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This is a serious post from a heartbroken pediatrician.  I know the statistics: neonatal deaths account for 40% of deaths in children <5years of life.  Most neonatal deaths occur at home within the first 28days of life, especially in Sub-Saharan Africa and Southeast Asia.  Midwives are critical in decreasing death rates.  Check, check, and check.  Now, what can we actually DO in a low-resource area with insecurity, to really make a difference?

Imagine that you simply did not have access to prenatal care as a first-time mother.  Imagine now that you feared for your safety to simply travel 10km to get help.  You go into labor at home, at night, without a midwife, an epidural, or a birth plan.  Labor does not progress and you are in severe pain, unable to walk.  You can’t travel at night due to insecurity.  The next morning the baby is not moving and you travel by motorcycle to the nearest referral hospital.  The nurses receive you with care and compassion, but the baby doesn’t have a heartbeat.

We see this almost EVERYDAY!  Many babies are dying before they have a chance to be born in OUR HEALTH ZONE!  We are seeing the reality of women coming to the hospital with obstructed labor and babies in distress or already dead.  If the hospital doesn’t respond in a timely way(and even if they do), we see babies die in our hospital as well.  These last few months our Nyankunde Hospital’s maternity department saw upwards of 10 fetal deaths.  In previous years the number of fetal deaths was 1-2/month, so this current crisis is truly a public health emergency.

Insecurity and violence have long-standing effects on a community.  There are obvious sequelae of violence: death, displacement, children don’t attend school, families break apart, roads close, and people sell/move valuables.  Then there are less obvious effects of violence:  negligence of children, psychological trauma, not to mention the inability to farm rural areas, and lack of access to health care.  Violence always affects the most vulnerable among us:  pregnant women and children.

At present, there are only 4 of 12 health centers functioning for prenatal care and uncomplicated deliveries in our health zone.  The other 8 health centers are closed due to insecurity.  This means that women are probably not getting any prenatal care.  Many of them are going into labor and delivering at home because they come from insecure areas.  Women are not traveling due to insecurity of the roads and they simply are not arriving in time.  Babies are dying at home.

This is the worst that I have seen fetal and neonatal mortality since we arrived in 2013.  It is sad.  We have decided that it is time to re-open a ward for antenatal care from insecure areas around Nyankunde.  The facilities aren’t much to speak of, but adequate.  It is a room close to the maternity ward with beds, mattresses, mosquito nets, and access to clean water and washrooms.  Ideally, women with higher risk pregnancies would come 2-3weeks prior to delivery, as well as first-time mothers, women with repeat caesarian sections, or women from insecure areas lacking a midwife.  We plan to consult these antenatal cases when they arrive 2-3 weeks prior to delivery.  We will be making public health radio announcements welcoming women from these outlying areas with little/no access to care, first-time mothers, and anyone who needs a safe place to live for the weeks preceding delivery.  We may need to use the hospital vehicle to pick up these women on certain days at disclosed locations.  These women will need to be promptly evaluated and determine what their needs are.  There is a precedence for this kind of intervention in this area, but we have no idea what the community response will be.  The response could be tremendous.

-Pray for us as we see the breakdown of insecurity in our area, to not lose HOPE for the future.

-Pray for our maternity department as they desperately need more experienced nurses.  We have lost a lot of good nurses due to insecurity and decreased salaries.

-Pray for the physicians working with pregnant women in this high-risk environment.

-Pray for the message to get out to more isolated areas and for women to be willing to come.

-Pray that we would find the right support person(s) to support this effort.

Thank you for your interest and support.


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