CMAJ • November 4, 2008; 179 (10). doi:10.1503/cmaj.081414.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Tabah, L.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tabah, L.
Related Collections
Right arrow Working in other countries (including aid work)
Right arrow Maternal-fetal medicine

News

Dispatch from the medical front

Hard work, harder numbers

Lindsay Tabah

Hamilton, Ont.

Birth is hard work, no matter what part of the planet you call home.

But I learnt that women giving birth in rural South Africa suffer more than others because of one simple fact: numbers (read $).

That's right: debt.

The maternity ward at the Church of Scotland Hospital in Tugela Ferry, where I recently worked, was 30 million rand ($5 million) overbudget in 2007.

That is hard to believe given that we regularly ran out of linens, hand soap, sterile gloves, paper towels, fetal heart monitor ink, paper and belts, chlorihexidine, gauze, amnihooks, KY jelly and proper-sized suture material.

There were definitely no women demanding their epidurals at this hospital (and no midwives pushing them).

You were lucky if you had a cotton sheet to lie on. And I never heard one complaint about the 32 degree Celsius heat in the labour ward (there were no fans or air conditioning).

Certainly the Health Department of Kwa-Zulu Natal has a lot on its plate: take for instance, the province's fight against multi-and extreme-drug-resistant tuberculosis that goes hand in hand with the province's HIV epidemic. In 2004, 40.7% of antenatal clinic attendees in the province of Kwa-Zulu Natal were HIV positive — the highest rate in all of South Africa.


Figure 15
View larger version (120K):
[in this window]
[in a new window]

  		Two-year-old Sifiso is one of the 200 babies who are born HIV-positive every day in South Africa. Image by: Reuters / Juda Ngwenya

 
Happily, thanks to the Prevention of Mother to Child Transmission Program, close to 100% of the women who delivered at the Church of Scotland Hospital knew their status, and almost all of those who were positive had self-administered nevirapine at the onset of labour, and their babies were given a dose within the first 72 hours of life.

Still, major challenges continue to plague the South African Prevention of Mother to Child Transmission Program. For example, although aiming to provide a 6-month supply of formula to HIV-positive mothers, district hospitals are often out of stock, leading to mixed feeding.

Lack of follow-up of mothers and their HIV-exposed infants results in some babies not receiving nevirapine after birth, and women not receiving the antiretroviral treatment they so desperately need.

Certainly for a woman like Zanele, an HIV-positive 30-year-old mother of 3, who has a young family to raise, a properly funded program would go a long way to ensuring that her children have a mother and an HIV-free childhood.


*    Footnotes
 
CMAJ invites contributions to "Dispatches from the medical front," in which physicians and other health care providers offer eyewitness glimpses of medical frontiers, whether defined by location or intervention. Submissions, which must run a maximum 400 words, should be forwarded to: wayne.kondro{at}cma.ca






This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Tabah, L.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tabah, L.
Related Collections
Right arrow Working in other countries (including aid work)
Right arrow Maternal-fetal medicine