Role of Paramedics in Community Maternal Health in Developing Countries - Research Paper Example

?Role of paramedics in community maternal health in developing countries Scenario Questions Face sheet Participant: Rene Wilson Location: interview conducted by the US at the hospital. Date and time: Length of interview: one hour. Special circumstances: none. Questions This question was meant to put the respondent at ease The respondent was freely conversational and so I let him express himself This query highlighted maternal care This question was more critical on the actual maternal practice in the countries covered 1. Tell me about your experience when you went at Third World countries? I went to India as part of a Community Health Placement in November 2011. We worked one day in a one of their major hospitals in New Delhi and three days in a smaller district hospital. We also assisted in an even smaller clinic for one week. We also assisted in mother’s classes and health education sessions in these small clinics and visited local families in New Delhi and in two of their rural areas. 2- How did you find the delivered of emergency care in that country? During our stay with the hospital, we witnessed how the emergency workers rendered emergency care to a patient who was brought in after a motorcycle accident. I noted that the emergency staff were efficient in their rendered care. We were also impressed in how the staff were able to carry out their tasks even with their limited equipment. They were old school emergency workers and it was something we were not used to witness in our own country where we had the latest equipment and technologies. I also noted however that the hospital was understaffed and there were several emergency cases being handled by the medical staff and they were often prompted to prioritize their services, and at some point, some patients were ignored. In the area of Tripura, heavy rains caused a landslide which prompted rescuers to assist in retrieving some of the injured and dead bodies. About five died, but 10 were rescued. The retrieval team was efficient but the lack of equipment in digging through the mud hampered their progress. It placed the rescuers at risk of being buried in a second landslide in the area. The emergency team only had three spine boards and three neck braces. At some point, they had to immediately transport the injured in order to reuse the spine boards and other equipment. We were nevertheless impressed in the skill of the team in retrieving the injured. Their actions showed that they have carried out many other similar rescues in the past. 3. What type of maternal care do you deliver in that country? While in New Delhi, I was able to observe midwives in the rural areas deliver babies. We assisted in some of the births, mostly these were spontaneous vaginal deliveries. We were impressed with the skills of the midwives in delivering the babies. At one point, one of the babies was not presenting cephalically, but the midwife was able to turn the baby and to deliver the baby safely. We were nervous and concerned about this, but we saw that the midwives were able to carry out the task safely and efficiently. We also assisted in the bathing of the babies, and the postnatal care of the mothers. 4. Do you believe it is possible to sufficiently deliver emergency maternal services for what you observed? I think that it is possible to sufficiently deliver emergency maternal services in the areas we visited. The experience of the staff in delivering infants despite the limitations they had was very much impressive. They were used to functioning under these conditions. We could not even imagine delivering babies and maternal services efficiently under these conditions because we were used to functioning with modern equipment and technologies. We also noted that in one of the districts we visited, there was only one ambulance on standby. When one of the mothers had to be referred to the hospitals, the ambulance was used, but we were wondering what the district would do during simultaneous emergencies. Moreover, we were concerned about the distance to the nearest hospital, which was about 30 minutes away. 5. What kinds of maternal care issues are encountered in the areas you cover? Maternal care issues I noticed involved the lack of family planning practices among the families. Many of them were on the poverty line or below, but they had an average of 5 children and above. I also noted issues in water supply where the hospital and district hospitals were on limited rations. This created problems in hygiene and sanitation among the mothers, and the staff. 6. Are you able to assist in managing complications for maternal and health deliveries? I am able to assist in normal births, but I do not have the necessary training yet to assist in complicated deliveries. 7. What are the barriers you encounter in the delivery of emergency maternal health services in the area/s you cover? I consider limited equipment, limited, staff, lack of family planning, poor hygiene, limited health education as barriers in the areas I covered. I found out that health education is an important need for the people I found out one of the most important needs of emergency care in India This was hard to wrap myself around the fact that people were buried alive by landslides because of severe deforestation at the mountainsides I found out the important roles of midwives in third world countries. I found out that even with limited resources, nurses in developing countries can manage to carry out their tasks. I found out that family planning, contraceptive education was needed for this region of the world I found out that I need to improve my skills in maternal health services in order to include management of complicated births Investments in areas covering maternal health delivery are needed in order to improve health outcomes. Face sheet 2: Participant: Lorna Russo Location: interview conducted by the US at the hospital. Date and time: Length of interview: one hour. Special circumstances: none. This question allowed the respondent to relax The respondent was detailed about their experience The respondent was clearly in awe of midwives in the areas they visited 1. Tell me about your experience when you went at Third World countries? I went to Vietnam as part of a Community Health Placement in December 2011. We worked two days in one of their city hospitals in Hi Chi Minh and three days in a smaller rural hospital. We also assisted in an even smaller clinic for 5 days. We also assisted in breastfeeding classes and family planning sessions in these small clinics and rural areas. 