Urban Hospital Visits
Thursday and Friday of last week we continued with interviews in hospitals around Stone Town. We visited Mwembe Ladu Hospital where we were able to speak staff and mother in both the maternity ward and the antenatal clinic, and the Rahaleo antenatal/reproductive health clinic.
Based on our interviews at all three locations last week, anemia definitely seems to be the biggest issue with antenatal care. It does appear however, that most women are getting hemoglobin tests during pregnancy. There are two different types of hemoglobin tests used by facilities, the Hemocue and Emission Plus, and tests range from 1000 – 2000 shillings (~$0.50-1.00). So far it seems that testing is available and affordable, but we are interested to see if our results differ as we start to reach more rural settings.
Drug shortages and noncompliance with prescribed supplements and advice on diet seem to be the bigger problems with anemia. Hospitals get supplies based on the districts they are supposed to be serving, however patients come from farther districts to access the hospitals they perceive as higher quality. Staff at Rahaleo said that 3-month drug supplies only last 1 month.
Pre-eclampsia is the other big antenatal problem. One indication of pre-eclampsia is high protein in the urine. Urinalysis requires electricity, which is intermittent in Zanzibar. Designing a device that doesn’t require electricity is something we’ve talked about recently. We’d like to focus more on understanding the current lab technology used for urine testing so we can think about ways to improve it.
We’ve only been able to see one maternity ward, but staff there said hemorrhage was the biggest problem. All PPH cases are referred to Mnazi Mmoja (MMH). It seems that everything beyond basic care is referred to MMH, which contributes to the overcrowding. We haven’t been allowed to access the maternity ward at MMH, which is difficult, as we can’t talk directly with the people facing the complications we hope to help solve.
Ultrasound testing is uncommon. It is only ordered when a complication is suspected. From what we have found, the cost is approximately 10,000 shillings (~$5.00). We briefly discussed portable ultrasounds, which the SUZA team thought was the most useful idea. We like the idea but are wary about the feasibility of the technology.
One thing that hospital staff continuously mentions is the need for more health education. It is almost unanimous among health workers that mothers’ ignorance about health conditions and noncompliance with doctor advice are the biggest failure in maternal care. Education sessions at the clinics are offered early in the morning, so many mothers miss them due to logistical issues or because they simply want to get tested and don’t care about education or changing habits. Family planning has been widely rejected due to religious and cultural beliefs, and also partly because women have heard that family planning drugs cause weight gain. Family planning education is important for the population in Zanzibar as multiple, closely spaced pregnancies can lead to complications such as hypertensive disorders (pre-eclampsia) or PPH.
Finally, we have noticed that transportation is a major barrier to care for mothers, even for women who live fairly close to Stone Town. Most women in the maternity ward had come in a taxi or a neighbor or friend’s car. One woman told us that for one of her pregnancies she had scheduled a taxi to take her to a facility, but it was late and she was forced to deliver at home with an inexperienced local midwife. We expect transportation problems to get worse as we move away from the urban town center.
We experienced our own delays with local transportation taking a dala dala across the island this weekend. After numerous stops to load up on food, sticks, and other supplies, what should have been an hour trip ended up being closer to two and a half.
