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04/17/14

Every Mother Counts speaks  with nurse-midwife Jeanne Ginette Fanfan to better understand the impact of these trainings, which cover topics such as normal labor and birth, newborn care, emergency and high-risk obstetric care, gender-based violence, emergency contraception, newborn resuscitation, breastfeeding, and family planning, including IUD insertion.

At University Hospital in Mirebalais, Haiti, training for doctors and nurses is a key part of raising the quality of care.

In Haiti, a lack of access to medical care makes childbirth a potentially life-threatening event for women and newborns. Because of Haiti’s high maternal death rate, and to overcome the disparities that negatively impact the health of women, University Hospital was designed to be a center of excellence for maternal and newborn health.

Nurses, nurse-midwives, and nurse assistants conduct the vast majority of deliveries in Haiti. While their nursing school education is comparable to what’s offered in the United States, Haitian nurses usually don’t have access to continuing education, which helps them apply the latest medical science and clinical techniques to their lifesaving work.

To remedy this, Partners In Health, with EMC support, invested in extensive training for nursing staff in the maternal ward, who perform about 45 deliveries each week under the supervision of obstetrics-gynecology (ob-gyn) doctors.

Miss Fanfan, what is your role at University Hospital? (Nurses in Haiti are referred to as “Miss” as a term of respect.)

I’m a nurse-midwife at Hôpital Universitaire de Mirebalais. My job is to manage the care of pregnant women who are delivering and of patients who have obstetrical emergencies, such as preeclampsia (high blood pressure in pregnancy) and eclampsia (seizures following high blood pressure), which is the largest cause of maternal death in Haiti, post-partum hemorrhage (bleeding after delivery), and placental abruption (when the placenta separates from the uterus before the baby is born).

I also provide general obstetrical care in the hospital, and work with the ob-gyn. I’m also responsible for reporting on our activities to ensure the quality of the data that we’re collecting, so I input information into the hospital’s electronic medical record system and fill out paper forms.

You’ve participated in many trainings at University Hospital. How have you applied what you’ve learned?

One example is in managing cases of retained placenta. On occasion, we have patients who arrive at the hospital after delivering at home with a retained placenta. Usually they’ve delivered at home with the help of a matrone, a traditional birth attendant, and they come to the hospital because the retained placenta causes continued bleeding after the baby is born. These women usually come in with their babies between two and six hours after they’ve given birth, and they are hemorrhaging because they haven’t passed the placenta.

I’ve learned to better manage the cases. I put in a urinary catheter because sometimes a full bladder impedes the passage of the placenta, and draw blood, which I send to the laboratory for analysis. The blood analysis allows us to test for anemia, gather information on the patient’s blood type, and test if her blood is clotting well.

I also help the woman by doing physical maneuvers to see if the placenta will pass naturally or if a care provider needs to remove it artificially. If so, either I will perform the procedure or I transfer the woman to the operating room for surgeons to do it.

After the placenta is removed, we place the women under observation, helping them nurse their babies. We also provide a blood transfusion if the lab results show that the woman is severely anemic or has lost a lot of blood. If the placenta was removed artificially, we put the women on antibiotics to prevent infection. Once the women are stable, I discharge them home.

What specific trainings have helped you in these situations?

We had training on management of post-partum hemorrhage, and I learned about the best way to manage these cases. At University Hospital, we have special protocols that help us follow the latest medical science in caring for patients. These protocols have helped make sure we do everything we can to help patients in particular situations, like women who have retained placentas.

The continuing education has helped me learn new information that has come out of the latest research that’s been published in medical journals. Also, our staff participates in morbidity and mortality reviews, which help us learn from cases where a patient was injured or died.

It’s also been a great learning experience to work alongside a strong medical team, including the ob-gyns, nurses, and nursing assistants. It’s also great to work with all the resources we need, such as medications, supplies, and diagnostic tools.

You’ve worked as a nurse-midwife in Haiti for many years. How do you feel about your work at University Hospital?

I am very happy to work at University Hospital. This is the perfect moment to be part of the hospital staff, because we have a great team to work with.

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