Leadership in public health care system needs to be dynamic and while emphasis has been placed on creating policies, the greater challenge is to enforce those policies, says Medical Chief of Staff at the Mount Hope Women’s Hospital (MHWH), Dr Karen Sohan.
Sohan said experts at international bodies such as Pan American Health Organisation (PAHO)/World Health Organisation (WHO) and the Royal College of Obstetricians and Gynaecologists have produced well researched policies that can be adapted to T&T.
“Our efforts and energies need to be focused on the implementation of policies. It is extremely encouraging that the majority of the staff of MHWH have been working diligently to enforce policies that ensure quality maternal health care,” Sohan said.
Recently, the MHWH was recognised by PAHO for its innovation in addressing systematic issues related to maternal and child health care. PAHO’s Director Dr Carissa Etienne, during an official visit to T&T, visited the Barataria Health Centre of the North West Regional Health Authority and the MHWH.
During her visit at the health centre, she was told of all the services provided to the community and the strides being made in providing quality health care. At the MHWH she heard of its progress in primary health care and maternal health, among other contributions to the health and well-being of the people of T&T.
Etienne congratulated Sohan and her team and challenged them to replicate their strategy nationally and further afield.
“PAHO/WHO will continue its technical support to the Government of T&T and its agents, and all stakeholders whose interests align to serve and provide the best quality health care to the people of T&T,” Etienne said.
Speaking with the T&T Guardian yesterday, Sohan expressed delight at Etienne’s comments.
“I am particularly pleased that the director has recognised that improvements in maternal and child health require innovation,” she said, adding that three projects at the MHWH were highlighted during Etienne’s visit— collaboration of primary and tertiary health services to ensure equity of antenatal services to pregnant women, Fetal Medicine Services since October 2014 and obstetric emergency drills.
Sohan said about 70 per cent of antenatal care occurs at health centres but specialists in Obstetrics and Gynaecology are based in the tertiary hospitals.
“Therefore, we are missing the opportunity to provide expert antenatal care to the majority of pregnant women and monitor the well-being of the fetus. Any intervention in obstetrics that is going to reach the ones that need it the most must be aimed at the primary health level, so this project serves to bridge this gap.”
With respect to Fetal Medicine that deals with the assessment of the baby’s health before delivery and includes assessment of some of the most high risk pregnancies, Sohan said the MHWH is the only public institution offering these services.
“It is part of the national policy that all pregnant patients with Zika will be offered fetal medicine evaluations at MHWH,” she said.
Sohan said a six-member team from MHWH attended the PAHO sponsored work-shop on post-partum haemorrhage in April and a few weeks later they re-enacted the drills at MHWH to the benefit of the entire hospital. Post-partum haemorrhage is one of the potentially preventable causes of maternal morbidity and mortality.
According to Sohan, this is one of several measures being implemented to ensure the institution is working diligently to prepare for an anticipated increase in deliveries linSeptember, October and November. Sohan disclosed that for t March and November 2015, there were 316 and 410 deliveries respectively at the MHWH.
“Though this had been suspected previously, it was not until the data was computerised that the trend could be confirmed. This information was shared with the minister last year,” Sohan said.
“The challenge for the providers of maternal health care like myself, hospital managers, boards of the RHA’s and the Ministry of Health led by the Minister, is to prepare for the anticipated increase in numbers and therefore potential complications,” she said.
Work has already begun at the MHWH in organising resources to cope with the additional demands on the health care system, including a plan to increase the bed capacity.
Sohan admitted that there is a space issue at the MHWH as the current hospital is the exact structure that was built in the late 70’s.
“This would mean that whereas an area was designed to accommodate four beds, during these months we would increase to six to eight,” she said.
Further, the human resources would have to be re-organised to ensure quality care is maintained despite the increased work-load, involving a greater number of midwives and nurses being rostered per shift, as well as minimising time-off for doctors during this period so that teams have their full complement of staff.
Sohan said patient turn-over will need to be addressed, as last year, during this period, the waiting time for beds had increased.
“One simple measure that was identified that could assist in alleviating this problem was twice daily ward rounds by senior staff so that patients could be discharged both mornings and afternoon, instead of the customary once a day round,” Sohan said.