Improving Services for Obstetric Emergencies

Lindsey Pollaczek

Medical Research Center, Tonkolili and Bo Districts, April 19-20

About 15 percent of all deliveries will be complicated and will require emergency obstetric care. Many complicated cases can be managed at a lower level facility if the skilled birth attendant is trained in the management of basic emergency cases and has the tools they need to do their job. This skilled birth attendant is also trained to recognize the danger signs when a woman does require referral to a higher level of care where cesarean section and blood transfusion are available, and can make that decision promptly in order to save a woman’s life.

Successful emergency obstetric care requires three critical components:

  1. Trained providers at each level of the health system who know how to manage and when to refer emergency cases;
  2. Availability of the proper equipment and supplies to manage such cases; and
  3. A functioning referral system that can move a woman quickly to the appropriate level of care.

Medical Research Center (MRC), a Sierra Leonean nongovernmental organization and Direct Relief’s key partner in the country, is focused on providing inputs to each of these levels in order to improve emergency obstetric care. MRC has been working in Sierra Leone for more than 30 years and works closely with the Ministry of Health to improve healthcare delivery at the level of Peripheral Health Units (PHU), the health centers closest to the community that provide essential primary care and maternal health services. With support from organizations like Direct Relief, MRC distributes medicines, supplies, and equipment to the health centers that care for women in pregnancy and childbirth. MRC has also trained all healthcare workers that provide delivery services in basic emergency obstetric care and has established an ambulance referral system to transport women in emergencies to the nearest hospital.

But the nearest hospital is often very far away. To witness just how far, I traveled with MRC staff to one of their most remote operational areas, the chiefdom of Sambaia. For more than three hours we bumped over incredibly rough terrain which included a long, steep climb and descent through the hill country, then another hour of travel to reach the village of Bendugu. When we told people at the hospital in Makeni town that we were heading out to Sambaia, they all shook their heads and commented on the long distance and disadvantaged community. Our trip was in the middle of day in the dry season, but emergencies happen at the most inopportune times, like late at night in pouring rain. It’s difficult to imagine a woman in obstructed labor making this treacherous journey in any scenario.

This demonstrates the critical importance for MRC to continue improving quality of services in remote areas so that more woman can deliver safely at the health centers, and when a case requires emergency transport, the health workers are able to identify danger signs early enough to make the call and save a woman’s life.

Yele Community Health Center, also supported by MRC, is down the road in Bo District. Yele CHC has been selected as the basic emergency obstetric care referral center for its chiefdom of over 50,000 people. The community health officer in charge, Peter Konneh, is a dynamic man who is passionate about improving maternal health and proudly recognizes that the health center has had zero maternal deaths in the last few years, thanks to its work to educate the community and ensure that its staff is qualified to manage nearly all obstetric cases.

Peter was a young boy when the civil war broke out and rebels invaded his home village in Kailahun District in eastern Sierra Leone. It was a terrible time for thousands of Sierra Leoneans and Peter was one of many who were forced to flee their homes. After spending 10 years in a refugee camp in Guinea, Peter returned to Sierra Leone and trained as a community health officer, which is just below the level of medical doctor. Upon graduation, MRC employed him in 2006 and he was posted to Yele CHC, where he has committed to overseeing this important work for the long term.

Direct Relief has been working with MRC since 2008 and has provided three donations of medicines, supplies and equipment for the 32 health centers, hospitals, and the School of Midwifery in Makeni. MRC purchases medicines and supplies that are not donated, which is a significant expense. MRC is an excellent partner for Direct Relief; the medical supplies we provide do a great deal to support the primary care system and strengthen emergency obstetric care in Sierra Leone.

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