2- How did you find the delivered of emergency care in that country? During our stay with the hospital, we witnessed how the emergency workers rendered emergency care to a patient who was brought in after a stabbing incident. I noted that the emergency staff were speedy and efficient in rendering emergency care. We were also impressed in how the staff were able to temporarily stop the patient’s bleeding while an operating room was being readied. I also noted however that the hospital was under-equipped. Only five operating rooms were available at any point and the hospital was serving a big and heavily populated city. In the smaller rural district area, a drunken patient was brought in after he fell into a gutter and sustained a three inch gash on his right arm. I noted how the nurses serving the district clinic efficiently handled the belligerent and uncooperative patient. I also deduced that it was a situation they were very much used to handling. 3. What type of maternal care do you deliver in that country? While in Ho Chi Minh, I was able to observe nurses assist in the delivery of babies. We assisted in some of the births, which were all normal vaginal births. There were more midwives than nurses in the birthing wards and the obstetricians were only called in cases of primipara births, and birthing complications. 4. Do you believe it is possible to sufficiently deliver emergency maternal services for what you observed? I think that it is possible to sufficiently deliver emergency maternal services in Ho Chi Minh City, however, this may be difficult to accomplish in the rural areas which do not have sufficient staff, equipment, and ambulance services. In the rural district we visited, there was no ambulance and they often had to use private transport for their hospital referrals. We also noted that the maternal mortality rate for the district we visited was also high. 5. What kinds of maternal care issues are encountered in the areas you cover? Maternal care issues I noticed involved the lack of health education among the families. Many families were not aware of the immunization available for their children and for pregnant women. As a result, the number of maternal deaths was also high, and infant morbidity and mortality was also high. 6. Are you able to assist in managing complications for maternal and health deliveries? I am able to assist in normal births, however, I cannot assist in complicated births yet because I do not have the necessary skills in this area. 7. What are the barriers you encounter in the delivery of emergency maternal health services in the area/s you cover? I consider transport services, poor health education, limited staff, as barriers in the delivery of emergency maternal services. Also, health education, especially in breastfeeding was important to the community I found out that hospitals in developing areas could not afford state of the art ER equipment The role of nurses and midwives in maternal care was highlighted by the respondents Ambulance services are crucial to the efficient delivery of maternal care Education on immunization is needed in these areas in order to improve maternal and child mortality and morbidity The midwives in the areas are highly skilled in managing complicated births; these skills are hardly possessed by midwives in developed countries Shortage of resources is a major issue in developing countries Face sheet 3: Participant: Janina Campbell Location: interview conducted by the US at the hospital. Date and time: Length of interview: one hour. Special circumstances: none. The respondent was very much engaged about the country she visited She was also open about her experiences and was keen on expressing the needs in these communities She was impressed by the skills of the nurses and midwives in these areas 1. Tell me about your experience when you went at Third World countries? I went to Thailand as part of a Community Health Placement in December 2011. We worked two days in one of their city hospitals in Bangkok and four days in a smaller rural hospital. We also assisted in a small clinic for 6 days. We also assisted in health education for pregnant mothers. 2- How did you find the delivered of emergency care in that country? During our stay with the hospital, we witnessed how the emergency workers rendered emergency care to a patient who was brought in after falling down steps. I noted that the emergency staff were efficient in stabilizing the patient’s foot which was fractured during the fall. They placed the patient’s foot on a splint and wheeled him into the x-ray room. They were also quick in administering pain relief, in preventing any jarring of the patient, and in helping the patient relax. In the smaller rural district area, we observed how the nurses managed an elderly patient having high blood pressure. I noted how the nurses monitored the patient’s BP and how they eventually referred the patient to the rural health physician when the patient’s BP was not going down. 3. What type of maternal care do you deliver in that country? While in Bangkok, I was able to observe and assist midwives in the delivery of babies. There were several infants being delivered at the same time in one delivery room, but most of the births were vaginal deliveries. I observed one cesarean birth but this was handled efficiently by the obstetrician; the nurses assisted and we were only allowed to observe. 4. Do you believe it is possible to sufficiently deliver emergency maternal services for what you observed? I think that it is possible to sufficiently deliver emergency maternal services in Thailand, especially in the cities. In the rural districts, they may not be able to handle complicated births because of limited staff and equipment. 5. What kinds of maternal care issues are encountered in the areas you cover? Maternal care issues I noticed involved limited knowledge of infection control practices among the parents and some staff members. As a result, there were many cases of sepsis and bacterial meningitis in the areas we visited. 6. Are you able to assist in managing complications for maternal and health deliveries? I am able to assist in normal births; I do not have the necessary training in complications of maternal and health deliveries. 