An Update from the Field - Patient Story
Below is the story of Malebohang Setona, a patient at the Nohana health center in Lesotho who is benefiting from the Maternal Mortality Reduction Project.
Written by Susan Sayers, Hannah Hughes, and Charles Howes
March 21, 2012
Malebohang Setona is 21 years old, nine months pregnant, from the village of Ha-Kori, which is about a 3 hour walk from the Nohana health center. She is pregnant with her second child. Her first child, a girl, is 3 years old. She is married, and her husband, 26 years of age, is at home, unemployed. They have some fields which they plow, and they have a few livestock. Just Malebohang, her husband, and her first child live in their household, and her mother-in-law lives nearby.
Malebohang delivered her first child at home, attended by mothers in the village and her mother-in-law, without complications. At that time that her first child was born, the Nohana health center had been rebuilt by Partners In Health (this was done in 2006) but we had not yet launched the Maternal Mortality Reduction Project (MMRP) here, and the women’s shelter at Nohana did not exist.
A very soft-spoken woman, Malebohang described how she came to learn about the MMRP. She attended a community gathering where a Maternal Mortality Reduction Project Assistant (MMRPA, a traditional birth attendant who PIH has trained to be a maternal health worker) informed the community about the program, the importance of women attending antenatal visits and delivering at facility, the ability to stay at the clinic while awaiting delivery. Malebohang was not yet pregnant then, but when she became pregnant, she approached the MMRPA, and they came together to the Nohana health center for her first antenatal visit.
In total, Malebohang received three antenatal visits, including an ultrasound early in her pregnancy to determine the gestational age of the baby. When we asked her what her expected delivery date was, she smiled, and replied in Bosutho “March 27 ”. She checked in to the women’s shelter on March 2. At the shelter, she receives three meals a day; she is required to bring her own linens and toiletries. Importantly, her mother-in-law is supportive of her being at the shelter; she came to visit Malebohang last week. Her husband is at home taking care of the other child.
When asked about the benefits of the program, Malebohang, through a translator, said that “in case of emergencies, I will get the appropriate care here, unlike at home.” She added that she and the other mothers are “very thankful for the support, for their own good and for their babies.”
In the five years that Partners In Health (PIH) has been working in Lesotho, we have expanded comprehensive health care services to seven health centers and one hospital in the mountainous, rural areas. This year PIH-L scaled up a successful pilot program to improve access for women in these isolated areas to comprehensive pre- and post-natal care, and to delivery at health facilities with a skilled nurse-midwife. This year PIH added 450 community health workers trained to educate women about the importance of facility-based care during pregnancy, and accompany them to health clinics. PIH-L also built maternal waiting houses at six clinics, where pregnant women who live far from the health facility can stay to ensure they are close by for delivery. By connecting women and children to the health system at a critical time, this program is also increasing the number of HIV-positive women who receive services to prevent transmission of HIV to their children, the number of children who receive vaccinations and are screened for malnutrition, the number of HIV-positive women screened for cervical cancer, and the number of women who receive family planning.
In partnership with the government of Lesotho, PIH will soon break ground on a 100-bed hospital in Mamohau-- where women will receive care for free. In addition to increasing the number of people in the mountains who are receiving high-quality health care, Mamohau will serve as an emergency referral facility for all PIH-L clinics, providing emergency obstetric services and serving as a base for training and research activities. With the addition of Mamohau, PIH-L serves an estimated 235,000 people in rural Lesotho.
Lesotho by the numbers: This year, PIH has completed nearly 2,000 prenatal care visits, 460 deliveries at clinics, and 10,500 family planning visits.
Training Offensive Brings Ultrasound Imaging to Mountains of Lesotho
Posted on 02/08/2012
Ultrasound imaging has long served as an invaluable diagnostic tool for clinicians in the United States and other wealthy countries, not to mention a routine way for expectant parents to get a first glimpse of their babies. Now, following a two-week training offensive in late January, ultrasound is being used for the first time to save lives and assist nurses and doctors at health centers high in the mountains of Lesotho.
“Today we found a set of twins in one woman who didn't know she was pregnant, and another with a placenta previa (potentially life threatening if it bleeds later in pregnancy)," Dr. Sachita Shah reported in an email from one of the remote mountain clinics. Shah is a specialist in emergency medicine and ultrasound at the University of Washington and the lead author of the PIH Manual of Ultrasound for Resource-Limited Settings. She conducted the training in Lesotho along with her colleague Dr. Daniel Mantuani, a fellow in emergency ultrasound at Alameda County Hospital in Oakland, CA.
During their two weeks in Lesotho, Shah and Mantuani hopscotched by single-engine plane from one isolated mountain clinic to another, training nurses at six of the seven rural health centers operated by PIH. At each clinic, they made sure that the portable ultrasound machine provided at a steeply discounted price by Sonosite was working properly and that there was at least one person trained to use it. In several cases, as Shah reported, the nurses put their training to use immediately to provide lifesaving care.
“Just wanted to let you know that we had a great ultrasound save case today at Bobete health center in the mountains," Shah wrote in another email. "A 32-year-old woman presented to our clinic, supposed to be in her first trimester sometime, with bleeding and lower abdominal pain. She was pale and dizzy with standing, with a heart rate well above normal. Our nurses grabbed the Sonosite Titan ultrasound machine and me, and started scanning her. They realized her uterus was empty and she was bleeding from a ruptured ectopic pregnancy, which can be life-threatening.
"We were able to transport her in the single car to the nearest operating room an hour away but she remained stable. Right after she left, we realized we forgot her chart, and so the nurse ran off into the hills to chase down a horse-riding local, who rode off, chart in hand, to cut the ambulance-car off at the next crossing to give them the chart…It was a rapid diagnosis of a life-threatening disease by our newly ultrasound-trained maternity nurses here! So exciting….."
Shah and Mantuani also trained clinicians at the two hospitals where PIH works in Lesotho. At Mamohau Hospital in the mountains, they trained a total of 14 nurses, focusing on use of ultrasound to assist in pregnancy, labor, and delivery. The course brought together nurses who work in the hospital's maternity ward and others who administer PIH's Maternal Mortality Reduction Program and five health centers. And at Botsabelo Hospital, the national referral center for treatment of drug-resistant tuberculosis, they taught doctors how to use ultrasound to detect fluid that can accumulate around the heart and in the lungs of TB patients.
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