MONTREAL and BAMAKO, MALI — In the hope of reducing maternal mortality in a region where 1 woman in 31 loses her life as she carries or gives birth to her baby*, a workshop has been organized in Mali today by the Global Health Initiative of the University of Montreal Superhospital Research Centre (CRCHUM) and the Government of Mali’s Ministry of Health.
Since 2006, researchers affiliated with the CRCHUM, the University of Montreal and the University of Bamako have led a research programme that comprehensively and intensively analyses the various why so many of these deaths are happening in the Kayes region of Mali. The results of this study should enable the implementation of practical solutions.
Time is the greatest enemy of these women, the research team discovered. Armed with accounts provided by 240 women who had survived an obstetrical emergency and a further 240 accounts provided by the families of women who had not, the team was able to identify three types of delays in the delivery of critical treatment thanks to the leadership of Dr. Mamadou Traoré, Dr. Alexandre Dumont and Dr. Pierre Fournier, a scientist affiliated with the International Health Unit. The 480 dramatic and overwhelming stories enabled the researchers to reconstruct their obstacle-strewn ordeals.
The study revealed that women hesitate to consult a doctor when the people who surround them – family or traditional midwife – do not recognize the signs of an obstetrical emergency. “It’s difficult to overestimate the importance of the enemy of time when emergency care is required. Although they could have easily been cured, many women hesitate and die as a result,” said Dr. Fournier. This is what the researchers classify as the “first delay.”
The study of this first delay revealed that the likelihood that a woman will survive is largely determined by the second and third delay: the time it takes to get to a health centre and the quality of the care that she will receive once she arrives. “Once the decision to go has been taken, these women and their families must still find transport and money for the treatment costs, which further delays their departure,” explained Dr. Dumont. “Some will travel in a cart, spending hours on tracks travelling through the bush, in difficult conditions and with a consequently considerable travel time.”
The third delay occurs once the women arrive at the health centre, where the patients may encounter poorly trained staff who are unable to redirect them to adequate treatment. When the time comes to perform a cesarean or a transfusion, blood may not be available, the surgery team may be incomplete, or the treatment itself may be inappropriate.
Dr. Coulibaly, coordinating research doctor in Mali, affiliated with the CRCHUM and the Regional Health Department for Kayes, met all of the families involved in the study. “I remember one husband who did not hesitate to undertake a lifelong debt in order to ensure that his wife could consult a city clinic… in vain. Instead of immediately undertaking and emergency cesarean, they waited and undertook multiple expensive examinations. His wife literally bled to death while he tried to get together the amount needed for her transfusion.”
More than one hundred doctors, midwifes and department heads of the Government of Mali’s social and health services will participate in today’s workshop. According to Professor Mamadou Traore, team researcher, the programme results have given some precise direction as to the actions that should be taken to improve both clinical practices and the national programmes for reducing maternal and infant mortality.
*World Health Organization,. UNICEF, UNFPA, World Bank (2010). Trends in Maternal Mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: World Health Organization