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Delivering on a promise in Guatemala Saint Peter’s hospital has helped nation turn around mortality rate of new moms

Dr. Bipin Patel is the chairman of pediatrics at The Children's Hospital at Saint Peter's.-(PHOTO BY AARON HOUSTON)

Back in 2000, an average of two women died every day from pregnancy-related causes in Guatemala.
That’s not a problem that can be fixed through a couple of medical missions.

“(It has) to be a sustained project,” said Dr. Bipin Patel of Saint Peter’s University Hospital in New Brunswick. “Episodic missions are easy — you get in a plane, go there for a week and then come back and you feel good.”

Nothing was easy (or cheap) about the $75,000-a-year project that The Children’s Hospital at Saint Peter’s initiated a decade ago to reduce that two-maternal-deaths-a-day figure, but it has had a profound effect in the region the hospital is focusing on — where the local health ministry reported maternal deaths had plummeted to zero in 2011.

But that staggering figure, as reported by UNICEF, might not have even been apparent to someone living in Guatemala City, where private hospitals offer care comparable to what you could get in the U.S.

“The disparity (in level of care) keeps increasing as you go further and further away from the city,” said Patel, chair of pediatrics at The Children’s Hospital.

When you get far enough away from urban centers, needing a cesarean section — a typical and relatively safe procedure in the U.S. — would sometimes spell death.

That’s just one of the many types of preventable maternal and infant death that disproportionally occurred outside Guatemala’s urban hubs. And it’s just one part of the problem that Saint Peter’s University Hospital has been addressing — and making progress on.

Patel first became apprised of the women’s and children’s health problems in Guatemala’s rural areas after a delegation from the Diocese of Metuchen reported back from a 2004 mission there.

The delegation discovered a great need for the New Brunswick-based Children’s Hospital to export its expertise in treating high-risk pregnancy and newborn care. And they told Patel to see it for himself.

So he and a group of physicians from Saint Peter’s traveled to the village of Chiquimulilla, which is about 18.6 miles from Guatemala City.

“And we saw that a lot of kids were dying in the first month after birth,” he said. “Nearly 80 percent of women were delivering at home, not by trained physicians, but by community birth attendants they called ‘comadronas.’ They had no formal training.

“And for these deliveries, there was no hand-cleaning, and it was a septic environment. So many of these babies died of infections.”

When Patel returned, he won the support of Saint Peter’s administration, which allocated funds for five clinics in an area that had almost no doctors or nurses. He aimed to create a region-serving health project that would be sustained.
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In 2007, three years after the project began, Patel realized that they had missed a step by going straight to establishing clinics. They needed to start where Guatemalans started: with comadronas.

For Guatemalans, there’s no one else to go to — comadronas are the de facto childbirth experts.

So Saint Peter’s launched a rigorous training program for comadronas. And it was done with the understanding that convincing these revered caregivers that there was more to learn wouldn’t be easy, as Patel explained:

“When we met with the first group of comadronas, one toothless woman, the eldest in the group, came over to me and said, ‘What are you going to teach me? I’ve delivered hundreds of babies.’

“My response was, ‘We’re looking exactly for someone like you. We need you to teach the others how to do it correctly.’ … We had to recognize she was a leader, and take a (non-confrontational) strategy.”

It was after a few years of training that the local health ministry delivered the promising news about the region’s lack of maternal deaths.

UNICEF has also reported that Guatemala as a whole has significantly reduced its maternal mortality rate in recent years, shrinking 50 percent since 1990.

Still there’s progress to be made. The goal of the Saint Peter’s Guatemala project is to reduce the region’s consistently high infant mortality rate.

To that end, Patel said the organization has incorporated bag-and-mask resuscitation equipment into their comadrona training.

“The common skepticism is: some of our comadronas can’t read or write, so how can they be taught to do resuscitation with a bag and mask?” he said. “And, sure, it’s not easy — most people couldn’t do it. But it’s designed with the thought that it might be laypeople using the equipment.”

Between the education and the clinics, the Guatemala project has an annual budget of $75,000 that sometimes fluctuates. The region has a tendency to produce unexpected costs.

That’s something that David Jaipersaud, an administrative director of pediatrics at Saint Peter’s, learned quickly.

“People were asking, why are we (paying so regularly) for things like tire changes?” he said. “But when you go down there and see the road conditions … it’s surprising that we didn’t get requests every week.”

But there were some lessons about cost-effectiveness that physicians at Saint Peter’s have been able apply back in New Jersey.

“You wouldn’t think twice about throwing certain supplies out over here, spoiled as we are,” Patel said. “But everything you have there you have to be very careful of how you use it, because there’s no ready supply.

“We can’t be wasteful — that’s something we’ve become more mindful of.”

E-mail to: brettj@njbiz.com
On Twitter: @reporterbrett

Creepy crawlers

During the trips Dr. Bipin Patel took with other Saint Peter’s team members, they would often stay in local motels.

Bats, bugs, rodents — you name it — you can find it scuttling around in those motel rooms, Patel said.

David Jaipersaud of Saint Peter’s, on his first trip to Santa Rosa County in Guatemala, never for a second forgot about that.

“David, big and tough as he looks, got really scared of a scorpion crawling into his shoes,” Patel said. “Because I told him they like dark places like shoes, he never took his shoes off — even when sleeping.”

Jersey hospitals doing work all over the world

While New Jersey has a number of hospitals launching efforts to help developing countries, it’s worth recognizing the Garden State hospital staff members that are doing the same.

After the Philippines was devastated by a typhoon in November 2013, nursing leaders at Robert Wood Johnson and other Middlesex County hospitals raised $10,000 in funds for aid.

That’s an example of the endeavors the Middlesex Chapter of the state’s Philippine Nurses Association has been spearheading for nearly a decade.

Myrna Young, the chapter’s president and nursing education specialist at RWJ, said that among other things, the chapter organizes an annual mission to the Philippines to provide health care services.

“Some of our nurses went to Cebu in October to do health care training and to donate medicine,” Young said. “These are remote areas that have sometimes one doctor and no hospitals. The people cannot afford health care services or treatment.

“So our nurses do free screenings, checking blood pressure and other things. … It is one of our missions to provide that community support.”

Brett Johnson

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