Sierra Leone has one of the highest maternal mortality ratios in the world for every 100,000 live births, 1360 women will die. In Norway, that number is just 5 women per 100,000 live births; in the US, it’s 14; according to the United Nations Population Fund. Why are so many women dying in Sierra Leone? The answer is simple: childbirth can be complicated and there are simply not enough health care providers to address the needs of this small West African country of 7 million people.
just 10 specialist surgeons were available in public hospitals; with about 150 doctors in total. But there is hope: a new study of more than 1200 women C-sections in nine Sierra Leone hospitals shows that community health officers with surgical training are a safe alternative to medical doctors when it comes to outcomes for Caesarean sections.
Van Duinen’s research is conducted as part of his work with a non-profit organization called CapaCare; co-founded in 2011 by Håkon Bolkan; a surgeon at St Olavs Hospital and a postdoc at NTNU. CapaCare offers a two-year training programme for selected community health officers (CHO); with the goal of teaching them to do surgeries such as Caesarean sections, appendectomies, and hernia repairs.
After the two years of training, graduates also spend a year as an intern at one of the main hospitals in Freetown; after which they are given the position as a surgical assistant community health officer (SACHO). To date, 31 participants have graduated from the programme; with another 33 in training. But CapaCare’s work is not as simple as just producing qualified graduates Sierra Leone’s medical community; health care officials and the population as a whole have to have confidence that the CapaCare graduates can perform surgeries at least as well as medical doctors.
Researchers in a prospective study decide which data to include before they collect it; which ensures data quality. The Sierra Leone C-section study also included a home visit 30 days after the birth; which allow van Duinen and his colleagues to see how mother and child doing in the period after discharge.
For example, one baby that recorded as a stillbirth in the hospital and one baby that had been recorded as death were both found to alive when the researchers did the home visits. Three of the mothers and 28 of the babies who were alive when they left the hospital also died in the month after birth; which researchers would not have discovered without this extra follow up.
van Duinen met Bolkan with the first CapaCare student who was just beginning his training. The idea of training non-doctor medical personnel to do emergency surgeries task sharing already something he knew about. During his medical training in the Netherlands.