Speed Bump

After a week celebrating promising short-term results, we were due for a bit of a reality check. The first couple of places we visited gave us all such an incredible sense of hope and possibility it's been hard to stay grounded. Before long though we were reminded that saving all mothers and newborns isn't easy and won’t happen overnight. Progress is possible, but not without overcoming some challenging obstacles.

Driving back out to the Fort Portal region of western Uganda for the second time, we turned off the main route to Kabarole Hospital, a health center that serves as one of the referral centers for this region. We were greeted by a smiling, but obviously tired Dr. Loy who led us into her office. The feel of the clinic matched the discussion and tour that followed. The hospital corridors were dark because of limited natural light and intermittent electricity and peeling paint revealed cracks in the walls. Still, despite the many challenges they face working here, the hospital staff was committed and pleasant.

Dr. Loy gave us an overview of the hospital’s statistics before and after starting work with Saving Mothers, Giving Life. So far she's been able to train staff and purchase supplies, which allows them to receive more mothers. Once word gets out that a facility is actually equipped to care for women and once they have a transport voucher to get there, the number of women coming to the facility to deliver begins to rise. Often, this increased patient flow overwhelms a facility. Despite these challenges, Dr. Loy’s statistics and headline-results were impressive and reassuring, just like everywhere else we visited this week. 

It was impossible to deny the strains on the system that in our other facility-visits had remained seemingly unaddressed. Dr. Loy was exhausted from having performed a C-section in the early morning hours of her previous nightshift.  Clearly there wasn’t enough support staff to share her burden. The number of C-sections has risen from 36 per month to 100 per month with no increase in staff. In poorer countries like Uganda it’s estimated that the C-section rate is far below the 10% the WHO estimates it should be in countries where obstructed labor causes so many maternal deaths.

We toured the operating theatre and learned that while the hospital had received a three-fold increase in delivery and C-section kits plus new sterilizing equipment, but the C-section kits won't fit in the new sterilizer. This means they have to use an older, slower sterilizer, which often causes  backups in the OR. In addition, the designated maternity ward and delivery area are small and cramped. One woman with sepsis was housed in a room next-door, but poor ventilation made this inadequate.

We took in all the surroundings and information and offered encouragement. Despite everything, this hospital is still reporting a rapid decline in maternal deaths, but our wake up call was this: they continue to register up to 15 perinatal (newborn) deaths a month; a figure that’s almost incomprehensible.

EMC's mission focuses on reducing preventable maternal deaths, but we believe in the continuum of care that impacts infant survival as well. Our visit to Kabarole Hospital underscores that we must ensure that mother and newborn not only survive the delivery, they must also survive the critical post-partum period and well beyond those first 24 hours.

The big lesson on this visit was a reminder that changing good and bad outcomes doesn't always happen overnight. Even significant investments in weaker health systems can't address all challenges at once. Having a focus is important, but what’s truly needed are balanced, thoughtful strategies that keep the entire package - mother, newborn and child health - at its’ heart. As we left Dr. Loy, we wished her luck and a good rest.  That’s the same advice we'd offer any other marathoner, who, like Dr. Loy, is in it for the long haul.