The security man came with his usual feet-dragging steps and called, "Dokita, emergence!" "Which unit is it?" I quizzed. "Maternity," he said. I jumped out of bed and with my torchlight ran to the Medical Centre. The time was 3:06am and it was on November 26, 2015. As I approached the Centre, I saw the headlight of a motorized tricycle, popularly known as "Motor King."
In this area it is not uncommon to find such means of transport for emergency cases and as I drew closer, I felt a sense of urgency. There in the back of the motor king was a pregnant woman bleeding. As she was assisted to the ER, every step of hers produced the sound "tim", "tim", "tim". And that was the sound of blood clots as they dropped. This woman and many others were saved in 2015. It took the collective effort of nurses, doctors, security men, orderlies and the community to achieve this feat.
The King’s Medical Centre (KMC) recorded zero maternal mortality in 2015. This is a feat that saved the lives of all the 721 women (that is over 735 babies including 22 sets of twins) who delivered at the KMC. To meet the Sustainable Development Goal on maternal mortality (SDG-3), little efforts such as this may mean a lot for Ghana. KMC is a hospital in the Kumbungu district of Northern Ghana that serves 238 communities with a population of over 130,000 people.
Resolve to achieve zero Maternal Mortality in 2015
31st December 2015 was a moment of joy for the team of health staff at KMC having recorded zero maternal mortality. At the beginning of 2015 we looked forward to this day when we would say, no woman died in the year in this hospital from pregnancy related causes. As a team, our goal for 2015 was "to improve efficiency and organizational culture" and within this goal, we resolved to do all we could to prevent maternal death in 2015. Every woman who attends prenatal care or gives birth in this hospital must walk home alive. Today this goal is achieved and the team feels really excited we could contribute to the global effort to reduce maternal mortality. Even though achieving this goal has caused us countless sleepless nights and several cumulative hours of C-sections, repairing ruptured uteruses, manually removing placentae and managing postpartum hemorrhages, it is worth it, and the team feels fulfilled.
Setting realistic goals in the hospital and pursuing them to reduce maternal mortality
I am tempted, based on my experience, to propose that setting goals at the facility level is the way to reduce maternal mortality. When local health team makes input into the goals being set, they own the process and will commit all effort to it to attain those goals. In setting our goals for 2015, the director, all supervisors including heads of pharmacy, lab, theatre, maternity and the various wards were involved. They each set sub-activities to get to those goals. As we rolled out in 2015 with the goals, I could see all emergency drugs, which hitherto were not available, were now available, staff were virtually running around anytime there was a maternal case. Theatre response time improved. It was as if everyone was saying “we are in this together”. I remember in some occasions I could be called about six times in the night, and although I felt weak and my body unwilling, I remembered the promise we had made collectively. And as the leader of the team, I did not want to be the loose link. It happened to my colleague doctor and other team members as well, who worked hard in the course of the year.
In other areas outside maternal health, the team set a goal to reduce expenditure to income ratio by 10%. It was delightful to watch how nurses were watchful on their use of disposable gloves, syringes and other consumables. Security men and cleaners would recite this sub-goal to themselves ‘we are reducing expenditure to income ratio by 10%”. In the face of delayed NHIS payments across the country, there couldn’t have been a better goal than this. Today the internal auditor hints the Medical Centre was about 77% on target regarding this goal.
Adapting innovative methods in maternal health service delivery
In 2009, the King’s Medical Centre introduced the “birth hole concept”, a socio-culturally accepted method of squatting birth. This was in response to a situation where women were attending the ANC but were not giving birth in the facility. When we noted that almost every home had a “birth hole”, (a small hollow dug in the hut floor), we introduced an improved version in our delivery room. This approach led to a significant increase in attendance and the number of deliveries by over 200%. Of course, we saw it makes sense to give birth by squatting. If all animals do it, if our women will ease themselves or pass urine by squatting, why can’t they give birth by squatting through the same canal? Now with our goal of saving all women at birth, we feel we are on the right course to making a lasting difference in the lives of the people in the Kumbungu district. The communities around here are using every means possible to transport sick people especially maternal cases to the medical facility including the use of motor-king.
I salute the King’s Medical Centre team for recording zero maternal mortality in 2015. I was discussing this with a friend and she did say; “but there were cases referred to TTH”. My response, “that is how it should be, early referrals save maternal life”. Saving the lives of all the 721 women who delivered in 2015 at the King’s Medical Centre may not be big, but if all facilities set goals and could save most women, maternal mortality will cease being a big issue in Ghana. Elsewhere in Dodowa, I have read about a team effort to reduce maternal mortality, led by Dr Brightson. It gives me hope that we can collectively reduce maternal mortality to very significant levels. Not through the top down approach as it has always been. The hospital and its staff should set their own goals and own it.
Congratulations to all the mothers who utilized and continue to utilize the services of the King’s Medical Centre in this remote part of Northern Ghana. The team looks forward to serve you better in 2016 as it seeks to expand its maternity unit to enable it handle all the women in the 238 communities in its catchment area.
Dr James Duah
The writer is an Epidemiologist and the Medical Superintendent of the King’s Medical Centre in the Kumbungu district.
TAKING IT TO THE NEXT LEVEL
The King's Medical Centre worked under a lot of constraints delivering over 735 babies including 22 sets of twins with zero maternal mortality in a year in 2015. The Centre has to work in very small space of just three small rooms and where we have to use the main female medical ward for pre and post delivery.
For this reason we wish to take this to the next level by constructing a modern Maternal Health Block and to scale up all the innovations already in place. To donate towards this project please click on this picture or this link: DONATE
DONATE BY CHEQUE
If you would like to give via Cheque,
1. In the UK or US please make it payable to '58i' and post it to 58i, 104-114 Talbot Street, Nottingham, NG1 5GL.
2. In Ghana, please make the Cheque payable to the "The King's Village, Ghana" and post to the Director, The King's Village, Ghana, P. O. Box TL2018, Tamale, Ghana