'Lola Adewoyin and Agha Ibiam
13 December 2007
Lagos — According to experts, maternal mortality is the major killer of women, especially the rural folks in Africa, Nigeria inclusive. However, there is good news that efforts are being made to reduce this scourge with the invention of a device that can reduce haemorrage in women. 'Lola Adewoyin and Agha Ibiam write
If you have in no way been affected by maternal mortality, the greatest killer of women of child bearing age, then you have no business reading this. I mean if you have never lost a relation, both close and distant, a neighbour, a friend, a friend's friend, anybody whatsoever to maternal mortality, please, don't read this.
This write-up is meant for those with passion for women, those who had one time or the other felt the pang of pain at the loss of the pregnant women, even if she was mere acquaintance.
Let's look at it this way, on your way home everyday, you come across this heavily pregnant woman, since the day you took notice of her, she had remained in your thought and each time you pass through the place, you sub-consciously look for her, not for anything, though, but to be sure that she is still there and well.
Then after a while, you remember that you have not been seeing her at the usual place, may be at the side of the road where she sells roasted corn or fried akara, you became worried and asked the shoe shiner who seemed to be there always and he said "she died last week while trying to give birth." Then you asked, "what killer her?" he answered: "they said she had hemorrhage."
This is the scenario most of the time, especially in developing worlds, of which Nigeria is taking a pride of place. More than 500,000 maternal deaths occur worldwide annually, mostly in developing countries. Of these deaths, 30 per cent - the largest single percentage - are due to obstetrical hemorrhaging. "For years, healthcare workers have had to stand by helplessly and watch these women die of something that's almost entirely preventable," Professor Oladosu Ojengbede, a Consultant at the University of Ibadan, said in a lecture delivered on his behalf by Dr Oludare Morhason-Bello.
However, there is now hope for women. An innovation, the Non-pneumatic anti -shock garment (NASG), has the potential to end preventable deaths, caused by excessive bleeding after child-birth. The garment reverses the effect of shock on the body's blood distribution. In shock, the brain, heart and lungs may suffer loss of oxygen, because blood accumulates in the lower abdomen and legs, the anti-shock garment applies external counter-pressure to the legs and abdomen and returns blood to the vital organs, stabilising body pressure until the patient reaches a hospital. The garment was developed by Zoex Corporation, Palo Alto, California and is distributed exclusively by Dyna Med, Carlsbad, California.
After a simple training session, anyone can put the garment on a bleeding woman or anyone that needs it. Once the bleeding has stopped, he or she can be safely transported from a home birth or primary health-care centre to a referral facility for emergency obstetrical care.
Though Ojengbede's representative said he was not sure of the cost yet, he however said it is not more than $200. He also said a garment could be used 100 times, while its maintenance is very easy. After each use, the person in charge needs detergent and a little disinfectant added to the water for washing, after which it would be spread to dry under the sun.
After this, it is ready for use by another person. What explanation can we give a child whose mother died of Post Partum Haemorrage? Do we tell the child that the mother died because a community or its representative could not afford a garment that costs less than $200 and could be used to save 100 lives?
Illustrating the efficacy of the garment, Ojengbede told a story of a woman who was in a similar sad situation. "By the time the 29-year-old woman arrived at the emergency room of the University College Hospital in Ibadan, Nigeria, she was unconscious. She had no blood pressure or pulse. Five days earlier, she had given birth, and now she was dying from profuse post-partum bleeding. The family members who accompanied her began the rituals of mourning. They were crying, falling to the floor, tearing at their garments," recalls Ojengbede.
But Ojengbede and his staff had been trained in the use of the anti-shock garment (also known as Life Wrap). Originally developed for battlefield use, the device has the potential to save lives and protect hundreds of thousands of women from the effects of post-partum hemorrhage. "Made of lightweight neoprene, the garment resembles the bottom part of a wetsuit. It can be manufactured inexpensively and is reusable up to 100 times. When the suit's five Velcro closures are tightened around the patient's body, the compression stops blood from flowing to the lower extremities and forces it back to the heart, lungs, and brain to counteract the shock.
"The results are immediate and dramatic. A few minutes after the suit was applied to Ojengbede's patient, she began to revive. Summoned to her bedside, her relatives watched in amazement as the woman raised her hand and asked where she was. You can imagine their sheer joy," Ojengbede said.
Ojengbede has seen or heard many similar stories since the anti-shock garment was introduced in Nigeria as part of a Macarthur-funded study carried out by the Women's Global Health Imperative at the University of California, San Francisco and the University of Ibadan. Pilot studies took place in Egypt, where the garment was used to keep women alive in busy urban hospitals, while they waited up to 36 hours for a blood transfusion. Early results indicated that those treated with the garment lost half as much blood as those treated using standard methods and the use of the garment saved more lives. In Nigeria, the study is focusing not only on hospital use, but also on rural health care stations, where the suit is being tested as a first aid tool until women can be transported to better-equipped facilities. The garment's success is having a ripple effect, Ojengbede says.
"Once word gets back to a village that a woman has survived, more families are willing to seek treatment for obstetrical hemorrhaging." Because the early results proved so promising, MacArthur has invested $400,000 to expand the study in Egypt in an effort to yield statistically significant evidence of the suit's effectiveness.
If the study provides scientific proof that the garment works, MacArthur has plans to support scaled up use of the suit to the point where government agencies can incorporate it into standard health care. "We believe the anti-shock garment holds great potential to save tens of thousands of lives each year," says Jonathan Fanton, president of the MacArthur Foundation.
"It could be a very simple solution to a seemingly intractable problem." Rigorous studies like those underwritten by MacArthur are critical to convincing the medical establishment and gaining the imprimatur of global health organisations, Suellen Miller, a professor of public health at the University of California, San Francisco who directs Women's Global Health Imperative's Safe Motherhood Programmes and coordinates the anti-shock garment study said.
"Once it's deemed an essential device, donor agencies such as UNICEF and USAID will be willing to pay for it," Miller explained. Back home, individuals could buy the garment for their village health centres and in the absence of one, it could be in the local chief's palace, where everybody could access it. This could be part of the community development projects of our representatives at the local government up to those at the National Assembly in Abuja.
"I've spoken to some people who have expressed willingness to get at least one for their villages whenever it became available, especially remote villages where it is not easy to access health facilities", because according to Ojengbede, "the garment had been used on a patient for two weeks, she was kept alive for this period till she was able to access health-care and is alive to tell the story."
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