One of the reasons we love to sponsor young women in Tanzania is because when they graduate not only are they registered nurses but also registered midwives. Tanzania has a population of nearly 49 million, many of whom live in rural areas away from facilities with trained staff capable of providing prenatal and birthing support for women. Only half of the women who give birth in Tanzania each year are attended by a skilled birth attendant. According to 2013 World Bank statistics, 410 women die per 100,000 live births in Tanzania from complications related to childbirth. In comparison, the US rate of maternal deaths is 28 per 100,000 live births.The main causes of maternal death are hemorrhage, infection, hypertension, obstructed labor and unsafe abortions. Many of these deaths could be prevented with proper care.
Although progress is being made to reduce maternal mortality, Tanzania (like many sub-Saharan countries) will not meet the 2015 Millennial Development Goal 5: reduce maternal mortality by three-quarters between 1990 and 2015. Additional healthcare workers are needed in order to support continued decline in maternal mortality rates.
IIncluded in this month’s newsletter is a short animated film entitled “Why Did Mrs. X Die?” The original film, based upon a lecture by obstetrician Dr. Mahoud Fathalla, was made in 1988. More than 25 years later the story is being retold, with Mrs X representing the universal woman in her journey through pregnancy. We do hope you take a few minutes to watch this informative film.
Following are several emails from students that talk about their experiences in labor and delivery.
Zuena, a second year student at Tukuyu School of Nursing writes:
I hope your fine, for my side am doing fine especially on my studies. Two weeks ago I have been in labour ward and I was faced with different cases among this is PPH. (Note: PPH is post-partum hemorrhage.)
The mother known as Salome O. admitted in labour ward with a history of labour pain. She is gravida two para one and in her family there is no any history of hereditary diseases. After admission we perform physical examination and her finding is normal, lie longitudinal, presentation is cephalic fundal height is 38cm.
On vaginal examination the cervix was soft and thin, dilatation is 8cm, position is LOA (left occipital anterior) the ischial spine is normal, sacropromontary not reached, sub public angle is 90 degrees and four knuckles accommodate.
The vulva was clean not dirty and there is no abnormal vaginal discharge, no oedema, no signs of female genital mutilation and there is no genital warts. Few hours when the membrane ruptured and cervix become full dilated the woman was delivery female baby with the Apgar score of 8 cm in the first one minute and 10 after five minutes.
When this minutes exceed this we call it retained placenta. We have tried to manage the woman by rub up contraction, give uterotonic to sustain contraction in order to control bleeding, but still the woman continued to bleed. (Note: Normally we expect that after baby delivery the placenta should expelled out before 30 minutes.)
When the condition continue to become worse we have tried to call a doctor, and doctor perform manual of placenta. Management and nursing care monitor her vital signs, administer intravenous fluids so as to resuscitate mother, encourage nutrition intake, give psychological support, administer two unit of blood and give antibiotic so as to combat if there is any infection. Those are management that I have done to this woman, and I was enjoyed so much to see the woman progressed well.
What would have happened to this woman had she not been in a facility with trained staff? Would she have become just another statistic? Chances are the answer would be yes.
Paschalina, a second year student at Kilimanjaro Christian Medical Center writes:
I hope your fine. Me too. I well continuing with my studies. Am very happy to inform you, that am in my clinical rotation especially in labor ward. And I have one case to be interested, that is one mummy delivered at home, a big male baby having 4kg of body weight, and on history taking she got many complication that is POST POSTPARTUM HEMORRHAGE, LOW OXYGEN SATURATION, and DIFFICULT IN BREATHING, when the time they come to Hospital she died on the way.
The video we have included in this newsletter takes you through this journey– the Maternal Death Road–and discusses the events that contribute to such a tragedies.
