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Necessary C-Sections…Midwives/Nurses Should be Trained

Very interesting article in NY Times about the need for C-sections in poor countries and the fact that they are cost-effective.  As well as humane and ethical.  And the doctor interviewed endorsed midwives and nurses being trained to perform them.

Caesareans Are Cost-Effective in Poor Countries, Study Finds

By 
Published: May 14, 2012

With many countries chronically short of surgeons, should laymen be trained in emergency surgery? It is one of the trickier questions in global health.

A new study by surgeons and global health specialists, mostly from Harvard Medical School, concluded that performing Caesarean deliveries extensively in 49 poor countries would save 16,800 mothers’ lives annually and prevent many fistulas — internal tearing that can occur in prolonged or obstructed labor after blood flow to vaginal tissue is interrupted, causing it to die. Such injuries can cause lifelong anguish.

The median cost of a Caesarean in these countries was assumed to be $141. In most countries, the operation would save 2 to 6 times its cost in income created by mothers who otherwise would have been left dead or disabled, said Dr. John G. Meara, an author of the study, which was published last month in PLoS One.

Caesareans are almost as cost-effective as simpler interventions like measles shots andAIDS drugs, the study found.

The $141 figure was from the World Health Organization, Dr. Meara said, and seemed to assume the surgeries would be performed in hospitals by doctors. Asked if he would favor training nurses and midwives to do Caesareans, he answered, “Oh yes, absolutely.”

Not only would that save more lives at much lower cost, he said, but trained midwives and nurses would be less likely to emigrate, as many doctors do, because wealthier countries are unlikely to let them practice.

Laos: Maternal & Infant Mortality Stats

Why does Laos need Clean Birth Kits?

Here are the stats on Laos and maternal and infant mortality from GFMER – WHO – UNFPA – LAO PDR Training Course in Reproductive Health Research in Vientiane, 22 September 2009.

Health situation ( source census 2005 )
1. Crude Birth rate : 34.7
2. Crude Death rate : 9.8
3. Life expectancy : 61 Female : 63, Male : 59
4. MMR : 405/100.000 LB (MDG=260, US 11 per 100,000)
5. IMR : 70/1000LB  (MDG=45, US 7 per 1,000 — 34 countries better than US, Singapore has 2/1,000)
6.U5MR : 98/1000LB (MDG=55, US 7.5)
7.Total Fertility Rate : 4.5
8. Antenatal Care : 26.7%
9. Delivery at hospital: 10.8%
10. Postnatal care: 6.9%
12.water supply : 67.15 %
13.Sanitation : 45.68 %
14. AIDS prevalence : 0.02%
15. IBN coverage : 60%.

“Maternal Morbidity” from Maternova

This is a good explanation what maternal morbidity is and why it’s such a huge issue from Maternova’s blog.  For every woman who dies 20-30 suffer maternal morbidities.  Read on:

Maternal morbidities can be acute or chronic and include mental health issues, infertility, anemia, fistula, infections, uterine rupture and scarring, and genital or uterine prolapse. Clinical terms like ‘morbidity’ and ‘fistula’ are another way of saying ‘a lifetime marred by suffering and stigma’ in the case of postpartum depression, psychosis or obstetric fistula. These conditions frequently stem from obstructed labor and they impact a woman’s ability to care for herself and her family. Often, maternal morbidities also result in financial hardship, stigma, social isolation, divorce and domestic abuse. And because women play a key role in care giving, food production and other economic activities, it is estimated that maternal morbidity costs the global economy $6.8 billion annually.

“Mother’s Health Worth the Investment”

This article comes from Ophelia Dahl, the co-founder of Partners In Health, Paul Farmers org.  The excerpt describes the need for local, life-saving medical care for women and that it’s expensive — but not nearly as expensive as letting them die.

But over 350,000 women still die every year in Haiti, Malawi, and other developing countries, because they can’t afford or can’t reach the care they need. They die because they do not have access to … a network of care that reaches right into the villages where the most vulnerable women live, that ensures they deliver their babies at health centers with the help of a skilled midwife or doctor, and that can refer and transport them to a hospital with surgical facilities in an emergency.

None of this is rocket science. Doing all of it isn’t cheap or easy — except when compared to the cost of inaction.

How do you quantify the cost of more than 350,000 women’s lives a year? Measured in moral and human terms, the value of even a single woman’s life is incalculable, compounded by the fact that when mothers die in childbirth, their babies often die as well, and their older children are left orphaned and at high risk.

For those who prefer to measure costs in dollars and cents, my friend and fellow co-founder of Partners In Health, Paul Farmer, recently co-authored a paper analyzing the costs and benefits of the most expensive piece of the necessary network of care — surgical services to provide Caesarean delivery for obstructed labor. The conclusion: the economic benefits of saving women from death and disabling injuries would be six times greater than the costs of providing surgical care.

Other studies have shown that doubling global investments in family planning and pregnancy-related care — from $11.8 billion to $24.6 billion — would prevent more than 250,000 maternal deaths a year.

If you do the math, the increased investment amounts to the cost of about six weeks of the war in Afghanistan. That seems a small price to pay to make motherhood as much an occasion for celebration in Haiti and Malawi as it is in the United States.

My CBK Project: Unexploded Ordinance in Laos

The place that I am going is unfortunately the location of many, many UXOs.  I’m not worried, I’m  not one to wander off the beaten track (literal beaten track, the proverbial one is where I live:).  Here’s a exerpt from an article by ANTS BOLINGBROKE-KENT.

The statistics relating to America’s bombing of Laos defy hyperbole. In their efforts to cut the trail, the U.S. flew 580,000 bombing missions, dropped over 2 million tons of ordnance and gave Laos the deadly accolade of being the most bombed country in the world. The legacy of this still exists today: 50,000 people have been killed by UXO in Laos since 1964 and around 200 people still die every year.

This was a key aspect of our story, and near Sepon, Laos, we filmed a private UXO clearance team run by the MMG Sepon Mine. The team leader was a Swedish ex-special forces giant of a man called Magnus, cooler than a winter’s day in Magadan and harder than Rambo on steroids. Magnus has worked in every bombed hellhole on the planet, and his geographical resume reads like an FCO warning list: Sudan, Iraq, Afghanistan, Iran, Bosnia, Kosovo. “Sudan was terrible,” he admitted, “but this is still the most bombed place on Earth.” Just that day his team had uncovered two live 750-pound bombs and a phosphorus bomb within feet of the main road to the mine.

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