go right for a long time. It is the art of inculcating emergency
preparedness drills periodically to keep the adrenaline flowing in the right
direction to save lives. It is the unending advocacy to ensure that maternal
health remains top on the agenda in the midst of a multitude of health issues
jostling for the top slot.
Pauline may have left us but the loss we felt has never
subsided. The loss is reinforced every time we see a death notification signed
off as post-partum hemorrhage. It gnaws deeply every time women in the village
speak in hushed tones in funeral about how the deceased bled to death in
childbirth.
There is a reason why hemorrhage has never been dislodged
from the top slot in the list of causes of maternal death. It is a wake up call
to all of us to rethink the efficiency of our interventions in its prevention.
It is not a game of thrones. The first step in facing a dreaded opponent is
having a healthy respect for the havoc they can cause to spur us on to prepare
better.
We may have done our best but we must figure out how to make
our best even better!
Post A Comment:
0 comments: