While hypertension and eclampsia remain the two leading causes of maternal deaths in Guyana, the Chief Medical Officer feels more has to be done to improve the attitude of the country’s nurses as way too many complaints are received from mothers.
“Nurses’ attitudes and patients’ outlook of the institution go hand in hand and it is sad and difficult to understand when reports are made of rude nurses… We have to work with the nursing fraternity…,” CMO, Dr Shamdeo Persaud, said in a recent interview with Stabroek News.
When asked about possible reasons for nurses’ attitudes he attributed it to lack of supervision of junior nurses. Pesaud said that in an effort to lower the number of complaints he has been persistently reinforcing to medical institutions the need to have more than one senior nurse on duty at a time so that patients can have recourse on the spot. “A lot of it may be lack of adequate supervision that we provide, too. People must have that that recourse. That is if you are not satisfied with what one nurse says there should be someone else you should go to. Mothers should be able to say ‘I am dissatisfied with what you told me .I need to see your supervisor.’”
He added “That superior can now advise, confirm or reassess the patient… I keep insisting that this needs to be strengthened at all levels. If you don’t get the response required there are levels …some of our workers need to look at a way of improving on how they deal with situations.”
Further he stated that his chosen method of recourse is needed as doctors can only diagnose accurately after being told by patients their conditions. “It is you who knows your body best and rightfully should be listened to,” he said.
Giving an extensive insight into the investigations of the cases of maternal deaths reported so far for this year, Persaud said more needs to be done in the home and at the community level to help expectant mothers. He compared the causes of the more than 40 accumulated maternal deaths for the period 2009-2010 and said while some areas had been tackled more needs to be done in others. “What we learnt in 09 and 2010 and how we integrate them into a plan of action have all been taken in the health sector to avoid further deaths. However we still are in the challenge of what needs to be done at the community level in the home and so forth. It is not a health sector problem it’s an all of society problem and the country needs to understand that,” he said.
When it was pointed out to him that of the maternal death cases for this year none had any laxity in joining an antenatal clinic or following medical directives given and were given clean bills of health upto the time of delivery, he said he had information to the contrary. “I am not sure that is the case as you state because we have investigated 9 cases. Hypertension and eclampsia still remain a challenge and remain a problem. Sometimes this can happen during the course of delivery and we can strengthen this more in terms of managing hypertension.”
Pressed, he gave the example of an Amerindian woman from the hinterland, who had joined the village health centre during the 35th week of pregnancy. “She died at the Issano health post. This is with her ninth child. She joined at 35 weeks, had no significant pains, and from her ante-natal record she was advised she should deliver because the foetus did not gain weight as expected.” He reiterated what Minister of Health Dr Bheri Ramsaran had said in an interview: that multiparous mothers often felt that since they had birthed several children with no complications it would always be that way. Ramsaran had said “Some women are easy with their health and don’t do what is correct. They feel that they made number one, two and five without going to clinic and doing it on their own number ten will be just as easy. But every child is different and we will have to take educating pregnant women more vigorously.”
However, he admitted that the Ministry of Health still has a far way to go if it is to achieve the Millennium Development Goals pertaining to maternal mortality. The Health Ministry was criticized in 2010 when there was a staggering 25 maternal deaths. This prompted the then government and ministry to implement measures as a means of bringing the numbers down. In 2011 it did decrease as 14 maternal deaths were reported. It was because of the high death rate that the United Nations had in 2011 stated that Guyana had made insufficient progress in curbing maternal deaths and was not on target to reach the 2015 Millennium Development Goal, much to the disappointment of then minister of health Dr Leslie Ramsammy.
“I still think we have some way to go. We should have less than 10 maternal deaths per year. This year, as at June, there were in all, nine deaths during delivery and seven direct maternal deaths. We are looking at if we can keep things tight and then the crop season is usually at the end of the year; we might make it. We have to keep our fingers crossed and put our efforts now… I think we can do it,” he said.
Measures currently in place to bring the level of maternal mortality down are, the introduction of the Masters Degree in Obstetrics and Gynaecology, the training of ultrasound technicians, commissioning of a theatre in the maternity section, workshops on high risk pregnancy and the recent neo-natal care programme for nurses along with the Ministry of Health’s ALARM (Advances in Labour and Risk Management) training for nurses.
