A maternal health emergency: Maternal mortality rates in Sierra Leone are among the five highest in the world.11 out of every 100,000 women die during childbirth in the United States. 890 women within that same population will die in Sierra Leone. 40%  of maternal deaths in Sierra Leone are attributed to uncontrolled bleeding after birth – a Postpartum hemorrhage (PPH). And in a country of 6 million people, there are only 3 obstetricians and fewer than 300 trained doctors.
After five years away from Sierra Leone I returned home to tackle maternal mortality, addressing PPH as a priority.
At World Health Equity (WHE) we partner with The Massachusetts General Hospital Division of Global Health and Human Rights (GHHR) and the Sierra Leone Ministry of Health to implement an ambitious scheme to tackle PPH across the country.
GHHR developed a kit capable of treating PPH called a Uterine Balloon Tamponade (UBT).
The kit controls bleeding by applying pressure to the uterine wall of a hemorrhaging mother.
Comprised of a condom, a catheter foley and string, the UBT’s components are widely available in health facilities around the world, making it practical to use in remote and resource-poor settings.
Our plan of action was straightforward. Our team of Ministry of Health employees, a GHHR physician – Dr. Eckardt – and I visited 50 health facilities that made up the pilot UBT study. Our group had trained health providers from each facility on UBT use three weeks earlier.
Delivering care in challenging settings
One of the very first care centres we visited was staffed with just a midwife and a nurse. The centre, like many others, delivers between 9-55 babies a month.
Minutes after we arrived and just as we had begun our conversation with the midwife about UBT use in PPH management, a very pregnant woman called Mariama was rushed in on the shoulders of two friends.
In the heat of labor and pouring with sweat, she moaned loudly as the midwife sat her in a chair. On the verge of tears and obviously in a tremendous amount of pain without intravenous pain killers, she answered the midwife’s questions.
The midwife, a concerned look on her face, ordered the nurse to help the patient into the labor room immediately.
Dr. Eckardt, the doctor from our team popped her head from around the labor room door and said: “Jennifer, do you want to see a live birth? Just stay clear of the way!”
Nodding in acknowledgement, I watched the baby’s head start to emerge. A couple of pushes and out the baby came. The pink, fragile newborn let out a small beautiful cry as he sucked on his thumb, instinctively searching for food.
Immediately the nurse went back to the mother and began management of the third stage of labor, repeating the steps she had been taught during our UBT training workshop.
Working swiftly and accurately, she successfully prevented PPH and minutes later brought the crying baby boy back to his mother for breastfeeding.
Empowering Sierra Leone’s health care professionals
The resourcefulness and dedication of Sierra Leone’s health workers is truly remarkable.
However, unlike Mariama’s case, many deliveries end differently due to a lack of essential resources such as medication, electricity and running water.
But with the right support, the potential for dedicated maternal health personnel to tackle PPH is being demonstrated by the immediate impact of the UBT program – 14 lives being saved in just 7 weeks.
Sierra Leone is the first country working to roll out a nation-wide pilot UBT program. For the state of maternal health care in Sierra Leone, this speaks volumes.
The willingness of the country’s health providers to overcome limitations in infrastructure and embrace learning, leaves me confident that Sierra Leone is on its way to climbing down the list nations in most need of access to medical services.
If the health providers of Sierra Leone can overcome adversity, you can too.
The next time you are faced with a challenge, I urge you to adopt the same inspirational attitude that has saved so many lives in just a few weeks.
 – According to World Health Equity’s sources.
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- A maternal health emergency in Sierra Leone - 8th March 2016