Why women die....................................................Prof Yasmin Raashid Pakiatsm, and the rest of the world, is observing International Women’s Day toay – March 8. Concerned NGOs and members of civil society will raise women’s issues and the government will respond with empty rhetoric and hollow slogans while one woman will continue dying every half an hour in Pakistan due to complications related to pregnancy and delivery. There are no breaking news or headlines, no suo motu actions and no political commitments given to this particular aspect of a woman’s life. This shows the status of women in Pakistan. The unfortunate fact is that women are still struggling to get their right to healthcare. Pakistan is among those countries with extremely high maternal mortality ratio. Maternal mortality is defined as the death of a woman while she is pregnant or within 42 days of the termination of pregnancy. The World Health Organisation has pointed out clearly that three delays are responsible for maternal death. The first is the lack of awareness about the complications of pregnancy and thus a delay in taking a decision to take the patient to a health facility. The second delay is due to transportation difficulties in rural areas. The third delay occurs when a patient reaches a health facility and cannot get the required care due to lack of proper equipment, blood transfusion services and trained personnel who can provide operative services to save the patient’s life. A study was conducted in District Sheikhupura based on verbal autopsy. The study involved all reported and unreported maternal deaths that could be traced in the district in one particular year. A total of 27 such deaths were probed in detail to identify the role of each delay in these deaths. The result of the survey was very alarming. The first delay was minimal, while the second delay – usually considered to be a major player in rural areas – was not solely responsible for any of the maternal deaths. It was the third delay that was really responsible for maternal deaths. The sick mother had reached a health facility, but could not be saved because there were no emergency obstetric care services available. Factors contributing towards this third delay included lack of operative facilities, lack of blood transfusion services; shortage of trained staff; and the uncooperative and apathetic attitude of the available staff. It was disturbing to see that even secondary care hospitals lacked basic blood transfusion facilities while tertiary care hospitals lacked equipment like ventilators and cardiac monitors essential to manage critical cases that need intensive care. There was a marked shortage of trained staff in secondary care hospitals and a large number of specialised posts were lying vacant at THQ and DHQ hospitals. However, where trained staff was available, both in secondary and tertiary care hospitals, the attitude of the doctors and paramedical staff was so unacceptably offensive. On the whole, there was a general lack of concern towards the importance of human life and health of the patients. There was no system in place for evaluation and accountability in any of the public sector or private institutes. It was noted that deaths due to anaesthesia complications also took place in private facilities. It is well known that technicians and doctors who provide anaesthesia in private facilities are not properly trained in this particular speciality. Lack of clinical auditing and evaluation of private facilities permits them to play havoc with patients’ life. Since the third delay was found to be the dominating factor in majority of the cases, it would be meaningless to continue investing in community education, birth attendant training or deployment of community midwives until this delay is redressed. The development of referral networks is also useless because when the woman actually reaches a hospital that can offer her EmONC, she dies due to inadequate treatment and care. The government needs to take corrective measures on a war footing at the level of THQ, DHQ and tertiary care hospitals. It is very important that rural health centres – 20-bed hospitals – should be converted into emergency centres with all facilities for emergency obstetric services so as to minimise the time taken to reach a facility that can offer emergency services. The most important thing is ensuring the presence of doctors specialised in emergency obstetric care to be present at these facilities. The attitude of the staff can be corrected by developing training programmes in communication skills for these health personnel. Due to the burgeoning population, private facilities which advertise comprehensive maternity care should be taken on board and an avenue for public private partnership be sought. These private institutions should also be made a part of the referral network developed with public facilities and should have proper monitoring mechanisms. If such measures are not taken, then saving the mothers of Pakistan will remain a distant dream. As articulated so well by Mahmoud Fathalla, past president of the International Federation of Obstetricians and Gynecologists, “Women are not dying of diseases we can’t treat.... They are dying because societies have yet to make the decision that their lives are worth saving.”
Posted on: Sat, 08 Mar 2014 06:43:42 +0000