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QAP Contributes to a Life Being Saved
The human impact of QAP's efforts to improve the competency of birth attendants was evidenced when the life of a young mother in Nicaragua was saved by a medical team who had recently been trained to better manage obstetric complications.
In Nicaragua, QAP is working to evaluate and upgrade skilled birth attendant competency in support of the United States Agency for International Development’s (USAID’s) key strategic objective to reduce high rates of maternal mortality. USAID, in collaboration with UNICEF, is supporting Nicaraguan Ministry of Health efforts to improve the competence of health personnel who attend births. During the period June through December 2005, the Ministry of Health—with support from QAP, UNICEF, and CARE—conducted a national assessment of the competence of health personnel who attend births and care for newborns in Ministry of Health facilities. The evaluation tested over 1,300 health workers in 20 MOH hospitals (95 percent of the public hospitals in the country) and 43 primary care facilities.
On July 7th, 2005, the Ministry completed knowledge and skill evaluations for delivery care—including management of postpartum hemorrhage and other complications—in the Chinandega local health area. After demonstrating their skills to expert examiners at testing stations with anatomical models, participants were immediately informed of any deficiencies, then instructed on how to perform the procedures correctly. This method was employed so that each participant would be able to respond effectively when faced with a similar situation in their own facility.
Just three weeks later, on July 28, Bernarda Galindo Aguilar, aged 20, of the community of Mayocunda in the municipality of Villanueva in Chinandega, gave birth to a girl in the municipal health center. Dr. Margarita de los Angeles Fonseca Barcenas, an attending physician, provided delivery care according to established standards.
An hour and a half later, despite the best efforts of Dr. Fonseca, the patient continued to hemorrhage and began to show signs of shock. Dr. Fonseca began administering intravenous fluids and massaging the uterus to try to stimulate uterine contractions. When the bleeding continued, Dr. Fonseca, assisted by Dr. Marisela Morales and Dr. Sonia Gonzalez, two recent medical graduates in their year of social service, began bimanual uterine compression, an emergency procedure to stem blood flow to the uterus. Bimanual uterine compression was one of the skills on which these doctors were tested and trained during the July 7 evaluation. While performing bimanual uterine compression, the three doctors arranged for the emergency transfer of Ms. Galindo to Mauricio Abdalah Maternal and Child Hospital, 65 kilometers away.
To control the bleeding, Drs. Morales and Gonzalez continued performing bimanual uterine compression and abdominal aortic compression throughout the 50 minute ambulance ride until arriving at the hospital’s emergency room. There Ms. Galindo was transferred to the care of obstetrician Dr. Ivan Blandon, who, though not on duty, responded to the call and was awaiting her arrival.
During the transfer, Ms. Galindo remembers telling the accompanying doctors, “Don’t let me die, do everything possible.” “Hurry Martin, go faster. The last thing we need is not to make it,” Ms. Galindo’s mother heard the doctors yelling to the driver during the ambulance ride.
Ms. Galindo survived and was hospitalized for seven days. Without the timely and appropriate interventions by the health staff in the Villanueva health center, the story could have ended quite differently.
“As public health professionals, we often talk about our efforts in terms of statisticshow many hundreds, thousands, tens of thousands or more might be affected by an intervention. Of course, we do hope our interventions reach many thousands or even millions of people, but sometimes a single case can help put a human face on the otherwise abstract numbers," noted Dr. Steven Harvey, QA Advisor.
Congratulations go to QAP’s Nicaragua team, Dr. Oscar Nuñez, Dr. Luis Urbina, Dr. Cesar Rodriguez, Dr. Ivonne Gomez, and especially to Dr. Yudy Wong, the coordinator of this initiative. Congratulations and thanks, too, to our partners from UNICEF, CARE, PAHO, the Nicaraguan Ministry of Health, and the USAID Mission in Nicaragua for their many important contributions to the effort.
For more information on QAP’s work to evaluate and upgrade skilled birth attendant competency, please contact Dr. Harvey at [email protected]
The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.