Unskilled birth attendants contribute to poor natal outcomes’-Dr Oyefeso

By UCHE AKOLISA

Dr Olumide Oyefeso  a Canada-based paeditrician is the Executive Director of 4breath4life, a US-based non-governmental organisation that seeks to reduce infant-mortality through capacity-building of health workers and medical infrastructural support .

In this interview with UCHE AKOLISA, Oyefeso who was in Nigeria, recently, for a training workshop for birth attendants in Abeokuta, speaks on the challenge of reducing high neonatal deaths and other infant/maternal health issues:  

 

Recently, you just held a workshop for birth attendants in Abeokuta. How did it go?

The workshop was fantastic. We were able to train 200 birth attendants who were based in and around Ogun State. The birth attendants have strong influence in the community. We found out that they actually handle the majority of the deliveries in the community and we were impressed by their enthusiasm to learn. There are many of them who did not have any form of formal education but the interventions that we introduced to them were well-received and not only were they well- received, they were emphatic about getting another group of their colleagues to get trained and from what we see, we will probably be having close to another 200 that will be trained in the next few months. We were able to achieve this with a strong collaboration with the hospital staff of Sacred Heart Hospital in Lantoro, Abeokuta.

In Nigeria, due to the challenge of access, you find that most women in rural areas go to traditional birth attendants. What is the calibre of birth attendants did you people target because. ?

These ones are traditional birth attendants but we are not only focused on them. There are other medical providers including midwives, community health extension workers and even some physicians that can benefit from this training. But, the birth attendants in particular got our attention because as you can imagine their numbers are significant. Their numbers are significant as the gaps in their knowledge. Because, they are of a high number, practising with the gaps in their knowledge and the potential detrimental effect of that practice will be quite high but if we were able to boost their capacity, then automatically, we will have better outcomes.

You lay emphasis on ‘Golden Minute.’ What is the concept of ‘Golden Minute’?

The Golden Minute is based on the principle that any baby that is born should be breathing within the first minute of life and the implication is that for any child who isn’t breathing in the first minute of life, that child will need to be assisted to breathe. That function is met using a bag mask device, a face mask and also a suction device. We strongly emphasize the concept of the Golden Minute to the birth attendants in order for them to accurately prioritize the sequence of events that need to happen after the birth of the baby. There are many things that need to be done after the baby is born; We dry a baby, we stimulate a baby, there might be a need to cut and clamp the umbilical cord. But many of these steps are secondary if you have a baby who is not breathing. So, we sensitize them to the fact that breathing is their number one priority in the immediate period after a baby is born and that a baby who is crying actively after birth is obviously breathing well.

With the benefit of your experience abroad, what are the gaps you have observed in the Nigerian system in terms of deliveries, infant and maternal health, in general?  What are the reasons we are finding high maternal and infant mortality rate in Nigeria.

For the infant mortality, it has been found that there are three major factors that lead to it: In the immediate newborn period, we have asphyxia, infections and prematurity. In more advanced societies, there is very significant level of anticipation and preparation that go into play in delivering a child.

Some problems are anticipated ahead of time  and modalities are put in place to address these potential challenges that have already been identified. For example, a mother is going to deliver a premature baby after seven months, clearly the child is going to be at risk of infection, will be at risk of having difficulty in breathing, will require high level of skilled presence at delivery.

What is done is that, ahead of time, all the medical personnel in different specialties relevant to the care of that newborn will be put in place to anticipate those problems. But we don’t see that happening here and that is one of the big primary reasons why we have this foundation. Also when people deliver in smaller centres or at home, there need to be reliable referral system so, that when problems arise, there is a system in place for people to be moved to a place with higher level of care. What we find commonly in Nigeria is that there is a break in the chain of healthcare delivery; we have to have an improved healthcare delivery chain, from the simple centres/locations to up to the more advanced tertiary centres.

There are a lot of unregistered centres. So, when they have issues, they are afraid to refer because they don’t want government to know. What do you think government can do to bring about a functional referral system?

The truth of the matter is that government is playing an extremely inadequate role in healthcare. Government needs to be director and quarterback of healthcare and government needs to be more involved in that. The level of infrastructure that is available is appalling and this has been a song for decades. More resources need to be directed towards healthcare but government has to be more intentional with healthcare policy. Healthcare laws and regulations needs to be stronger. Laws and regulations are only as good as the paper they are written on if they are not enforced so that anyone who is engaged in an illegal practice of medicine, should be held   accountable to the full letter of the law and that will discourage anyone who has such intentions and the public needs to be more aware to know about what the standard of health is.