At 7:30 each morning, the doctors, clinical officers, and nursing staff of St. Gabriel’s gathers in a conference room. What follows is a ritual known as the morning meeting. The hospital director does a roll call of each department (1), and the night shift representative for each ward methodically goes through the number of admissions, tuberculosis patients, deaths, totals, and any interesting patients. At one morning meeting last week, a representative from the Labor Ward reported that a child had died. A terrible hush fell over the room, and after what felt like an eternity, Dr. Mbeya halted the normal progression of the meeting. He told our somber group that in Labor Ward, above all other places in the hospital, there was no time to waste.
That’s the only time I’ve sensed such palpable tension in the morning meeting. And while it’s a jarring reminder that we’re working in a part of the world where the neonatal mortality rate sits around 25 deaths per 1000 live births (2), where 71 of those 1000 children will die before their 1st birthday (3), I promised that this post would be on an uplifting and interesting topic. And I truly do think that the fuss caused by the loss of a neonate is an indication of St. Gabe’s terrific track record in that department. According to Dr. Mbeya, last year somewhere around 80 neonates died at St. Gabriel’s- I don’t have the official stats for you, but considering that the majority of admissions appear to be pregnancy-related, that’s pretty incredible. In light of this superior performance, to the staff of St. Gabe’s the loss of a single child remains as what it should be- a big deal.
To examine the roots of St. Gabe’s success in improving maternal and neonatal outcomes is to look at their preventative programs. Now, I’m a huge public health nerd (4), so in my eyes, these are some of the most important services that the hospital can offer. If incidence rates and theories of health behavior don’t tickle your fancy, I invite you to take another look at the numbers in the paragraph above. Even if you don’t appreciate the minutiae of public health programs, you’ve got to acknowledge their efficacy.
St. Gabe’s does a lot to ensure the health of the developing child long before delivery. The hospital’s antenatal clinic is a popular outpatient program where expectant mothers can come to monitor their pregnancy and learn more about how to ensure that their baby is born as healthy as possible. Nurses monitor weight gain, blood pressure, and general health of each mother, as often as every week if the women wish to come. Perhaps even more importantly, St. Gabe’s brings these services to even the most remote of villages. The hospital’s catchment region encompasses a significant portion of the Central Region district of Lilongwe, a large segment of which includes rural villages with limited transportation access. Even if an expectant mother can find a bike taxi or minibus to take her to the hospital, she still has to pay for it, a reality that makes weekly checkups at St. Gabe’s virtually impossible for the most impoverished families. In response to this problem, the hospital sends teams of health care workers to provide antenatal care remotely, increasing program compliance by taking away the hassle and financial barriers associated with commuting to the hospital.
Another service that has become overwhelmingly popular at St. Gabe’s is a shelter for expectant women. Starting in their 8th month of pregnancy, a woman can come from anywhere and stay next door to the hospital. The shelter sits adjacent to the Guardian’s Shelter, a place for family members to prepare food and wash clothing for patients. These women have weekly visits to St. Gabe’s antenatal clinic, as well as ready access to clean water, well-ventilated kitchen facilities, and a warm bed. If they should encounter any complications with pre-term labor or preeclampsia, they can receive medical attention almost immediately. And when the time comes to deliver, they are minutes away- no long walks or difficult bike rides involved!
On a related note, the Malawian government is making sincere efforts to reduce maternal mortality rates (5). In order to do so, the government has promised to pay for deliveries, making births in a hospital financially viable for women who previously might have faced unsafe delivery in their villages. (6)
What’s really unique is that St. Gabe’s commitment to infant health doesn’t stop with delivery. Their programs for malnourished children under 5 are especially comprehensive, with inpatient services, distribution of nutritionally enhanced peanut butter and meal (7), frequent measurements, and parental education. One day, as Nkechi and I were walking back from the Guardian’s Shelter, we saw a large fenced-in garden on the hospital periphery. Curious, we asked about it, and found out that the hospital actually uses the garden to show families that nutritionally sound food choices can fit into their lifestyle! The plot was modest enough, but filled with different fruits and vegetables that can be grown locally with minimal effort. The message came across loud and clear: a family can get adequate nutrition for their children, even if they are of modest means or live in a rural area!
There are plenty of other public health initiatives that I’ve caught wind of in the past week, and I could write for days on all of them! But you’re in luck, because I decided a) to spare you the comprehensive catalog of my nerdvana and b) hopefully make a point about a thread that is carefully woven through the heart of one of the hospital’s biggest sectors. My experiences over these past few weeks have taught me that St. Gabriel’s has made a serious commitment to continually improving treatment for both mothers and their children. Based on the programs I’ve described and the people who stand behind them, I am convinced that clinicians here not only engage in these practices, but believe in them, continuing to set the standard of care higher and higher.
(1). Paediatrics, Surgical, Male, Female, Private, Palliative Care, Labor, and Maternity. I’m probably forgetting a few..
(2). From the WHO ‘s 2012 Neonatal and Child Health Profile of Malawi
(3). That ranks Malawi at 174 out of 187 countries based on the UN’s Human Development Index.
From: http://hdr.undp.org/en/content/under-five-mortality-rate-1000-live-births
(4). One of the few, the proud, no doubt.
(5). THIS ARTICLE IS INCREDIBLE IF YOU LOOK AT NOTHING ELSE FROM THIS POST READ THIS!!! http://www.un.org/africarenewal/magazine/january-2010/save-lives-mothers-infants
(6). http://www.bbc.com/news/health-29228448
(7). This would be an example of the kind of nutritional supplementation used: http://www.huffingtonpost.com/meimei-fox/the-life-out-loud-a-peanu_b_3526957.html