Late referrals linked to high rate of maternal mortality

Addressing the challenge of maternal mortality is not a task that can be done without some strategic measures being put in place. And some of these measures must include the strategic implementation of standard operating procedures and specific protocols.
This approach was amplified by President of the Guyana-Jamaica Friendship Association, Dr. Frank Denbow.
During an interview with this publication recently, he emphasised the need for the establishment of protocols to help tackle the maternal mortality challenge.
“We need to have established protocols so that everybody is on the same page. What we have going on is everybody is doing what they think is the right thing and that’s not working,” Dr. Denbow insisted.
The Association was the key player behind the organising of a symposium held during the past weekend in collaboration with the Ministry of Public Health.
At that forum it was recognised that the setting up of protocols, particularly in remote health centres, would be an imperative. Of course this would be dependent on the level of service available there, Dr. Denbow asserted.
During the recent forum the maternal mortality situations in both Guyana and Jamaica were compared by Professor Horace Fletcher, Dean of the University of the West Indies Medical School, an Obstetrician and Gynecologist.
Dr. Denbow, alluding to the presentation by Professor Fletcher, pointed out that as in Jamaica, Guyana is often faced with the challenge of transferring women very late to referral facilities which is sometimes too late for intervening measures to be effective.
This often results in a situation where there is a high prevalence rate of maternal mortality in the main referral centres. And Dr. Denbow underscored that “most of those patients were not indigenous to that place. They came from somewhere else and they sometimes came 12 or even 24 hours before they died. In other words they were referred when they were at deaths door…”
For last year Guyana recorded a total of 17 maternal deaths. A total of 18 deaths were recorded during the two previous years.
While the referral situation is one of the biggest similarities between the two territories, Dr. Denbow noted that a greater challenge that is faced here is the issue of transportation. “Jamaica is much smaller. We have situations of people living in areas where there is no access to transportation or where the only transportation is by boat, and it takes several hours to get to referral centres,” considered Dr. Denbow.
“The time taken for somebody in some areas in the Pomeroon to get to Georgetown is a long period – to get a plane and all that kind of stuff. So we have a lot of challenges and the only way around that is to be able to identify problems early,” asserted Dr. Denbow.
He pointed out that with protocols in place, health workers can focus on identifying early pregnancy that is likely to be problematic and thereby help to “significantly reduce the prevalence of women dying in child birth which is a disastrous end to something that is supposed to be joyous.”
And identifying problematic cases could be easily recognised since, according to Dr. Denbow, “if you have a woman who comes to the antenatal clinic at four months and her blood pressure is 220 over 140, you know that in a place where you don’t have a doctor or there is a midwife or Community Health aid, that person is likely to be in a situation that you can’t handle the labour and delivery.”
And once the problems are identified, patients must be transferred to a facility that has the capabilities to effectively monitor and manage them.
Plans to set up protocols to tackle the maternal mortality issue come at a time when Guyana and Jamaica, like a number of other countries, are still struggling to deal with its impact and simultaneously strive for measures which confirm to the Millennium Development Goal (MDG) 5. MDG 5 speaks to efforts at improving maternal health with a view of reducing the mortality ratio.
There are eight MDGs which were set at the 2000 Millennium Summit of the United Nations to accelerate global progress in development.(Kaieteur News)