Written by TREVOR S BALEKE, An acute shortage of blood has hit Jinja Regional referral hospital. There is no single blood unit available to give patients in critical condition, hospital managers say.
The Observer has established that on average, 12 patients are referred to Mulago hospital daily for blood transfusions. Dr Micheal Osinde, the hospital director, said in an interview last Thursday that at least five children die every day in the children’s ward due to the blood shortage. The casualty ward and pregnant mothers are also affected.
“This is the worst the blood shortage there has ever been. And because this is a regional referral hospital, we receive patients from about 10 districts,” he said.
According to him, it costs $80 to process one unit of blood. Jinja regional referral hospital needs at least 70 units of blood in a crisis-free week.
“We do not just get blood from a donor and transfuse it into the body of a recipient. It has to be processed first,” he said.
“We don’t have a single pint of blood for all the groups in the laboratory,” he said.
Asked what could have caused the shortage, Dr Osinde pinned it on funding gaps in the ministry. He said the Uganda Blood Transfusion Service had run short of money to collect, process and store blood by last December.
Yesterday April 11, 2013, the High court of Uganda started hearing a maternal health case filed by the Center for Health Human Rights and Development (CEHURD) & others against Nakaseke District Local Government and the Attorney General.
On 12th April 2012 the Center for health, Human rights and Development (CEHURD) dragged Nakaseke District Local government to court challenging the way Nanteza Irene died in labour pain despite crying for almost 10 hours without any medical attention accorded to her.
This case follows a landmark maternal health case that was filed by CEHURD in the Constitutional court of Uganda in March 2011 (Constitutional Petition No.16 of 2011). The justices in that case advised the petitioners to seek other remedies in other courts of law.
By the time of this ruling (June 2012) CEHURD had already filed this case and had never been fixed for hearing. It is on record that 16 women die in Uganda daily and the more cases are delayed in courts the more women that die.
CEHURD is thus calling upon the High court to give a declaratory judgment that the acts, omissions and behaviors of the health workers and the local government towards Nanteza Irene (deceased) leading to her death violated her rights to life, to health, freedom from inhuman and degrading treatment and equality and that of her children.
“It’s the justices of the court that can end the preventable maternal deaths by according justice where it’s due. We cannot continue to see the injustices of women dying from preventable maternal deaths. We call upon the government to recruit, allocate and motivate health workers as well as supply necessary basic maternal health commodities in the health facilities as part of their Human rights obligations” Said Mulumba Moses, Executive Director of CEHURD.
The leading causes of maternal death in Uganda include massive shortage of trained, motivated and equitably deployed professional health workers to attend to births, lack of access to emergency obstetric care, lack of access to quality antenatal care, and lack of access to family planning services, hemorrhage, sepsis and above all lack of a political will to priotize the right to health..
Court will next hear the case on 17th May 2013 as counsel for the plaintiffs sought an adjournment to file a joint scheduling memorandum since the defendants had not signed the one that was prepared and hence wasn’t filed in court on time. His Lordship Justice
Benjamin Kabiito the judge handling the matter advised the parties to do a scheduling and file the same in court by 30th April 2013 such that on 17th May they come ready to proceed as he will not entertain unnecessary adjournments.
For more information, contact: Noor Nakibuuka, CEHURD, +256782496681
By Dr. Cory Couillard:
Annually, 16 million girls aged between 15 and 19 give birth each year. Ninety percent of the births in developing countries occur in adolescent marriages according to World Health Organization (WHO) statistics. In many countries, the risk of maternal death is twice as high for adolescent mothers.
Motherhood is often a fulfilling experience but sadly it is commonly associated with severe health consequences without proper care, education and support. Conditions that are related to pregnancy and childbirth are the second cause of death among women of reproductive age.
Severe bleeding, infections, unsafe abortion and high blood pressure conditions are four of the main killers that cause 70 percent of deaths. In all, over 358,000 women die per year and most of these are preventable.
20 million pregnancy complications
Maternal health simply refers to the overall health of a woman during pregnancy, childbirth and the postpartum period. More than 136 million women give birth per year and about 20 million of them experience pregnancy-related complications. Maternal health or the lack of it is a major public health crisis.
It is important to know that the bleeding after a delivery can kill even a healthy woman if unattended. The risk of death is directly related to the access and availability of proper healthcare services. Generally, access to services is related to the income of the family or individual. Less income generally equates to less access to care and greater risk of death or complication.
Women who are attended by trained healthcare professionals are rarer than you think. Nearly half of all childbirths in developing countries are not attended to properly. Attended childbirths still pose the risk of complications such as infections if cleanliness and hygiene standards are not strictly adhered to.
Unsafe abortion & infant death
There are over 18 million unsafe abortions that are carried out every year that result in over 46,000 deaths. Half of these abortions are considered unsafe.
WHO defines unsafe abortion as a “procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.”
It is estimated that three-quarters of newborn deaths could be prevented if women were adequately nourished and received appropriate medical care from early pregnancy through the post-delivery period.
