By Sola Ogundipe
A WOMAN dying in childbirth is no picnic. No one knows this as a fact more than Dr. Ugochukwu Chukwunenye, an experienced Consultant obstetrician and gynaecologist who strongly believes government needs to look beyond the widely acclaimed Midwife Service Scheme (MSS), as a means to curtaining the menace of maternal and infant deaths in the country.

Chukwuneye, who is Medical Director, Optimal Specialist Hospital, Surulere, Lagos, in a chat with Sola Ogundipe, speaks on a number of issues related to maternal death. He argues that government must first address the gaps within the healthcare referral system, then provide special budgetary allocations that would enable the private health sector upgrade their services to world standards if the dream of saving Nigerian women from pregnancy-related deaths is to realised. Excerpts:

ON the high incidence of maternal mortality in Nigeria

There are too many limitations that have not made it possible to reduce this calamity on a national scale to a minimal level. These are factors that have remained mainly the same over the years.

Many times, the women who die don’t have access to available services either out of ignorance or poverty or poor standards of education or poor awareness on what is available in the environment or because of traditional or cultural practices or religious beliefs. These things hinder them accessing the available care.

Even when some of these people get to the hospitals, the hospitals are not in a position to immediately address their needs. Some come in very bad condition and require urgent attention. Perhaps in that setting there is only one operating team and engaged in the theatre.

Then the patient will have to keep waiting until that first case is sorted out before she could have her own chance to be helped. Now that delay, which is the secondary delay, results into many deaths in General hospitals and Teaching hospitals.

It is not because the personnel on ground are not competent, they are very competent but they can only take a case at a time. It has been about limited facilities and limited staff as compared to the volume of patients they are addressing.

On addressing death during childbirth

Government at every level must look at what is going on at their facilities and ensure that they provide adequate operating units in the maternity section, have adequate number of operating teams depending on the number of emergencies they tend to receive in a day because no life is more important than the other. The fact that a woman arrived first does not mean that the second woman should be allowed to die.

Dr. Ugochukwu Chukwunenye

Government has a role to provide enough operating teams or operating theatre or get into a kind of arrangement with good private hospitals who can be contacted and they can immediately take such a patient to that facility for the operation to save the life of mother and baby.

On impact of skilled birth attendants and community health workers

The Midwives Services Scheme will definitely make some contributions down the line. It is a relatively new scheme but the improvement cannot just be attributed to MSS and to extension workers alone. Over the years, we have continuously had well-trained hands leaving the Teaching hospital setting and going into the communities and they are gradually changing the landscape.

Pregnancy and childbirth

Many of the patients that die in pregnancy and childbirth, midwifery cannot help them. The only thing midwifery can do is that if they see such patient on time they can encourage a referral to where they can be helped but they cannot help them.

On the hospital referral system

There is definitely a problem with the referral system. Many people don’t know, for instance, when they are in trouble and that they should be asking to be moved to better facilities. Some are where they are maybe because of financial considerations. But if you are having a problem, then you should know when to leave.

I think every Nigerian woman should know that if she has been in labour for 12 hours and she has not delivered, then something should be done to help deliver her. If where she is it cannot happen then that is the time for her to start making arrangement to go elsewhere. The same thing if a woman delivers and one hour on she is still bleeding, I think she should get a referral unless that bleeding is being adequately addressed.

Why government should allocate resources to develop private hospitals

Why then should government expend public resources to go overseas for treatment? Why should Nigerians be flown to South Africa at government expense because they are very ill and need to be treated in private hospitals? They are not going to government hospitals in those places.

So you see government funds being utilised in private businesses in other lands. So why not develop our own so that nobody is thrown out? I read that it was well over $120 million that is involved in flying Nigerians to seek treatment in other countries from U.S to India and Israel annually. If we can help our hospitals to get there it is a lot of savings for the country.

On his call for budgetary allocation for private hospitals

The best way will be a kind of revolving loan scheme which has extremely low interest rate. There are so many things we want to do. For instance, each time we look at the 25 per cent interest the banks are asking us, we cannot go through it. We have the ideas, we know what to do but we can’t do it because of the very high commercial interest rates.

If government funds that have been set aside to help hospitals that are ready to access them at very reasonable interest rates, that will help catapult our hospitals. I know there are so many hospitals at that stage ready to move if they can get the capital.