Birth Preparedness and Complication readiness

Case Scenario

“In a rural area of Nepal, a woman is due to childbirth and she lives almost 5-6 hours far from the health care center. She belongs to low middle income socio-economic class. she is not aware of danger signs of pregnancy. Her family members think that childbirth is simply a natural process of giving birth and there is no necessity of special precaution because they gave birth to their children at home without anyone’s attendance from generation to generation. They know there is ambulance service but they don’t know the contact details of the ambulance service. The woman, her husband and other family members are not aware of any danger signs of childbirth. She starts getting contraction and pain but her mother in law is very sure that she delivers baby without any events. Her labor progresses, but instead of head, the cord prolapses. The outcome is yet unknown”

In above scenario, what are the conditions that can lead to adverse events of maternal and child morbidities, deaths?

1.  She is not institutionalized for the childbirth.
2.  They don’t have enough money saved for childbirth
3. They don’t have vehicle even if they want to take her to health care center in case of   emergency. She might reach the health center after golden hours.
4. They even don’t know when should they be contacting health care workers
5. They haven’t identified the people, who can donate blood if needed
6. They will take very long time to identify the complications, arrange money, vehicles and to decide which health center, they will be going.

What could have done to make sure healthy childbirth?

1. Birth Preparedness and complication readiness!!: definitely an answer among many others.

What is Birth Preparedness and complication readiness?

Whenever we study measures that effectively helped to reduce maternal mortalities and neonatal mortalities, we encounter the phrase ‘birth preparedness and complication readiness’. Birth preparedness package is simply a set of planning strategies that better assist the process of giving birth to a child to make child bearing process safe, appropriate, affordable, and accessible. Though birth preparedness is equally important to everyone, this concept is much more relevant and emergent for the developing world, where the childbirth is taken for granted and maternal death and newborn death during the child bearing process are high. It is proactive step to preclude maternal and newborn complications and mortalities. This strategy includes preparation of family, who are expecting child with counseling for preparing anticipated funds for delivery of baby, vehicles for transportation, probable hospital and health care providers, warm clothes for both baby and mother, blood donors in case of need, educational materials regarding danger signs of pregnancy, childbirth and postpartum period. In a birth preparedness package, counselling and educational materials are provided to the couple and family informing all the preparation.

How it impacts?

It helps in tackling three delays, identified to be main causes of maternal and newborn deaths. Birth preparedness obviates delay in seeking, delay in reaching and delay in receiving the care at the time of birth. For example, in the aforementioned case scenario, there is a high possibility that the family members would take a longer time to identify that the prolapse of cord is a danger sign of the childbirth that may cost child’s life and even if they identify the danger signs, they will take longer time to arrange money, vehicle or if they don’t have any transportation facilities, it will take even days to reach health care facility and health care providers. These delays may cause mother’s morbid conditions, death, and fetal death.

A woman or a family is considered to be prepared for birth and tackling tentative complications if they arrange estimated money, identify blood donors, transportation mechanism, know danger signs of pregnancy, childbirth and postpartum, identify health care providers and health care center.

Promoting Birth Preparedness and complication readiness is one of the three major strategies of safe motherhood and newborn health program of Nepal, others being Aama Surakshya Program and expansion of 24-hour emergency obstetric care services at public health facilities. These strategies have been successful in decreasing the maternal mortality rate of Nepal.

Let’s get into the Action: World Mental Health Day 2016: Psychological First Aid

7^th October, 2016: While I was coming out of the W.T. Young Library, University of Kentucky after short session of study, I was stopped by a girl. She politely asked me to fill up the form if I have time. I couldn’t decline it.

The form was standardized assessment tool for mental health status and when I completed filling up the form, the other girl immediately scored my test and referred me to a trainee consultant, who counseled me for short time. May be I didn’t require longer counseling based on my score and she informed me to come to the center if I need any help. They were providing psychological first aid. They were essentially working in response to World Mental health day 2016 with theme of Psychological first aid. That simple information actually helped me to find ways if I need any help in the future.

We are human and I feel human emotions are the most unpredictable things in the world and the distance between our normal mental status and abnormality is very thin. Anyone can switch over to other side at any moment. An instant of stress, anxiety, physical diseases, imbalance in the neurotransmitters could switch us to dark side of our mental health status. Especially when the world is turning competitive, eccentric, individualistic, we may suffer the things which we don’t want to. Even the healthiest looking human could be living with unseen turmoil and emotional disturbances around us.

A case of Nepal: Nepal was about to recoil from the wreckage of ten years long civil war (1996-2006) and was about to produce its precious new constitution. In April 2015, massive earthquake hit the Nepal and left many people bereaved due to loss of family, home, tangible and intangible valuables. Still many of us see its aftermath in shattered, cracked walls of home, teary eyes of the people who lost dear ones, mother, father, sisters, brothers, sons, daughter and other relatives, frustration because of amputated legs, nails and wires lingering in the bones, scarred skin and faces, frightful expression of kids and adults when something shakes the bed.