Currently, about four million infants die within their first month. Improved access to medical care and maternal nutrition would significantly reduce stillbirths, which now number 3.3 million worldwide.
Many women in developing countries give birth before the age of 18. Many of these women have been married off as children and lack the education, money, and status to get adequate healthcare services.
Complications run rampant in adolescent pregnancies. Children having children will face substantial risk from having small pelvises that can obstruct labor resulting in long labor times, birth injuries and an increased risk of still born babies.
Education highest priority
Experts at the World Health Organization point to education as the primary way of addressing maternal health in many developing countries. Education can address the root causes — poverty, low status of females and lack of access to healthcare.
The education of girls and young women does a lot more than just improving the lives of mothers; it protects children’s health, facilitates healthy families, creates less of a burden on healthcare delivery systems and overall improves society.
Dr. Cory Couillard is an international healthcare speaker and columnist for numerous newspapers, magazines, websites and publications throughout the world. He works in collaboration with the World Health Organization’s goals of disease prevention and global healthcare education. Views do not necessarily reflect endorsement.
Annet Nakaibale, a mother of eight, knew she was carrying more than one baby, but did not expect triplets. As fate would have it, labour pains struck when she was by herself in a grass-thatched hut.
The 35-year-old narrowly survived death. She recently successfully delivered triplets without anyone’s help.
The resident of Bukwaya-Inuula in Bugaya subcounty, Buyende district, says the labour pains began at about 7:50am when all her children had gone to school and the neighbours to their gardens.
“The pains started abruptly but I did not have the energy to walk to my neighbours, who were tending to their gardens,” she says.
Nakaibale delivered the first child, but hardly had she reached for the razor blade to cut the umbilical cord, when the second baby came. “After cutting the second cord, I thought it was over, but fresh pains erupted and the third baby came.”
As Nakaibale lay in a pool of blood wondering what to do, she heard someone walking past her hut and she made an alarm.
“Help, I have delivered triplets, but I am desperate,” Medi Kabolu, the passerby, narrates. “The triplets were crying helplessly, lying bare on the ground.” He did not know what to do, so he also raised an alarm. Sympathisers gathered around her and mobilised a motorcycle that transported her to Bugaya Health Centre III, 15km away.
The babies’ weight had not been established, but they were healthy, according to medical workers at the health centre. Unfortunately, Nakaibale’s husband, David Kaduku, left four months ago to burn charcoal in Kiboga Forest, so he was not at home to welcome the bundles of joy.
“I am happy that I survived because I would have bled to death. I thank my fellow residents for their support” Nakaibale, says.
She says four months ago, the attendants of a nearby drug shop had examined Nakaibale and revealed that she was carrying more than one baby, but did not divulge more details.
On why she did not consult the experts, Nakaibale says she could not afford sh10,000 to hire a boda boda to Bugaya Health Centre III.
Challenge of health facilities in Bugaya
Charles Musasizi, the district health inspector for Buyende, says Inuula parish comprises 14 villages with only one health facility, Bugaya Health Centre III.
He adds most maternal deaths result from failure of mothers to make it to the health centre because they cannot afford the transport costs. Musasizi says there is also shortage of medical workers. The people manning the drug shops usually double as midwives.
According to Dr. Thomas Suubi of Suubi Medical Clinic-Mateete, Sembabule district, an expectant mother must be put under surveillance to minimise pre-and post-delivery complications.
Recently, Sarah Naigaga, a resident of Buseete, Buyende district in eastern Uganda, also delivered a baby in Buyende livestock market. Such occurrences are common, since the Melinda Gates Foundation that used to transport pregnant mothers in Buyende and Pallisa districts phased out the project in 2010.
Understanding the risks involved
Any pregnancy is challenging, but for a multiple pregnancy, the experience is more demanding and the risks, high
If you are expecting more than one child, you are at a greater risk of pre-eclampsia, a life-threatening condition that occurs during pregnancy and/or immediately after giving birth.
The condition is characterised by a rapid rise in blood pressure that can lead to seizures, stroke, multiple organ failure and death of the mother and/or baby. One, therefore, has to understand and appropriately respond to the warning signs of preeclampsia before the condition gets out of hand.
Multiple pregnancies are high risk and an obstetrician must watch the pregnancy closely because it can result in pre-term birth. A pre-term birth is when a baby arrives before 37 weeks of pregnancy.
The further on into your pregnancy you are, the more likely it is that your baby will do well. This is because his organs will be more mature, his lungs will be better prepared for breathing and he will have more strength for sucking and feeding.
You may face physical complications from the added strain of carrying additional weight for a longer period of time, and you might feel some extra psychological stress over wondering how you will feed and care the babies
Sometimes one baby will get more than its share of oxygen and nutrition at the expense of the other. This puts both in grave danger, as the overload on the larger twin can be just as lethal as the deprivation to the smaller one.
Regular ultrasounds are, therefore, needed to make sure the babies are growing at roughly the same rate.
Delivery poses dangers as well. Breech babies are frequent. This is where the baby’s buttocks and/or feet will be positioned. This makes C-section the safest way to deliver.