On Monday, the 23rd of February 2009 the news wires picked up a story

Feb. 22 Chairman of Board of Directors of the Teaching Hospital, Professor Femi Ajayi said the babies, three boys and three girls, who are under intensive care unit at the hospital, weighed between 650, 600, 850, while the three others weigh 900 grams respectively. He disclosed that the woman had two kids before the latest delivery.

The woman, who comes from Ijebu Igbo in Ogun State, is said to be in stable condition. Professor Ajayi attributed the feat and the success of the birth to “pure professionalism”….but then the lady died and he described it to the Nigerian Tribune as “unfortunate”

This was the first time the nation would be recording this highest birth as four were delivered at one hospital in Minna, Niger State, last year. The father, a battery charger, was said to have fled when he received the news. The Ogun State Commissioner for Health Dr Abiodun Oduwole was on ground to see the mother and the children. The management of the Hospital has decided to take care of the medical bill in a bid to lessen the burden of the parents of the sextuplets.

Then the mother died…The sad situation with maternal mortality in Nigeria is often referred to these days ….but as an academic and technical term.

This lady’s story brings this situation to life.

Obvious questions: How many times did the lady to antenatal care during the pregnancy? If she did, who knew how many babies she had inside her? What was her haemoglobin? Were any ultra sound scans done? Where and to who was she referred.

If, as it is likely to have been the case, the woman appeared at the hospital in labour, how were the healthcare workers to have known anything about her condition? If she did not go for antenatal care…the question is why? It was not her first baby, so she would definitively be aware of the need for this. What was her pre-delivery condition and who knew aboout it?

The nation has been taken to the heights and depths of the emotional roller-coaster by this story. When this lady appeared in hospital there would have been a lot of activity.. Doctors and nurses would have operated through the night, for the babies to be delivered at 4.00am. Governors and concerned Nigerians would make commitments of money, equipment and expertise to ensure survival of these tiny babies. We gather that incubators were promised and delivered to the hospital by the state executive governor….they ended up in the store of the hospital!

But this is the problem! Do we always have to wait for a catastrophy to occur and then begin to throw huge sums of money at it when simple preventive measures costing next to nothing in comparison could have prevented it? As we needed a series of plane crashes in Nigeria to take safety importantly in our airspace, so might it be with maternal mortality, sadly.

We hope that these kids survive….but lets face it…if they do it will be a miracle and truly by the HIS Grace, nothing else. The reason…simple….

If you fail to prepare, you must be prepared to fail…

Mrs Amuda Bello [now of blessed memory] is married to a battery-charger. That simple statement gives a fair idea of the family income. They already have 2 children and this was her third pregnancy.

Now imagine this scenario in Ogun State;

• Mrs Amuda Bello suspected she was p
  regnant and went to a comprehensive health centre near her house and registered for ante-natal care.

• At the time she is given her ‘health passport’. This is a green book similar to versions used in Japan and Malaysia, where vital health information is recorded.

• Her height, weight, blood pressure, haemoglobin, blood type and urine analysis are done and recorded. The healthcare worker also records her civil state, number of previous children and various other details that are known to impact positively or negatively on pregnancy outcomes; including who to call in an emergency.

• The mother-support scheme which the local state chapter of the National Union of Road Transport Workers [NURTW] supports Mrs Amuda Bello to get safe and timely transport to healthcare centres when they are in labour.

• Throughout the pregnancy, Mrs Amuda Bello gets to visit the health centre at least 4 times. She gets her two doses of tetanus toxoid as necessary.

• An ultrasound scan is done shortly after her first visit; the operator was a little unsure of what he saw and refers her to the radiographer in Ogun State University Teaching Hospital.

• The several small limbs were seen and there is excitement in the hospital in anticipation of delivery of these special children in a few months time.

• Her blood levels, blood pressure and weight gain and all other crucial indicators are all monitored carefully and any concerns are recorded. Any anaemia is detected and managed.

• After the sixth month visit, she and her husband are referred to OSUTH because of the number of babies.

• Naturally Mr Bello is worried – more mouths to feed – but he knows that the state government is responsible and sympathetic.

• Mrs Bello goes to OSUTH with her ‘health passport’. Immediately the nursing sister looks through the book, she calls the consultant obstetrician who swings into action. Mrs Bello is admitted in anticipation. Theatre is booked and prepped, blood is ordered to be on stand-by, the anaesthetist and paediatrician are called into conference, the nursing sister in SCBU [Special Care Baby Unit] is ready with the incubators… only 2, but never mind, the babies will be tiny, they can share. The hospital grapevine buzzes with the excitement, Nigeria’s first set of sextuplets in a long time, perhaps ever, are about to be delivered!

• In the best of circumstances the children would need intensive care for several months. In the best of circumstances it would be a challenge….

• Is this really too much to ask…really?
  

But the greatest challenge would be for the children….not the mother.

Not the mother…yet she died. Our country…

If only we could say with confidence that we did the best that we could to prepare for emergency paediatric health care (before, not after the event).

If only our country allowed us to celebrate Mrs Adamu! We would have mobilised as usual…send gifts and love for the mother, the babies, the family…instant fame. What would it have taken?

The ‘health passport’ is not a figment of imagination. It exists in type in many various forms in many places. At its most basic, it expands the scope of information that is presently available in the ‘Road to Health’ chart used nationally to record all infants’ immunisations. The ‘health passport’ could easily be adopted by state governments as part of their free health programmes to ensure that the free health goes where it is directed, achieves what is expected and gives reliable data of who it has impacted.

This ‘health passport’ would also produce a sense of responsibility to both patient and health worker. Mothers-to-be have all their vital information with them wherever they may end up. Healthcare workers no longer have to work ‘blind’ when faced with a pregnant patient. No matter what cadre of healthcare worker a patient meets, relevant information is recorded that can determine future life-saving care.

That important first step into a care pathway.

It is time we stopped applying the fire engine approach and started planning for avoidable disasters? Just as a driver has a moral obligation to object to driving a car with bad tyres on the highway, are healthcare professionals not obliged to insist of getting the tools they need to work…and not MRIs, CT scans…but the very basic tools to start off with.

Aluta….

Special thanks to the colleague “on ground” who has kindly provided most of the ideas for this post…and for insisting that all it really takes is a critical mass of people to stand up and be counted. She chooses to stay annonymous!