Nurses—Making a Difference in Global Health
Nurse Stories: Reduce child mortality
Village Health Workers: Reducing Maternal and Infant Mortality
I-oh, I-oh, I-eeeeeee…, I-ooooooooooh cries a petite young woman in the operating theatre at Julia Hospital within the compound of the Comprehensive Rural Health Project: Jamkhed, (CRHP) in Maharashtra, India. Her full-term pregnant belly is no larger than a small football.
She is not from a project village. She did not receive prenatal care. There was no village health worker to teach her proper nutrition during pregnancy, no one to dispel the myths and superstitions, no one to make sure she had a safe delivery.
She has been in labour far too long. She is exhausted and the fetus has been in distress for hours. The woman went to the hospital near her village but was referred to Julia Hospital because she needed a C-section and could not afford to pay the 8000 Rupees ($180 Canadian) for the procedure.
There is another delay as the CRHP physician attempts to convince the grandmother that a C-section is absolutely necessary. To de-mystify the procedure, the grandmother is brought into the delivery room and sits cross-legged on the floor in the corner.
There is no more time to waste, every second counts. Within a few minutes the doctor is working the stuck head of the baby out of the birth canal and bringing a limp baby girl into the world. There is no cry. There is no movement. She is so tiny and so blue.
Grandmother gets up to check on her granddaughter and the baby. She is gently asked to stay seated. Alone she sits as tears begin to roll down her cheeks. The realization is setting in that this situation is far worse than she imagined. There are no extra hands to comfort her. They are all being used to save two precious lives.
The baby is whisked to the awaiting tray lined with the mother’s sari-cloth so the baby can start to build immunity to her new home environment. Immediate efforts are made to start an IV, intubate the baby, and get oxygen started. As the physician sutures mom’s incision, she regularly asks in Marathi how the baby is doing. After several tense minutes, the baby girl is intubated and given oxygen and she begins to pink up. However, she remains limp.
The clock on the wall ticks off the seconds, then the minutes. Come on little one come on. Women of India are strong. You can make it.
Very slowly her chest starts to expand on its own. A group exhalation of held breath is heard around the second operating table on which the baby girl is fighting for her life. Her little lungs are starting to work and so she breathes on her own and intubation is discontinued shortly thereafter.
The baby’s reflexes are good when running a thumbnail up the sole of her long narrow foot but her arms remain limp. A small plastic hose is positioned close to her nostrils giving her extra oxygen as she struggles with grunting sounds to keep breathing on her own. A heat lamp is brought in to keep her warm until the physician can examine the baby. Once examined, the baby is weighed, 2.3kgs, not a good weight for a full-term baby. CRHP village babies are at least 3kgs at birth.
Mom and baby are taken to the intensive care unit where the little one is place into a warmer with an oxygen hood. A nasal-gastric tube is inserted for feedings because neither mom nor the baby has the strength to breastfeed. If the little girl survives, there may be brain damage due to the length of time she was in distress before delivery.
The little girl is moving her arms now but remains in guarded condition. Only time will tell how the baby will do. Thanks to private donations, the portion of the woman’s hospital bill above the amount she can pay will be covered.
By 2005, 97% of pregnant women were receiving prenatal care in project villages and the infant mortality rate dropped from 174 in 1971 to 24 in 2005.
In rural India, Village Health Workers are essential members of a well-functioning primary health care team. They are instrumental in reducing maternal and infant mortality by providing good prenatal care, appropriate safe deliveries, and regular home visits during the post-partum period.
If this mother’s village had a Village Health Worker, she and her baby girl would not have suffered such birth trauma. As things are, one can only hope that next time, the mother will seek prenatal care from a Village Health Worker in a nearby village and head straight to Julia Hospital for the delivery. Hopefully, the baby girl will survive and live a productive life with limited long-term consequences of the avoidable trauma suffered at childbirth.
Resource:
Comprehensive Rural Health Project www.jamkhed.org
Author’s Contact Information
Lee Mantini RN, MHScN
Health and Development Consultant
RR3 Picton, Ontario Canada, K0K 2T0