Update Report on Maternity Care in Chad
February 2007
When Angela
Gorman and I visited the Maternity department of the l’Hôpital
Générale Référence Nationale (HGRN) for the
first time on this visit, the midwives were in a meeting, so we waited outside
the room for a while. When one of the midwives came out of the room, we
looked round the corner of the door and were greeted by a sea of happy faces
and were almost stampeded by the midwives. They were ecstatic to see us
again and they hugged and kissed us. It was quite overwhelming and made
us realise that the help we are giving to the hospital is highly appreciated,
not only by the mothers who benefit from the donations but also by the midwives.
One of the midwives said, “when you visited last time, there were
deaths, deaths and more deaths and now there are none”. This is mainly
due to the fact that we have sent Magnesium Sulphate to treat eclampsia,
which is the most common cause of maternal deaths in Chad. We have also
sent antibiotics to treat sepsis and drugs to treat pre-eclampsia. Sadly,
however, when we were there, there was one maternal death from uncontrollable
post partum haemorrhage I was a little disappointed that the midwifery practices
have not changed very much since our last visit, but the midwives are very
keen to be taught various techniques to improve their practices. We discovered
the reason for the babies not being put to the breast immediately after
birth. There is a superstition in many African countries, including Chad,
that the colostrum is “dirty milk” and unsafe to give to newborn
babies. They are only given water for the first 24 – 48 hours, so
there must be many avoidable neonatal deaths due to dehydration and hypoglycaemia
(low blood sugar) We did see one of the midwives trying to persuade a lady
who had just given birth, to put her baby to the breast. By doing this,
a naturally produced Oxytocin is released from the brain into the Mother’s
blood stream. This causes the uterus to contract and therefore helps to
stop any post partum haemorrhage. In the West, mothers are frequently given
injections of Oxytocin to contract the uterus rapidly after the birth of
the baby. The Chadian
mothers are still delivering supine, but hopefully that will change. We
have put teaching notes up on the wall in the Labour Ward to remind the
midwives what they have been taught. We are also sending out laminated teaching
files from our notes in the near future Both Angela and I gave several hours
of lectures on various techniques concerned with midwifery and neonatal
resuscitation and general care. The lectures were all very well received
and also extremely well attended by the midwives, who all participated well
and asked lots of relevant questions. Some of them even stayed up after
doing a night shift to come to the lectures. They are all very keen to learn
and we were pleased that all our work to prepare the lectures had been so
helpful. Angela’s nephew Simon was our interpreter. He is absolutely
fluent in French, but he had problems making the midwives understand him,
as the Chadian French has a slight “patois” to it. As soon as
Grace Kodindo came into the classroom and acted as our interpreter, all
was well! Perhaps in the future we should try to send African French speakers
to do some of the training/translations, as it seems to be a problem for
good French speakers. Simon had no problem translating for us during our
many meetings with the hospital director.Last year there was a strike in the hospital for 8 weeks due to the fact that the staff had not been paid for a few months! During this time, some of the equipment that we have sent was stolen. We were very disturbed about this and had almost daily meetings with the Hospital Director, the Deputy Chief Medical Officer of Maternity, the Senior Administrator of Maternity and the Chief Pharmacist. We are both very confident that in the future, the drugs and equipment we send will be accounted for. We have even signed a two-year co- operation agreement with the Hospital Director between the HGRN and HFGK. The Chief Pharmacist is going to inform us if they are running out of any drugs or equipment and we will then transfer some money to the pharmacy account, so that he can purchase what is needed. The only drug we need to continue supplying, as it is unavailable in Chad, is Magnesium Sulphate, the life saving drug for eclampsia. It is obviously better to send money to purchase the other drugs needed, because they are very much cheaper in Chad than in the UK and there will be no freight charges, which are very costly. Some people, however, are not very keen to send money to an African country. Angela and I can assure everyone that the account the money will go to is ONLY for the Pharmacy at the HGRN. The Chief Pharmacist has promised us that he will send receipts for everything he buys. While we were there, we gave him some euros to buy sutures and he showed us the documentation, which was signed by several people. Obviously, in the first instance we will only send a small amount of money as a “test” case.
Dr. Grace Kodindo has now left Chad and is working in New York with Columbia University for five years, researching into maternal deaths worldwide. Her special countries, which she will have to visit, include Chad, Colombia and Myanmar. We all wish her well in her new and exciting venture. She will be a great asset to the research project. She is still willing to act as a liaison between HFGK and the HGRN.
By Pippa Zintilis