This morning, the SCOPE team hit the road!
A team of data collectors from the University of Gondar joined Sheldon and me as we set out to visit and assess health centers in the rural areas near Gondar. The FLAME study, which is the research arm of SCOPE, is visiting 30 health centers to assess their current capacity for maternity care. Of those 30, many will be selected as sites for an upcoming project from the SCOPE team- training local priests and pairing them with health educators to encourage women to give birth in the safest way possible.
Early in the morning, we left the bustling city of Gondar, and headed out into the green hills to the north. The landscape was surprisingly rugged, with terraced fields hugging the sides of the endless steep slopes.
Ethiopian health centers typically consist of several simple concrete buildings, with open waiting areas in between. Most are run by a ‘health officer’- a clinician with three or four years of training, who is able to treat most common illnesses and refer more complex cases to doctors at regional hospitals. The health officer works with a team of nurses, midwives, and sometimes lab or pharmacy technicians.
Each of the health centers that we visited today served an area of about 35,000 people. Though they both had electricity, the facilities were basic. At one center, the local greenery was encroaching on the maternity clinic hall!
One of my jobs here is to assess for the presence of certain important supplies in the maternity areas. It was clear upon seeing the first space that the midwives were working with basic tools. Used instruments were rinsed in successive buckets and autoclaved. Plastic instruments such as suction catheters, which would have been considered disposable in the US, were being carefully cleaned for reuse. If the labor did not go as planned, the health officer advised us that an ambulance could take up to five hours to arrive. In the meantime, the midwives had limited options to stabilize patients with complications. The health centers were unable to perform cesarean sections, blood transfusions, or forcep assisted delivery.
At the second health center that we visited, the door to the delivery room was closed. The midwife was assisting a laboring woman inside as her excited family waited outside.
We introduced ourselves to the family members waiting patiently outside the delivery room- I recognized the joy tinged with worry that is universal among loved ones waiting to hear if a baby has arrived safely, especially in a basic environment such as this.
While waiting, the family was repeating an hourly ritual of making coffee from scratch. Coffee ceremonies are central to Ethiopian culture, and the family explained that they wanted to surround the laboring mother with the feeling of home- including the smell of fresh roasted coffee beans. As finished our assessment and left, the mother was still laboring and the family was still anxiously waiting.
As we headed back to Gondar, I thought about what I would do if I was working in a facility like this when an obstetrical emergency arose. Prenatal care is essential to screen for women who may be at a higher risk for complications during childbirth. Yet many women in rural Ethiopia do not complete the recommended four prenatal visits. They often give birth at home with only relatives assisting, using the health center only as a backup if problems arise. Unfortunately, when women arrive at the health center with emergencies, their needs may already be beyond the basic capacity of the health center staff, and it may be too late to send for help.
It was clear how important it was to make sure women know to come to the health center throughout their pregnancy, and to make sure that women feel comfortable and supported by their community, including their faith leader, when accessing health care.
As the sign on the delivery room door boldly says- no mother (or baby) should die while giving birth!