I
recently read an article that one of my midwifery friends posted on Facebook
discussing the impact of traumatic births on healthcare providers. This article
was particularly striking as it discussed the psychological toll that traumatic
medical events have on healthcare providers, citing a Danish study that
examined the effects of a traumatic birth on midwives and obstetricians. The
one thought crossing my mind as I read this was how these traumatic events were
being described as a singular event for an individual provider. They repeatedly
referred to this event and the traumatic birth in a way that is
disharmonious with the reality of my current context, Malawi. If I had read
this post 10 months ago, I would not have paused on these words, wondering if
someone had forgotten an “s”. However, the experience of the midwives and
obstetricians in Malawi is that these events occur far too often. This article
left me wondering about the magnitude of psychological toll endured by an
average healthcare provider working in a resource-limited setting, where
traumatic medical events are unfortunately the norm.
The
reality of our jobs as healthcare professionals is that at some point in our
careers, we will have a negative outcome. The reality in resource rich countries
is that most of the negative outcomes occur despite having exhausted all
possible treatment options. However, this is not the case in resource-limited
settings, where life-saving blood products, antibiotics, or intravenous fluids
are often out of stock (“finished”), or there is no oxygen due to a power
outage. The psychological toll is substantial when you know you did everything
possible to prevent the negative outcome. How about if you couldn’t do
everything possible because of a lack of resources? How about when the negative
outcomes are occurring weekly, or sometimes daily, as opposed to a handful of
times in a career? I wonder how much these factors contribute to the brain
drain of healthcare providers, in particular physicians, from Malawi and other
resource-limited countries.
Having
attended morning report in the OBGYN Department several times in the past few weeks,
I have become acutely aware of the issues of maternal and neonatal mortality in
Malawi. Being the epidemiology geek that I am, I knew Malawi’s numbers
(maternal mortality, neonatal mortality, infant mortality, fertility rate,
etc.). However, it is one thing to know a statistic and another to feel the
magnitude of the issue. Malawi has made great strides in the past several years
to improve both of these health indicators, but still has room for improvement
in order to meet the Sustainable Development Goals.
I
have fortunately become involved with a practice improvement project that is
attempting to address this issue of negative birth outcomes by introducing the
use of an affordable fetal heart rate monitor called Moyo. These devices are
pretty amazing in that they are portable, can monitor both fetal and maternal
heart rate, and can trace/graph fetal heart rate for 30-minute intervals.
Currently, midwives use a Pinard fetoscope (think small megaphone) to monitor
fetal heart rate. All my midwifery friends have probably successfully heard a
fetal heart with this device, but I have failed on multiple attempts. It
is definitely not easy to use and can take time to find the fetal heart rate.
The Moyo monitors will hopefully ease the task of monitoring fetal heart rate,
while allowing for closer monitoring in patients at high risk of fetal distress
(i.e. bad outcomes). I am excited to be working with an amazing team on this project.
Hopefully, we can improve the quality of fetal monitoring on the labor unit,
and ultimately, decrease negative birth outcomes.
As
my service winds down, I find myself more contemplative regarding the goals of
our program. I truly believe in the need for increased human resources for
health (i.e. nurse and doctors) in the countries in which we are serving.
However, if we increase the number of nurses and doctors, but do not have
adequate resources, are we ultimately improving the quality of care?
I
leave you today with many unanswered questions. This blog post is far more
cerebral than the previous ones. I apologize for the lack of photos accompanying
my thoughts today. You will have to stay tuned for elephant/zebra/rhino
selfies.
