This calls for a serious situational analysis and implementation of evidence-based nursing and maternal practices. All these death cases have been blamed on negligence of the nurses, but I feel there is more to these deaths than negligence.
I am not saying those who are negligent should be let off the hook, but I would like to bring to light some aspects that also need to be considered in relation to these deaths.
The first is an absence of national nurses/midwife conferences and discussion forums. Nursing and maternal care are dynamic entities, hence, nurses/midwives need to be on par with the new trends in the maternal and nursing care profession.
Though there are in-services programmes in place, these are actually repetitions of what is already known and from experience they are usually non-effective in responding to the ever-changing nursing and midwifery practices. Inviting national (if there are any) and international experts in the maternal nursing care field to address the conferences could also be beneficial to our maternal care sections.
The second is inadequate care during and after delivery. Frankly speaking, inadequate care provided during the birth period is reflected as negligence. However, there are factors that are also neglected when one judges the level of care provided during the birth process.
The patient-to-nurse ratio, of which the number of mothers far exceeds the number of nurses, should be addressed. Financial considerations have become more important than patient care, which is mainly a common practice among nursing/maternal care supervisors, in their quest to become better financial managers. I am referring to the absence of standby calls system for nurses, so that there is always an available cover up nurse when such a need arises.
The unavailability of medical personnel in the maternity departments, where there is usually no general practitioner or obstetrician readily available for maternity departments, is a matter of concern. Nurses have to call the medical doctor on standby to come and see these women.
Hence, there is a need to have an obstetrician or a gynaecologist in the maternity ward on a 24-hour basis, so that there are no more delays in arriving to see the patient, thus facilitating early intervention whenever a problem is detected.
Another shortcoming is the absence of national protocols. It is imperative to develop a national protocol on maternal and neonatal care. If we can respond to the seriousness of malaria and tuberculosis by formulating national policies on these diseases, then we also need to address the ‘maternal and child deaths disease’ by formulating a national policy that provides guidance and addresses this problem.
Dedication and motivation cannot be taken for granted. Nurses and midwifes need dedication and motivation for them to carry out their duties. We can upgrade the skills, update the knowledge and import nurses, but without these two attributes, improvement in nursing and maternal care is practically impossible.
Nursing and maternity services have become marketable entities, which should assist nurses and midwives in realising their social and economic dreams. Do we really expect these nurses to be productive if they are not dedicated or are de-motivated?
One should do a proper situational analysis, because focusing on negligence as the sole factor may not give a clear picture of the whole problem. Lastly, my sympathy goes to the bereaved families. Hopefully those concerned with maternal and child health care will find strategies to prevent further cases of maternal and baby deaths.
Eva AN Velikoshi