Battling maternal deaths
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Chief Medical Officer, Dr. Shamdeo Persaud
Chief Medical Officer, Dr. Shamdeo Persaud

— Guyana seeks to reduce number of deaths to 10 by 2020

COGNISANT of the fact that it fell short of meeting the Millennium Development Goal (MDG) target for maternal mortality in 2015, Government continues to put a series of measures in place to bring the numbers down, but said all must get involved if Guyana is to achieve the target set out in the 2030 Sustainable Development Goals (SDGs).
Globally, maternal mortality has fallen by almost 50 per cent since 1990, according to the United Nations, but for Guyana, the numbers have not been favourable.
The country’s Chief Medical Officer (CMO), Dr. Shamdeo Persaud, said Guyana on average records 16 maternal deaths annually with a rate of 115 per 100, 000 live births. The country records approximately 18,000 pregnancies each year.
SDG 3 (Good Health and Wellbeing) Target 1, calls for the reduction of the global maternal mortality ratio to less than 70 per 100, 000 live births. For Guyana, this means that the country must record less than eight maternal deaths annually by 2030 for the target to be achieved locally, the CMO explained during an exclusive interview with the Guyana Chronicle.
Statistical data coming out of the Public Health Ministry indicates that Guyana in 2015 recorded 14 maternal deaths, two of which were indirect, putting the rate at 106 per 100, 000 live births. In 2016, 14 deaths were also recorded, but due to the number of births that year, the rate jumped to 116 deaths per 100,000 live births. Already for 2017, eight maternal deaths have been recorded with one of the most recent victims being 17-year-old Esther Edward, who died at the country’s primary health care facility – the Georgetown Public Hospital (GPHC) – after delivering a baby girl via caesarean section (C-section) on August 1.

NO EASY TASK
According to Dr. Persaud, the Public Health Ministry is working to reduce the actual number of maternal deaths to 10 by 2020 and less than eight by 2030, but maintained that it is no easy task.
In 2015, the Government set aside $133.1 million for expansion of the Georgetown Public Hospital Corporation (GPHC) Maternity Unit, increasing its capacity by 50 beds. The investment was made at a time when the hospital was faced with serious overcrowding in the Maternity Unit, which had left mothers no other choice than to double on the beds in an effort to access much-needed services.
By October 2016, the Public Health Ministry through the Government of Guyana had secured a US$8M loan from the Inter-American Development Bank (IDB) to assist in the reduction of maternal, perinatal and neonatal deaths. The programme was designed to improve the quality of care at 140 health facilities and in 88 communities, benefitting at least 140,000 women and 9,000 newborns per year over a period of five years.
The IDB had noted that despite progress achieved during the last decade, Guyana continues to experience one of the highest maternal and infant mortality rates in Latin America and the Caribbean.

With the funds secured, the CMO said the Public Health Ministry has been increasing its maternal care services across the country. It was pointed out that the Bartica Regional Hospital, a medical institution in the Cuyuni-Mazaruni District which was plagued with poor services in the past, now has the capacity to facilitate C-sections and blood transfusions, now that it is fully equipped with an operating theatre and obstetrician. C-sections and blood transfusions, Dr. Persaud said, are two critical services that are most often needed to deal with pregnant women with complications.
“We have already done the same for the Lethem Regional Hospital,” the CMO added, while noting that while the C-section can be conducted at the hospital under the watch of an obstetrician, the hospital does not have the capacity to do blood transfusions.
“We are working to have blood transfusions done there, but there is a system in place to access blood once a case pops up. Once the pregnant woman is identified, blood will be sent in, we have flights daily,” the CMO explained.
The Lethem Regional Hospital is located in the Upper Takutu/Upper Essequibo District.
The Georgetown Public Hospital, the West Demerara Regional Hospital, the Suddie Public Hospital, the Linden Hospital Complex and the New Amsterdam Public Hospital are all up and running with all of the essential services being provided to pregnant women.

CLOSE TIES
Additionally, Dr. Persaud said the Public Health Ministry has established close ties with the six private hospitals in the country, St. Joseph Mercy Hospital, the Woodlands Hospital, Dr. Balwant Singh Hospital, Davis Memorial Hospital, Georgetown Medical Centre, Medical Arts and the Annamaya Memorial Hospital.
“All these hospitals can do caesarean sections and provide blood transfusions,” Dr. Persaud assured the Chronicle
“Our challenge still remains though in those hinterland regions where these essential services are needed,” he posited while pointing that the majority of the hospitals are situated in urban areas.
As such, he said the Public Health Ministry is working to improve the referral system. While critical patients and those with complications are transferred to the district hospitals, the majority are transferred to the Georgetown Public Hospital.
The CMO posited that health workers have developed a practice of giving patients the referral slip and leaving it up to them to submit it to the referral hospital, but that should not be the case, especially when dealing with pregnant women.
“We would like to move away from that and once we see a complication arising in a pregnant mother, that the system should take charge of that person and ensure that we look after the logistics,” he posited. Pregnant women, especially those with a second or third pregnancy, have developed the habit of ignoring their illnesses.

“That is the big challenge, especially with the hinterland women, they have other children, and they have their homes and all that. And they would try to delay and they would try to diminish, the importance of this referral. They would say well I had four children before, they say my blood pressure is a little high but not that high, and they would go ahead and ask for some medication, or come up with their own remedy,” the CMO further pointed out.
Dr. Persaud also used the opportunity to call on pregnant women to register at the nearest clinic as soon as they are aware of their pregnancies. According to him, many women wait until they develop a complication before seeking medical attention. Pregnant women, he emphasised, should join clinics during their first trimester.
Target Two of SDG 3 is closely aligned with Target One; however, the Public Health Ministry is still in the process of gathering data, even as it puts systems in place to safeguard the health and well-being of newborns and children under five.
Target Two seeks to end preventable deaths of newborns and children under five years of age by 2030, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-five mortality to at least as low as 25 per 1,000 live births.

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