This is just an example of a disaster in Nepal. There are other several emergencies like war and violence in Syria and other countries, everyday hurdles, deadlines, and racing and fleeting lifestyle in which we have to fit ourselves for every new advances, we are in constant need of psychological assurance and social settings that pacify our emotional disturbances and racing hearts.

In such scenario, expert consultation from psychologists and psychiatrists is not available and accessible all the time due to their inadequate number and limited presence only at the tertiary level care centers and urban areas. We need someone by our side who can provide psychological first aid just the way a simple trained person can deliver cardio pulmonary resuscitation to a dying person with cardiac arrest. A person who can make someone accept the reality and help to find the ability to fight with the reality. A person who can arouse the passion for something in life, a person who find time to listen and create social environment that bind people together.

World Health Organization (WHO) is celebrating this mental world health day on October 10 with the slogan of Psychological First Aid. This harbinger is innovative and pragmatic way to achieve the holistic health as our current health system is mainly focused on physical symptoms and illness. This will surely sensitize our current health care service.

What can we do?

Most of the time, I see the trend of celebration of such important days with conferences and workshop where all the professionals and specialists gather up and share knowledge and stimulate each other. But we fall short in taking action, providing and continuing the services to the people in need. I hope psychologists, psychiatrists, mental health nurse experts, public health professionals, social workers would be leading this motto to action. Training and Preparing a bunch of people for first aid is only one aspect dealing with it. Other measures like formation of some form of society and communities such as literary clubs, professional’s clubs, youth clubs, mother’s group, Recreation group in the college, schools, villages with principles of inclusion, group work and cooperation would be equally helpful.

Who are Public Health Professionals: Any Boundary??

Public health is not a very new subject. The history of Cholera epidemic and study led by John Snow and subsequent action of sanitary reforms dated in nineteenth century provide insight into evolution of modern Public health. Nevertheless, definition, area of Public Health remained vague for a long time.

We used to have discussions on definitions, scope and boundaries of Public health in Classes. I remember we agreed that Public Health is broad. Some even said, “the scope of Public Health ranges from beneath the land to the sky. There is no limit in the zone of Public health.” We concluded that everyone who are working to improve the health of people are Public health professionals. We weren’t completely wrong though. Indeed, if you are working for the welfare of people, that's absolutely public health action. But in my today’s understanding, it contravenes against the essence of Public Health.

Why do we need demarcation?

Before I clarify why it contravenes the principle of public health, I would like to focus why it is necessary to demarcate the scope and to define Public Health professionals.

Professional growth of Public health: Once you are certain that which land is yours, then you will be better able to design the city there. People will design the buildings, roads, other infrastructures, and invest money to expand the area. In similar fashion, Once the scope and area of Public Health is demarcated, it will be a lot easier to decide on what to invest, where to invest. At least the government will not be baffled whether to build a Hospital or Public health outlet providing education to a target group when government allocates funds on the title of Public Health.

Solidarity: only the wolfs form the pack, fishes make the school and animals make horde and similar people make the community. They can set a goal, solidify and work to reach that goal provided that they have resources. Such Unions will help to strengthen the communal feelings and they work for their advancements. This will help in leaving impact to the society.

Working Environment: This demarcation will help in ensuring the capacity and limitation of the public health professionals.

Who are Public Health Professionals?

Institute of Medicine defines Public Health Professionals, “a person educated in public health or a related discipline who is employed to improve health through a population focus”. Scutchfield and Keck in Principles of Public Health Practice restate that “The test for whether something should be considered part of public health is the presence of a focus on a population group or community and on a preventive strategy or a preventable outcome.” There are two key things that public health focuses an action of prevention and approach as population group or the community. The action of prevention ranges from primordial prevention to tertiary level of Prevention and this should be targeted to the Population health. To define a public health professionals and public health practice, these two factors should always be taken into consideration.

Because of vague definition of Public health professionals, it has become really difficult to enumerate Public health workers and It is a global issue. Physician, Nurses, veterinarian, engineers, administrators, anyone can be public health workers. However, the two key elements should be taken into consideration. It is essential to devise workforce taxonomy in Public health because of its current undefined nature. Public health occupations can broadly be divided into four main categories: 1. management and leadership, 2. professionals and scientific, 3. technical and 4. outreach and support services. Theses public health professionals should have professional competencies to carry out certain essential public health services such as monitoring health status, diagnosing and investigating health problems and health hazards in the community, informing, educating and empowering people about health issues, mobilizing community partnerships to identify and solve health problems, developing policies and plans that support individual and community health efforts, enforcing laws and regulations, Research.

It is necessary to reevaluate definition of Public health workforce for professional growth, unity and benchmark. 

References:

F. Douglas Scutchfield and C. William Keck. Principles of Public Health Practice. 2009.