Tackling the problem of unnecessary maternal deaths from postpartum haemorrhage (PPH) due to lack of appropriate and easily accessible healthcare in remote situations is both momentous and of great urgency. This is a narrative drawing from a personal (family) experience and, subsequently, from coordinating and conducting an introductory trial of a Bakri Balloon tamponade in referral hospitals in Western Kenya. As mother fate would have it, in March 2013, I joined a relatively small and young private university in the port city of Kisumu in Western Kenya as an Associate Professor of Clinical Biology whereupon two events occurred in the 'wrong' order - the first was my kid brother losing his newly wedded wife during childbirth (you guessed it - from PPH!!); the second being my being appointed soon afterwards as the Dean, Faculty of Health Sciences. The latter entailed running/coordinating faculty-based project and included reviving a moribund project, the Bakri Balloon Project involving three major referral hospitals within the region, the largest of which was where my sister-in-law died while giving birth - thank God the baby survived and is alive and well (just turned three on the 1st of June 2016!).
The scant information I got was that she simply bled out as the nursing team had been left without direction by the doctor responsible. The import of this is that the said nurses could have probably been able to save her life through the use of the Bakri Balloon tamponade since its insertion could've been done by the nursing team even without the specialist, of course after the relevant training. The institution's authorities promised a thorough investigation into the case but we are yet to hear what was unearthed from the investigations
The importance of the prevention of maternal deaths from PPH cannot be overstated, what with the well known but alarming statistics ascribed to it as the highest cause of maternal mortality worldwide with a prevalence rate estimated at 6%, but with Africa reported to have the
highest at about 10.5%. In Africa and Asia, where most
maternal deaths occur, PPH accounts for more than 30% (can be as high as 60% in resource poor settings)of all maternal deaths.
The Bakri Balloon used in the trial, funded by an American university, is one of the several sterile packaged tamponade devices being made available for the preventative measures being undertaken in various places. For our project, we hypothesized that the Bakri Postpartum Balloon can be successfully employed to treat postpartum hemorrhage refractory to the usual
conservative and medical interventions and will also help avoid operative and expensive
interventions including hysterectomies. This is more so because it utilizes minimal additional equipment for placement during postpartum haemorrhage and would be optimal for use in low resource settings. That brings in that very pertinent question of affordability in some of the poorest settings in Africa and Asia. The project recommends further involvement by both the governments and the donor society for sustainability and setting up respectively. But first, the need for further trials in such settings is needed to create awareness further afield as was evidenced by the pleas from one of the facilities which had the highest uptake for further engagement (mentioned in the project report).
By Prof. Gonzo K. D. Manyasi.
