Mission. According to the Collins English Dictionary, mission means a strong commitment and sense of duty to do or achieve something, often in a foreign country.
This past September, Broken Earth sent a team of OB/GYN physicians, residents and nurses on a mission to Bangladesh to provide education and training to local health-care providers on high-risk labour and delivery.
Bangladesh is considered one of the poorest countries in the world, with over 24 per cent living under the poverty line, many earning less than $1.90 per day. It’s also one of the most densely populated, with over 160 million people.
“It’s like another world,” says registered nurse Tracey Carter. “When we ventured outside the conference centre, that’s when it really hits you. There are people everywhere, some living on the streets. There’s lanes and lanes of traffic filled with cars, rickshaws and busses and it takes at least two hours to get anywhere. Accessing health-care services is difficult.”
Infant mortality rates in Bangladesh are very high. “Nine out of 10 births happen at home, often with minimally trained practitioners on hand,” says Obstetrics physician, course director and discipline chair, Dr. Atamjit Gill. “As a result, 30 per cent of women who give birth in this country, die of post-partum hemorrhage. Statistics like that are unimaginable to most of us, which is why it’s critical to help where we can.”
This is the team’s second mission to Bangladesh. One of the key educational tools, developed by MUN Med 3D Network, was a 3D printer. It provided cost effective 3D printed molds and models such as uteri, which significantly enhanced the quality of the workshops in that learners could practice their skills on anatomically correct replicas.
“Simulation-based medicine helps bridge the gap between theory and practice and is an important tool for both medical students and health-care providers. It is also critical in skills maintenance,” says Christine Goudie, designer and research assistant with MUN Med 3D. “This is especially true for high acuity, low occurrence medical emergencies, also called HALOs. These are the types of situations that occur rarely, but when they do, the health-care provider needs to know how to address them. In the case of postpartum hemorrhage, there’s is only one chance to do it accurately. Using these models as training tools will hopefully improve outcomes for women in this country.”
Tracey Carter gave a workshop on the medical management of post-partum hemorrhage using the uteri models. “I demonstrated a technique that was actually developed by a Bangladeshi professor, Syeba Akter – and she was present during the session. It was a little intimidating,” she laughs. “But it’s a great example of how we share information and learn from each other.”
And it’s very important that the education provided, is modified based on the current standards of practice available in Bangladesh.
Neonatal Resuscitation Program (NRP) instructor, Susan White, delivered education sessions based on the principles of the Helping Babies Breathe program. Using preemie and infant manikins, she worked closely with attendees to teach them about what’s known as the Golden Minute.
During the Golden Minute, the most important steps to help a baby breathe are performed. By one minute a baby should be breathing or receiving ventilation. The participants were taught the steps to initiate spontaneous breathing in a newborn that is not breathing, as well as how to provide effective ventilation using a bag and mask, if necessary. Keeping the brain oxygenated is key.
“They have little technology, such as cardiac monitors and pulse oximetry, a test we use to measure the oxygen level of the blood,” she says. “The heat source for the baby is often the mother’s body. We focused on the care recommended for all babies born breathing or crying and progressed to the steps recommended for those that need extra help to breathe, based on the resources that are available to them. It’s very hands-on.”
Given the high infant mortality rate, the delivery of bad news is often a reality for health-care providers. They not only need to be able to assist patients and their families, but be equipped to take care of themselves and to support other providers.
“We’re all human,” says Crystal Northcott, program consultant with Children and Women’s Health. “What happens to our patients impacts the care giver as well. I taught providers practical techniques to assist in the delivery and management of bad news such as still birth, miscarriage, poor outcomes or genetic abnormality to the patient, and how to support each other as well.”
While the standard of health care is not that of a developed country like Canada, Bangladeshi’s have a surprisingly positive outlook on life.
“These people are so happy, so kind. They’re very smart and very proud of their work. Hungry for education and so engaged,” says Tracey. “This is my second mission to Bangladesh. People who had attended my workshop last year were so excited this year to show me how they had changed their practice based on what they had learned – what I had taught them. This is one of best things I’ve done in my career.”
Feedback from team members was positive as well.
“I learned how resourceful people are in undeveloped countries and although there is still a lot of work to do, I’m amazed at how much of a difference a small group of people can make,” says Crystal. “Whether it is in our own backyard or on the other side of the world, we need to contribute in any way we can.”
Susan agrees. “If given the opportunity I would like to be a part of this initiative again. The participants engage you in their learning experience and appreciate every minute you are there. It was very rewarding. It also made me realize how privileged we are to have the health care system we have here in Canada.”
So what are the next steps? According to Dr. Gill, this trip laid the groundwork and clarified the goals of the next mission. Through the invaluable assistance and ongoing partnership with the Sajida Foundation, he wants to establish a grass-roots connection with those who provide direct care to women in their communities – the mid-wives. In fact, he’s already reached out to a local midwifery school.
“This mission was an excellent opportunity to introduce residents, our doctors of the future, to the concept of global health and helping less fortunate people in a poor country,” says Dr. Gill. “In fact, I am very thankful to my whole team for delivering this great educational event. If we can save one woman’s life from post-partum hemorrhage, if we can save one family from intimate-partner violence, one woman from the curse of fecal incontinence, it will be worth it.” ■
This story was written by Robyn Lush, a communications specialist with Eastern Health.