Mapamba, a third year student at Tukuyu School of Nursing writes:
My hope is that you are doing fine. Back to me I am ok. My friends I say thank you for everything you are doing for us. I am happy that I am on the last semester of my studies. Thank you very much because your contribution enabled me to reach here. Two weeks ago, I was in maternity ward. During my shift I was caring for mothers in the antenatal room. One among them was having irregular fetal heart rate and frequency was 160 beats per minutes and was weak. I asked the mother what is the problem with you? She said since yesterday I have vaginal discharge. I decided to make assessment on that discharge. I diagnosed that the mother has pre rupture of membranes. I connected IV ringer lactate and runs faster to resuscitate the baby then I reported to my ward in charge and I reported to the doctor and doctor prescribed antibiotic to prevent infection tablets erythromycin 500mg t.d.s. After one hour the fetal heart rate was 140beats per minute. I continued to monitor fetal beats half hourly then we took the woman to ultrasound then findings were good. After that we continued to administer IV fluids to monitor fetal heart rate until the end of my shift condition of the baby and the mother was good. I reported to the nurses entering the duty to ensure continuity of care. After one day the mother got a male baby with Apgar score of 8/10 to 9/10 and body weight of 3kg and method of delivery was spontaneous vaginal delivery. I was so glad for this mother to get her baby because the mother war having a bad obstetrical history as she was gravida 4 (“gravida” means number of pregnancies) 4 but living children zero. She was very happy also. My friends for this week we are preparing ourselves for mock examinations which will start on 8, June 2015 up to 16, June 2015. We need your prayers so that we can perform well. ME I WISH YOU SUCCESS IN YOUR LIFE. I AM YOUR FRIEND, Mapamba
This is a joyous occasion for mother and baby, but why did her other children die? Could their deaths have been prevented with education and proper supervision during labor and delivery?
This next email reflects the type of life-saving education that women and children receive when they have access to a reproductive and child health clinic. The government makes these clinics free to mothers and children under 5.
Lightness, a second year student at Kilimanjaro Christian Medical Center writes:
Hello my friends how are you? Hope you are fine, for me I’m fine and I’m doing good in my subjects. I like to inform you about my studies while I’m in the clinical area.
Last week I was in reproductive and child health clinic (RCH) in one of the health facility in Moshi disctrict where I enjoyed studying different health services that is provided in the community. This services including immunization to children who is under five years e.g. pentavalent vaccine, BCG for prevention of tuberculosis, TT or tetanus.
Also I enjoyed to provide health education to all pregnant mothers who attending in the RCH clinic about the preparation of labor and post natal care which is very important thing because they help them to prepare themselves, and one of the education which I provided to them is to make sure that they can take drug as instructed by a nurse or any health provider e.g. taking Sp for malaria prevention, TT for tetanus etc.
Also I provided H.education on the importance of going in the health facility once they got any sign of labor, and not only during labor but even when they can suffer any danger sign like severe headache, dizziness, PV bleeding, convulsion etc.
Hopefully women who have received this type of education will be able to recognize early warning signs and seek medical care.
As of the fall of 2015 it will have been 8 years since we started our sponsorship program at Kilimanjaro Christian Medical Center in Moshi. In 2012 we partnered with Tukuyu School of Nursing in the Southern Highlands of Tanzania. In 2015 we began sponsoring students at three additional schools. During 2015, 20 sponsored students will graduate, for a total of 66 students who have graduated with financial assistance through TNSP. This fall we will sponsor 45 students. We thank all of you for your continued support on this journey.
As always, we welcome your questions and comments. Please write us a note in the comments section below!
The photo at the top of this newsletter shows the first two sponsored students, Chiku and Jackline. In the center of this photo is Lilian Mejool a teacher at Kilimanjaro Christian Medical Center. Lilian will be coming to the U.S. at the end of August and will spend a term at the UMass College of Nursing as a visiting scholar. This visit was made possible through a special gift.
Again, thank you for your support!
Linda van Werkhooven, President
Tanzania Nursing Scholarship Program