Chemtai Mungo, MD, MPH
The First Lady of Kenya, Margaret Kenyatta, recently made history by running and finishing the London Marathon in April 2014. It is the first time a First Lady anywhere in the world has run a marathon in support of a cause.
The cause is the ‘Beyond Zero Campaign,’ whose goal is to improve access to maternal and child health services in Kenya. The Campaign appreciates the alarming figures surrounding maternal health in the country. Fifty six percent of pregnant women deliver unattended by a skilled health worker, risking their lives in the case of a complication. Another 5,500 women die annually due to preventable pregnancy related complications. Most alarmingly, a woman’s risk of dying from a pregnancy related condition in Kenya is 1 out of 55, compared to 1 out of 3,000 or more in developed countries. That means for any group of about 50 Kenyan women, one will die of a pregnancy related condition – often in her 20s or 30s.
What does this have to do with access to safe surgery? Safeguarding maternal health around pregnancy is inextricably linked to access to safe surgery. Out of about every 10 pregnant women, one or more will experience an anticipated or unanticipated complication at delivery, necessitating surgery in form for a cesarean section to safely deliver the infant. Pregnancy complications requiring surgery include but are not limited to breech presentation, obstructed labor, excessive bleeding after normal vaginal delivery, and a ruptured uterus. In these situations, without access to surgery, many women will lose their lives.
Unfortunately, many Kenyan health workers have more than a few anecdotes of maternal deaths they witnessed that would be highly preventable had the woman had faster access to surgical care. As a medical student doing a clinical and research rotation at a District Hospital in Western Kenya, I witnessed one such situation. "Joyce" was a woman who had been laboring for close to 3 days at home, many kilometers from the nearest hospital. After her (unskilled) attendant finally realized something was amiss, Joyce was transported to the hospital on a motorcycle. The District Hospital, the closest health facility with surgical capacity, was more than 4 hours away from Joyce’s village.
By the time she got to us, she was severely ill. Her prolonged labor had resulted in uterine rupture, and she was losing blood--fast. Upon arrival, the single operating theater at this hospital already had a patient undergoing surgery. If we had an extra operating theater, and additional staff and equipment, Joyce could have gone into surgery as soon as she arrived at the hospital and improved her chances of survival.
Unfortunately, we didn’t. The nearest hospital, a referral center, was about an hour away. In her current state, and without an equipped ambulance with the capability to resuscitate her in transit, she was too sick to make the trip. The surgeons at the district hospital rushed the current case the best they could. About an hour after arriving at the district hospital, Joyce finally underwent an emergency C-section in an effort to save her life and that of her unborn child. Unfortunately, Joyce had lost too much blood by that time and neither she nor her infant survived the surgery.
There are many stories like Joyce’s throughout Kenya, of women who lose their lives needlessly, because they did not have timely access to surgical care. As we reflect on the First Lady’s achievement in running the London Marathon, and on her Beyond Zero Campaign to reduce and even eliminate unnecessary pregnancy related maternal deaths, we must think about the critical role that surgery plays in this equation. We must increase the number of operating theaters available, particularly in rural areas where most women reside, while granting trained surgeons the necessary incentives to staff them. This investment in public health systems is crucial to preventing unnecessary deaths like Joyce's.
About the author:
Dr. Mungo is a first year Obstetrics and Gynecology resident at Kaiser Hospital in San Francisco, California. She earned her medical degree at the Univeristy of California, San Francisco, and a Masters in Public Health at the Johns Hopkins Bloomberg School of Public Health. She was born and raised in Kenya. She can be reached at @chemtaimungo.