When clinical mentorship saved a premature and mother
Two near death cases -with established lifesaving intervention procedures- in East Central Uganda (Busoga) last week have once again cast the light on the need for continuous clinical mentorship to improve health service delivery.
Frontline health workers are often faced with challenges of managing some cases yet they do not have senior colleagues that they can easily turn to for help. Such scenarios are common as witnessed by this writer during a clinical mentorship session organised under the Preterm Birth Initiative (PTBi) study currently being implemented in six hospitals in the Busoga sub region.
In one case, a premature baby presented with nasal flaring, severe chest indrawing, and was grunting. He was battling respiratory distress. To manage this case, health workers inserted a pair of small prongs to deliver extra oxygen through the nostrils.
However, on examining the baby, a visiting clinical mentor noted that the distressed baby needed more than nasal prong oxygen. This option is used when the baby needs a little extra oxygen to maintain sufficiently high oxygen levels in their bloodstream. Yet in this case the baby needed pressure to keep the lungs open.
“When you have a baby like that, they need continuous positive airway pressure [CPAP],” Dr Victoria Nakibuuka (Second Right in image), a neonatologist, told the medical staff on duty during the clinical mentorship. “With this severe chest indrawing, nasal flaring and grunting, it means that their lungs are about to collapse. The baby can even die. So we need to identify these babies, ensure that they are fed, kept warm and provide CPAP for them.”
The second case involved a postnatal mother in coma exhibiting physical symptoms of neurological problems. This was over 24 hours after delivery and the mother was being treated as post-delivery eclampsia case, without much success. In this case a visiting mentor requested for a blood sugar test. Results indicated that the sugar levels were three times way above the normal. It was this advice by the PTBi visiting mentor that helped figure out what was almost killing this mother.
According to the PTBi Uganda Study Manager Dr Gertrude Namazzi, incidences such as these call for health workers to draw lessons from and embrace tools such as the World Health Organisation’s Safe Childbirth Checklist.
“Human beings make mistakes and can forget. Tools such as the safe childbirth checklist should not be looked at by health workers as burdensome. The different pause points in the tool can help a health worker to establish whether they have not missed a step,” Dr Namazzi counselled.
The WHO avers that the Safe Childbirth Checklist helps health-care workers ensure that essential birth practices are performed at critical moments during childbirth for every delivery, every time. The PTBi study is piloting a modified version of the WHO Safe Childbirth Checklist as part of the intervention package.
Dr Lawrence Kazibwe (Right), a senior Obstetrician Gynaecologist with Mulago National Referral Hospital mentors junior doctors at Jinja Regional Referral Hospital.