Deliberate efforts being made to reduce Maternal Mortality

Dec 04, 2016 News

By Sharmain Grainger
The importance of medical education cannot be overemphasized. In fact it is a crucial feature in any health care setting.
Right here in Guyana, specifically at the Georgetown Public Hospital Corporation (GPHC), there is evidence to support the notion that medical education has been helping to improve the delivery of health care.

First graduating class of residents from the GPHC Obstetrics and Gynaecology Residency Programme. From left: Dr. Geremias Rangel, Dr. Natasha France, Dr. Ademola Biala, Dr. Anita Ramlall, Dr. Narine Singh.

Maternal mortality has been one of the most troubling challenges that the health sector has been faced with over the years. Many of us simply cannot get over the fact that a woman can carry a baby sometimes to full term with no daunting challenges and never make it out of the delivery room alive, or is barely able to live a few days after, because of some complication.
The GPHC, as the country’s main referral health facility, understandably, usually records the majority of such cases when compared to other regional facilities.
While officials have time and again highlighted the fact that many pregnant women are rushed to the GPHC only when they would have already developed a complication, thus leaving health officials there with little or no time to intervene, measures have quietly been implemented to better position the GPHC to improve its response.
This has manifested with the introduction of an Obstetrics and Gynaecology Residency Programme at the GPHC. Last month the first batch of students who participated in the programme graduated at the University of Guyana 2016 Convocation ceremony. The graduating class included: Doctors Geremias Rangel, Natasha France, Ademola Biala, Anita Ramlall and Narine Singh, who represent the first locally trained batch of Obstetrics and Gynaecology graduates – a historic achievement for Guyana.
According to Director of GPHC’s Institute of Health Science Education, Dr. Madan Rambarran, through the development of the programme, which was first introduced in 2012, there has been a more than 50 percent reduction in maternal mortality at the GPHC.
A noticeable reduction in maternal mortality has been substantiated by Dr. Janie Pak, the Obstetrics and Gynaecology Fellow attached to the Global Health WONDOOR Programme.
The WONDOOR programme is one provided by the University Hospitals in the United States, to reduce maternal and neonatal mortality rates through academic enrichment in under-resourced communities, both in the US and internationally.
Guyana was targeted for this support in light of findings that “Guyana has the 49th highest Maternal Mortality Ratio (MMR) in the world ranking with 270 per 100,000 live births. Compare this to the rate for the U.S. of 24 per 100,000 live births. WONDOOR has designed and implemented a sustainable and self-perpetuating residency programme that will raise the level of care. This four-year programme will help train citizens of Guyana in obstetrics and gynaecology for long-term success.”
Dr. Pak has been placed at the GPHC as a representative of the Obstetrics and Gynaecology Residency programme which is coordinated by Dr. Margaret Larkins-Pettigrew and Dr. Ruth Darkenne.
Dr. Pak has been at the GPHC since July 7 of this year and is tasked with helping to facilitate the clinical teaching of Obstetrics and Gynaecology residents. She has committed to lending her support in this regard until June of 2018.
However, Dr. Pak has underscored that while maternal mortality is a huge issue here its prevalence is not unique to Guyana. But according to her, there has been clear evidence that the Residency programme has been making an impact at the GPHC. As she displayed a graph, she pointed out that while there were a total of 15 maternal deaths at the GPHC since the introduction of the Residency programme in 2012, there has been a constant decline, with eight cases being recorded thus far for this year.
Because some of these cases are deemed as potentially preventable, strategic efforts are being made to prepare the residents in training to avert such daunting outcomes.
The goal of the Residency programme, a situation that is already being attained, is that crucial expertise is always available at the GPHC to attend to even the most challenging deliveries. It is also expected that the expertise that the residents are gaining will eventually be expanded throughout the country.
Part of the process too, Dr. Pak noted, is that it is imperative for physicians and nurses to work hand in hand, otherwise patient care can essentially be compromised.
Currently there are currently 22 doctors who are a part of the residency programme. And Dr. Pak made it clear that the training being offered here mirrors that which is offered in the United States. Although all of the resources used for the programme may not match what is obtained in the US, she insisted that the local programme has an identical curriculum.
“The standard of care that we are able to implement here in Guyana with the resources that are available is what we are teaching. Every week we do didactic teaching, every week we do OB simulations, we teach them evidence-based medicine on the most up to date curriculum…” said Dr. Pak, as she pointed out that the local programme essentially benefits from the guidelines from well established organisations such as the American College of Obstetrics and Gynaecology.
“We use a lot of their clinical guidelines as well as from Canada, the United Kingdom and Australia…all of these big (international) organisations we use their evidence-based guidelines to guide practices here,” related Dr. Pak.
One of the big and noticeable things that has materialised as a result of the programme, is the development of protocols to unify and guide clinical decisions at the GPHC. But the programme does not only entail a training aspect as, according to Dr. Pak, research and quality improvement projects have also been incorporated.
Sixteen research projects have already been completed, and at a recent Scientific Conference residents were able to present four of these which were recognised as outstanding.
Some of the projects that have been done have taken into consideration whether labour should be induced when a woman turns up at the Maternity Unit when her water bag has already been broken; risk factors for surgical infections, among others. The aim is to develop guidelines as to how issues related to these and a number of others that have been linked to maternal mortality can be addressed in the future.
Although positive results are already forthcoming, Dr. Pak noted that the requisite improvements at the GPHC are many. She however noted that it has been recognised that they can only be tackled a few at a time in order for them to be sustainable.
According to Dr. Pak, while it has been found that Guyana exists in a low-resource setting, there are still a lot of resources, and thus a lot of improvements that are possible to help advance the delivery of medical services. For this reason, the residents have been gaining experience to not only focus attention to individual patients, but to implement systemic changes that can help improve the delivery of care on a wider scale, suggesting that Guyana is on course to further considerably reduce the incidence of maternal mortality.