May 30, 2017 – Maternal Care

  1. What are some of the challenges that Kristin faces in pediatric oncology, and what kind of impact has she had on these challenges in Tanzania?

Kristin is a pediatric oncologist currently working in Tanzania at the Bugando Medical center. Prior to this she went all over the world learning and teaching international medicine to hundreds of people. Over her travels some of the challenges she has faced is adapting to the culture and health of another culture. Though she was formally trained in the US, many of what she learned had to be modified in order to provide appropriate care to people in other countries. She also had to find ways to educate people in a way that was effective for the respective culture where it was being taught. Specifically, in Tanzania not many people were able to read so awareness campaigns and educational programs made use of pictures and other forms of visualization. In pediatric oncology Kristin also has problems getting patients to continue coming for treatment because for the families it is expensive and likely far away for them to commute to the hospital, also it is hard for the families to up and leave their homes and farms for long periods of time because someone needs to stay back and maintain the household. Aside from the difficulties with patients, Kristin has found challenges in the fact that there is a lack of training in the pediatric center, and currently she is the only fully trained and licensed pediatric oncologist at that hospital or in the area. When she is not at the hospital there may be problems for other medical staff to properly diagnose and treat patients. Another challenge is a lack of organized record keeping so it is hard for her to keep up with the patient and their past and present treatment plans. To help combat these challenges Kristen has started her own NGO called ICCARE + DCP where she was able to create a cancer registry which keeps track of the patients and their health status. Through the NGO she has also been able to combat the inability for families to pay for medical treatment by providing funding for their treatment, chemo, labs, housing for patients and families, and general cost of care. They also have a clinic coordinator to follow up with patients to help reduce abandonment and make sure people keep coming for treatment as needed. One of the biggest things her NGO has done is help educate the locals by having awareness campaigns by intertwining local culture, like dancing, in with education of locals along with explanations on what exactly cancer is and why cancer treatment is necessary. With all of the work Kristin is doing in the hospital and with her NGO I know she will be able to reduce cancer rates in Tanzania and hopefully in many other countries.

  1. Check out this video– how would you implement this method of quantifying blood loss in Sub-Saharan Africa?  Can you see some challenges in applying this to the developing world?

Postpartum hemorrhaging is a serious condition that results in blood loss of more than 500 ml following vaginal delivery, and 1000 ml following c-section in 24 hours after birth. Some methods for preventing and monitoring it include measurement of blood loss following birth. This method may be difficult to implement across all of sub-Saharan Africa but with enough funding it may be possible. What I would do would be to run a several mobile clinics throughout main regions of sub-Saharan Africa and give pregnant women under-buttocks drapes and educate them exactly on how to use them, how to measure and quantify the blood loss, what amount of blood is too much, and the consequences of blood loss. The mobile clinics would also provide some sort of method for women to contact healthcare providers in the case of an emergency. An alternative solution would be to start clinics, similar to what Mama SASHA is doing where pregnant women can go for healthcare while pregnant and also go for training on blood quantifying techniques that they can perform when they are at home giving birth. In the case of an emergency the healthcare facility would have some sort of emergency vehicle that would be able to reach the mother in time to help stop the bleeding. The only problem with this would be finding a way for the women in need to contact the facility since it is unlikely that they may have phones. If the clinic was close enough they could set up some sort of walkie-talkie system. Another route with the healthcare clinic would be to have a wing for women who are in labor, and have trained professionals who will be able to deliver the babies and have equipment to quantify blood loss and be able to react to a situation where blood loss was too high. Obviously all of these possible implementation methods are dependent on a variety of factors like money, infrastructure, trained medical professionals, accessibility for patients, education about birth, risks, and blood weighing techniques, and access to things like phones or emergency vehicles. These ideas would also be difficult to get all over sub-Saharan Africa and be able to cover every single pregnant woman in the region. A good start would be having mobile clinics go around to villages and pass out things like under-buttocks drapes and educate women on them. This would help with the initial problem but the big problem I see is that if a woman measured her blood and had too much loss, there may be no way for her to access a doctor or fix the problem so she may die anyway. However, I would also educate them on ways to reduce risk or prevent hemorrhaging by doing things like breastfeeding or manually massaging the uterus to stimulate contractions and cause the expulsion of extra placental materials. If more education is increased and healthcare facilities were available in these regions we may be able to help reduce the risk of postpartum hemorrhaging.

  1. We explored many areas of maternal health care today – what you you think is the ‘easiest’ challenge to tackle (prenatal, during pregnancy, postnatal hemorrhage) and have a positive impact?  Why?

I believe that prenatal care would be the easiest challenge because it requires less intervention by doctors and requires less risk than during birth, and postpartum. Much of prenatal care involves education over things like safe sex, birth spacing, nutrition and general care during pregnancy. Malnutrition is also a serious issue for expectant mothers because they do not get a balanced diet and do not have vitamins to supplement the lack of nutrients in their diets. Additionally, while women are pregnant they need and additional 150-300 calories per day in order to facilitate healthy fetal development. However, women often eat last and do not get the calories they need which may result in neural tube defects, brain damage, premature birth, underdevelopment of organs, death and more in their developing fetus. (Parrotte) Organizations like Mama SASHA try to combat both lack of prenatal care and malnutrition through education and reward benefits for mothers. The premise is that women must attend four prenatal care sessions during pregnancy where they get general checkups and education about health and safety during pregnancy. After they attend these sessions they receive a voucher for receiving sweet potato vines that they can plant and grow at their house. Sweet potatoes are easy to grow and healthy as they provide people with vitamin A. This helps keep the mothers healthy both by receiving medical care, and by eating sweet potatoes, and produces healthier babies as a result. Another benefit for this organization is that it helps support local farms because the organization pays them for their sweet potatoes and promotes continued crop production and agricultural efforts. (Mama SASHA Project) Though there are challenges like accessibility, possible adverse effects on soil, and availability of only this one type of food, it is still a great example of how prenatal care can effectively be addressed to help limit things like miscarriages and preterm births. If this organization or other organizations like it were widespread across countries with high maternal or infant deaths, this may help provide them with the care and sustenance they need to result in a healthy pregnancy.

 

Parrotte, Kelsey. “How Malnutrition Affects Pregnant Women in Developing Countries.” The Borgen Project. N.p., 24 July 2015. Web. 31 May 2017.

“Mama SASHA Project.” Mama SASHA Project | The Center for Health Market Innovations. N.p., n.d. Web. 31 May 2017.

 

 

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