In Ivory Coast's central Hambol region, Doctors Without Borders (MSF) is partnering with the Ministry of Health and Public Hygiene to reduce maternal and child mortality. In 2017, their joint programme is extending its support to the region’s most far-flung communities.
He doesn’t yet have a name, but after just 48 hours of life, the baby boy is already a survivor. His mother, Fatoumata, barely 20 years old, had already given birth to twins two and a half years ago at home. This time in March, bearing twins again, she gave birth once more at home on the edge of the town of Katiola.
But the delivery was troubled, and when Fatoumata arrived at the hospital the first twin was already born but suffering from severe respiratory distress.
His brother meanwhile was stuck, awkwardly positioned, in utero.
The first twin was rushed to intensive care; his mother, to the operating theatre where her second baby was delivered by caesarean section. But despite all their efforts, the medical team was unable to save the first baby and his mother too passed away after several hours.
The odds were stacked against the mother: she had had no antenatal care, and when she arrived at the hospital she was too late, too sick, and had lost too much blood. Her second twin, the survivor, has been admitted to the newborn intensive care unit, regularly attended by the neonatal team and visited each day by his widowed father.
*Name has been changed to preserve privacy
This type of care is too expensive, too far away, or just simply unavailable
“Fatoumata’s story is emblematic of the reasons why MSF is in Katiola”, says Dr Gabriel Kabilwa, the medical referent for the program. “Here in the region of Hambol there are too many women every year just like Fatoumata, and newborns, who die during childbirth or soon after.
The principal causes in the women are severe haemorrhage and eclampsia [a hypertensive disorder during pregnancy]. For the babies, the key cause is sepsis [severe general infection].
Many maternal and newborn deaths are also the results of poor access to the level of care which would handle complications such as these. This type of care is too expensive, too far away, or just simply unavailable. That is why it is important to strengthen access to care in the most underserved areas of Hambol.”
“To achieve this, MSF’s partnership with the National Ministry of Health and Public Hygiene supports access to and the availability of quality care for women in the region, in Katiola hospital and three primary healthcare centres (PHC)”, explains Romain Jacquier, programme coordinator in Koutiala.
“These are the physical links in our continuum of care, that starts with monitoring of the pregnancy before delivery, and progresses through maternity care at the time of childbirth, the management of obstetric emergencies, and neonatal care when the baby has been born too small or suffers complications.”
Double the number of health centres supported in 2017
Since we began supporting the PHC, our joint MSF and Ministry team of midwives has assisted with direct care in the PHC, telephone consultations when PHC staff have emergency patients and organising a referral to the hospital if the women or newborns require it. MSF also supplies essential medicines, equipment and regular access to clean water in the PHCs and the hospital,” says Estelle Thomas, MSF’s activity manager for Hambol.
In 2017 the objective is to double the number of PHCs supported by the partnership and to help renovate Katiola’s long-standing mother-and-child health centre [known as the PMI].
Early in the morning, in the same week that Fatoumata arrived, Albertine has been referred to Koutiala hospital from Dabakala, more than 80 km away. Obstetrician-gynaecologist Dr Rasha Khoury explains Albertine’s case before getting ready to operate.
“She needs to have her baby delivered by caesarean section because her baby is bigger than her pelvis. This is a potentially life-saving intervention, because if her labour prolongs she risks a uterine rupture or dystocia [obstructed labour], and both could cause serious, future complications for her.
She has already had a caesarean for her first baby, and she took traditional medicine to accelerate the birth this time. In fact, this combination has already caused a partial uterine rupture.” One hour after surgery began, Albertine is out of trouble.
Her newborn survived but had to be resuscitated by a paediatrician and midwife, because his small lungs were filled with meconium [a baby’s first faeces].
He is under care in the neonatal intensive care unit. Says Rasha, “Without the quick referral from Dabakala, the emergency obstetric services here in Koutiala hospital, the trained staff, the blood bank and the newborn unit, mother and baby would probably have not survived.”
As part of MSF’s commitment to maternal and newborn care in Hambol, MSF is also aiming to strengthen the population’s access to healthcare through offering vaccination and care for victims of sexual violence.
Key 2016 figures
- The estimated 645 maternal deaths per 100,000 live births in Ivory Coast compares with 6/100,000 live births in Australia
- More than 3,000 births, 20% of them caesarean section, were assisted in 2016 by Koutiala hospital’s medical team
- 60 newborns each month are treated for complications at birth
- More than 1,200 deliveries were recorded in the three primary health care centres supported by the MSF-Ministry partnership