Guyana missed the bus, as did the rest of the Caribbean, with regard to reducing the rate of maternal mortality by three quarters as stipulated in the Millennium Development Goals (MDGs), which ended this year. The reduction, if in fact there was any at all in the Caribbean, would have been minimal.
In Guyana, the data that is publicly available is old. But it is horrifying. Instead of a reduction in maternal mortality, there was a marked increase at the halfway point of the MDGs, followed by a slight dip. Figures accessed by the World Bank and other agencies for global annual reports revealed that Guyana’s rates moved from 220 per 100,000 live births in 2000 to 280 in 2010 and 250 in 2013, which is the last date for which data is available. It would be interesting to see where it stands now.
The Sustainable Development Goals (SDGs), which last month replaced the MDGs, have harder targets. With regard to maternal mortality, the goal is 70/100,000 by 2030, instead of the fractional decrease that obtained in the MDGs. If Guyana continues along its current path—and it seems as though it is—such a goal would be impossible to reach.
There are practices in the health care system that are obviously harmful but yet endemic.
A case in point is the use of the drug misoprostol (Cytotec) to aid in inducing labour which has been blamed for several of the maternal deaths that have occurred here. The indication is that it is widely used and perhaps there have been more unhappy endings associated with its use than is publicly known.
Nevertheless, since its use in the termination of pregnancy was previously frowned on and given the fact that it has been named as the drug used in several cases where women have died from ruptured uteruses and other complications, there needs to be a stated protocol with regard to the prescription of Cytotec for this purpose. This should be done by the Ministry of Public Health after careful research of all studies of reactions to its use done in other parts of the world and it should be done quickly. After all, this is how public health works; decisions are made based on evidence rather than opinion.
Another consideration is the seeming lack of a protocol as regards Caesarian-Section (C-section) deliveries. In developed countries, women can opt to have their babies delivered via C-section if they so desire. It is a more expensive option and one that incurs a longer recovery time. But doctors usually present all of the options to their patients who choose the one they are most comfortable with.
In Guyana, because of the cost and possibly because there would be fewer specialists who could properly perform this surgery, women are only recommended for it when they are considered high-risk for natural childbirth. And even when they are, there have been instances when the health-care professional who is presented with the recommendation decides to have the woman attempt natural childbirth, after making an assessment. Sadly, there have been too many cases where that assessment was wrong and proved fatal. If there was a stated protocol in place, this would not occur.
The SDG, like the MDG before it, is set at a figure which indicates that the persons making these goals recognise that there will be cases where regardless of the care taken and the protocols followed women will die during childbirth. What it has set out to do is remove the preventable causes of such deaths from the equation and this involves setting a standard of care, which must be adhered to at all times. Failure to do so should attract severe sanctions.
In Guyana, despite overwhelming evidence of serious failure to provide even adequate care in some cases, there has never been a publicly known case of those at fault being made to face the consequences. The modus operandi has been over the years that an enquiry is held and a cause of death given. Human error is not admitted, though by logical deduction this must be the case some of the time and obtains not just in maternal mortality but all other aspects of health care. Is it the case that medical professionals in Guyana are untouchable? And if they are not, then it seems to be a matter of who will bell the cat.