Shortage of skilled obstetricians, a challenge to reducing maternal mortality – CMO

Aug 26, 2014 News

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A shortage of skilled obstetricians has been listed as one of the biggest challenges Guyana has had in its efforts to

reduce its maternal mortality rate.  This disclosure was recently made by Chief Medical Officer, Dr. Shamdeo Persaud, who, without specifying the number of trained obstetricians currently in the system, informed that strategic measures have been put in place to build capacity to address the shortcomings within the public health system.
Dr. Persaud, who was at the time addressing a forum at the Brickdam, Georgetown, United Nations Children’s Fund (UNICEF) headquarters, said that he is optimistic that an ongoing Multiple Indicator Cluster Survey (MICS) will reveal, among other things, the gains Guyana has been able to make in its quest to reduce maternal mortality.
Reducing the infant and maternal mortality rates, are listed among the Millennium Development Goals (MDGS) that Guyana, along with other countries of the world, are aiming to realise by next year.
And according to Dr. Persaud, “one of our key indicators that I think everyone is paying special attention to is the maternal mortality ratio of Guyana.” He however, acknowledged that “it has been a little bit difficult to get to our target but I know with the resolve of everyone, including Government and all of our partners, we are moving swiftly to achieve less than 80 (deaths) per 100,000 births.”
This therefore means, Dr. Persaud outlined, that Guyana is working towards less than 11 maternal deaths on an annual basis. “I am optimistic that we will do it this year and that we will continue to do it in the future.
Guyana recorded 18 maternal deaths last year. Of the recorded cases, 11 were directly linked to pregnancy complications while seven were triggered by indirect circumstances ranging from malaria to even heart condition.
The main direct causes recorded last year were mostly due to haemorrhagic conditions, hypertension in pregnancy, eclampsia and adverse effects relating to bleeding. There was also; a case related to an ectopic pregnancy and two, related to termination of pregnancies where some complications were encountered.
Two of the indirect cases were linked to malarial complications and there were three cases with patients who had various types of chronic diseases – with at least one being an HIV related complication.
One case entailed a patient who had an underlying heart condition which resulted in the unfortunate outcome of death, Dr. Persaud disclosed.
Ten of the 18 deaths occurred at the Georgetown Public Hospital Corporation (GPHC), of which six were related to direct pregnancy complications. Other institutions that recorded deaths during the past year were the Suddie, Diamond, New Amsterdam and West Demerara Regional Hospitals and the privately operated Balwant Singh Hospital.
Five of the women who succumbed to the various pregnancy complications were from Region Four; three each were from Regions One and Two; two each were from Regions Three and Five, and one each was recorded in Regions Six, Seven and Eight.
Several of these cases – both direct and indirect – warranted disciplinary action, Dr. Persaud said.
But aside from the skills challenge, he informed that there have been other challenges in achieving the goal of a reduced maternal mortality rate.  In fact Dr. Persaud disclosed that catering to the most-at-risk maternal population may not always be a simple task.  “One of the biggest challenges with maternal health is to provide for that small number…say (for example) every year 100 women get pregnant in a country, about 10 per cent of them will require some really specialised and sometimes some very expensive support during their pregnancy and at time of delivery,” noted Dr. Persaud as he went on to note that dealing effectively with such cases may at times, be dependent on the other existing challenges a country is faced with.
He however, disclosed that when the Health Ministry conducted an evaluation in 2010, it was discovered that Guyana was lagging behind in achieving the reduced mortality goal. And in order to address this detected shortcoming, intervening measures were put in place. According to Dr. Persaud, among these measures was the building of a stronger capacity in terms of managing complicated pregnancies. “We have done a lot of work jointly with UNICEF, with PAHO (Pan American Health Organisation) and other UN agencies and we are developing standard protocols for managing the various conditions like hypertension in pregnancy; pregnant women who have gotten malaria during pregnancy, how to manage those so that the outcome could be best for both mother and child,” explained Dr. Persaud. “I think the MICS will really tell us how those measures are working,” said the hopeful Chief Medical Officer.

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