MATERNAL HEALTH: OUR CALL, OUR RESPONSIBILITY

By Dr. Mpoki Ulisubisya

As a doctor, you’re often aware of your loved ones’ health risks before they experience them, and in that moment, you almost resent your medical knowledge. You know when a fever could be a sign of malaria. You know when a cough could be a sign of tuberculosis. You know when a lesion could be a sign of HIV or cancer.

So when my sister presented with high blood pressure toward the end of her pregnancy six years ago, and began to suffer convulsive episodes, I knew there was a high likelihood of childbirth complications, and that both her and her baby’s lives were at risk if she didn’t receive the appropriate care. Thank God, she was in good hands. Her doctor immediately indicated for emergency surgery, which allowed the clinical team to manage her condition and deliver her baby safely. I am pleased to report that my niece Iman Kissah is a vibrant and jovial six-year-old girl, and my sister is healthy as can be.

This outcome was made possible because of access to timely surgical and anesthesia care, which has a crucial role to play in ensuring that Tanzania’s women can have safe, healthy childbirths. And today, International Women’s Day, is an important occasion to remember this lifesaving medical intervention.

It is estimated that a Tanzanian woman dies during pregnancy or childbirth nearly every hour, which means that on this day alone, more than 20 families will suffer the loss of their most cherished member. On top of this sobering fact, many more women will experience a debilitating childbirth injury like obstetric fistula, which can lead to a life of pain and social exclusion. This reality – that a woman could die or nearly die while bringing life into this world – is unacceptable.

That is why we must continue to invest in strengthening and expanding surgical and anesthesia care throughout Tanzania.

Among the leading causes of maternal mortality in Tanzania are excessive bleeding and obstructed labor, the latter of which is also the primary cause of fistula. While these conditions can often be prevented before they become dangerous – through improved antenatal care, better linkages to health facilities, community health services and the like – they could also be dramatically reduced with high-quality, easily-accessible surgical and anesthesia care, particularly Cesarean sections and blood product services.

The challenge, however, is that surgical and anesthesia care is a complicated practice. It requires reliable infrastructure, medical equipment, drugs and supplies, which are often lacking in developing countries like ours. It requires a specialized workforce made up of doctors and nurses who are trained in carrying out intricate, high-risk procedures with no room for error. And it requires a health system that is far-reaching yet seamlessly connected, so surgical services are available wherever the patient is located, or within a short distance for a referral.

In my experience as a one of 22 anesthesiologists in Tanzania, I’ve seen firsthand how rare this combination of factors can be, especially in many of our rural communities. Some health experts cite a high cost for providing surgery and anesthesia at the district level, yet I believe it is actually one of the most rewarding investments we can make. A recent study estimated that providing one surgical intervention – Cesarean section – to treat Tanzanian women with obstructed labor would cost just over TZS 9 billion, while the overall economic benefit would exceed TZS 27 billion. Countless other studies also point to major social and economic returns on investments in surgery and anesthesia.

For this reason, my colleagues and I at the Ministry of Health, Community Development, Gender, Elderly and Children have prioritized surgery as a way of reducing maternal mortality under our Health Sector Strategic Plan IV. Our goal is to ensure that – no matter where a woman lives – she will be within a short distance from the surgical and anesthesia care she needs in the event of an emergency. In other words, our goal is to ensure that all Tanzanian women receive the same treatment that kept my sister and niece alive six years ago.

It is a heartbreaking reality to think of a child’s life without a mother, a husband’s life without a wife, a grandparent’s life without a daughter, yet it is commonplace in parts of the country where healthcare services are few and far between.

On International Women’s Day, it is incumbent upon those of us in the medical community to do whatever we can to safeguard women’s health and wellbeing at all times, but most of all, at the time when they so bravely bring life into this world.

Dr. Mpoki Ulisubisya is an anesthesiologist and the Permanent Secretary of Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children and Adam Lewis of Gradian Health Systems