7. What are the barriers you encounter in the delivery of emergency maternal health services in the area/s you cover? I consider poor hygiene, limited health education, and limited health resources as barriers in the delivery of maternal health services in the area I covered. Nurses in emergency rooms of developing countries function well despite their limited resources They are also keen enough to assess patients who need specialized care Referral systems are in place for cesarean births and births with complications Improvements in emergency maternal services are needed in the rural areas Infection control knowledge and skills have to be improved by the staff members in rural areas. In the rural areas with limited specialist care, midwives and nurses have learned to adapt. Sanitation and infection control is a major issue in developing countries Face sheet 4: Participant: Jodie Keller Location: interview conducted by the US at the hospital. Date and time: Length of interview: one hour. Special circumstances: none. The respondent was very enthusiastic in talking about her experience, hence her wordy and detailed answers to the questions. These answers however provided details which would not have been gained from other respondents This question provided information about the country covered and about the staff working in the areas covered 1. Tell me about your experience when you went at Third World countries? I went to Vietnam as a part of a Community Health Placement in December 2011. We spent time working in a large city hospital (one day), a smaller country hospital (2.5 days) and running clinics in small communities (total of 6 days). We also participated in health educations sessions, visited an orphanage and stayed with local families. 2- How did you find the delivered of emergency care in that country? We were fortunate enough to witness emergency care of a critical woman in Bach Mai hospital in the capital city of Vietnam, Hanoi. I was amazed as this critically ill woman was brought in and treated in front of a large group of foreign students (ourselves) there was twenty of us in the group. I found that although the staff were very highly trained and efficient, that the major issues faced were hygiene and effective sanitation. Little hand washing, use of gloves or sanitiser was witnessed. When I witnessed an emergency in the smaller quieter country town of Mai Chau, the woman was brought in and seen immediately, however once her condition was stabilized, she was left alone in the makeshift ‘emergency department’ for two days. In Mai Chau there is a noticeable lack of resources along with a severe shortage of relief staff. One nurse was working on her own within a particular ward as the other nurse had mumps and had been off sick for the past week and a half. There was no one there to assist the nurse or cover for her when she went home for an hour and a half for lunch. Resources are scarce and the Mai Chau hospital often runs out of supplies and has to send for them from Hanoi, 4 hours away. Although Mai Chau had an ambulance many of the patients are brought in by family members on motorbike which is likely to exacerbate any concerning condition that the patient is presenting in. In Mai Chau there are 2 fantastic general surgeons who can perform many emergency procedures but often many critically ill patients have to be transferred by road to Hanoi for treatment. 3. What type of maternal care do you deliver in that country? While I was not able to facilitate a birth whilst in Vietnam we were able to watch a C/Section which was very interesting. We found it strange that 16 of us could watch and take photos of the birth but the father was expected to stay out of the theatre! I also assisted in providing post natal care and check ups on a number of infants. We provided education about feeding, sleeping and development for the parents as well as information for the mothers own health as well. Feeding seemed to be the most important educational opportunity that regularly arose. The physical checks of the infants were just standard checks to ensure muscle strength and feeding were present. 4. Do you believe it is possible to sufficiently deliver emergency maternal services for what you observed? I think that maternal services in the regional areas were surprisingly good. I suppose that is because of the high number of women that give birth every year. Although there is a shortage of supplies and staff sometimes, the knowledge and experience of the health care staff is significant. For complicated births that leave a person in a critical condition, transfer to a major hospital would be necessary. I don’t think that this is all that different to health care and emergency maternal health services in Australia. 5. What kinds of maternal care issues are encountered in the areas you cover? Maternal care issues that I noticed included a lack of education for the mothers. Once they had the baby, there was very little education for the families regarding what to expect and how to feed correctly. Privacy was also lacking with new mothers sharing rooms with up to eight women and their babies on only four beds! As a result hygiene, sanitation and recovery are also compromised. 6. Are you able to assist in managing complications for maternal and health deliveries? I am training to be a nurse and have had no experience as a midwife so I would not feel at all comfortable in managing any complications. 7. What are the barriers you encounter in the delivery of emergency maternal health services in the area/s you cover? Barriers include lack of health education and limited resources. Health education is an important aspect of nursing care Training in emergency services were available to these areas Even with limited resources and equipment, efficient nursing services can be secured There is poor moral support for mothers delivering their infants in the areas covered. The referral systems in smaller regions are in place. Health education for mothers is lacking and needs to be improved. Limited resources hamper the efficient delivery of care. Skills training for nurses in developed countries also need to be improved. Resources in developed countries in terms of health care are often taken for granted, but these are important needs in developing countries. Summary of Issues Based on the data above, the following issues can be deduced from the respondents’ answers. 1. Emergency services and maternal care services have various limitations, mostly on their tools and their resources. The limited resources include shortage of staff, limited equipment, and transport facilities. Resources are mostly severely limited in rural areas where the transport facilities are limited to non-existent and the distance to the nearest hospitals is great. 2. Infection control practices are also lacking in these areas, mostly due to limited water facilities, and poor hygiene knowledge and practices. Health staff members also have poor infection control practices. 3. Breastfeeding, family planning, contraception knowledge are poor in some developing countries. These areas need to be improved by the government and by health professions. 4. Referral of cases must also be improved in order to ensure improved health outcomes for mothers and their babies. Read More