Kagera, Kagondo – During the last month of her pregnancy, Zainab Abas visited Kagondo Hospital and learned from an ultrasound that she was having twins. One was head down, but the other was in the breech position, bottom down.
Initially shocked, she was counseled about delivery by cesarean section, often necessary for breech babies, and gave her consent for the surgery. On the day of the operation, Dr. Ladislaus Buberwa, an assistant medical officer, worked with a surgical team to deliver Zainab’s strong and healthy twins. They also removed the placenta and administered medication to contract the uterus and stop it from bleeding.
However, Zainab continued to bleed. With no gynecologist was around, Buberwa alerted the surgical team that their 27-year-old patient had developed postpartum hemorrhage (PPH), a leading cause of maternal death in Tanzania.
The safe surgery project has empowered health care providers in Mara and Kagera regions to improve surgical outcomes through leadership training and skill building, followed by mentorship and supportive supervision.
In the past, when a patient developed PPH that could not be managed by medical intervention, to save their life, Buberwa and other skilled birth attendants in Tanzania resorted to removing the patient’s uterus. But now they had a better option.
Based on knowledge and skills acquired during a safe surgery clinical training and mentorship project led by Jhpiego, Buberwa decided to use a technique known as the B-Lynch suture. The procedure works to stop severe uterine bleeding after delivery, thus eliminating the need for surgical removal of the uterus and allowing women to have future children.
With support from the GE Foundation and Elma Philanthropies, the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children along with the President’s Office–Regional Administration and Local Government joined with Jhpiego and partners to implement the innovative safe surgery project in Kagera and Mara regions.
“Our project uses a unified and cohesive approach to impart leadership and clinical skills to the surgical teams and capacitate them through regular onsite mentorship, coaching and supervision,” said Dr. Augustino Hellar, the project director in Tanzania. “By doing so, we have contributed to the government’s mission of reducing maternal and newborn mortality and improving access to essential surgical, obstetric and anesthesia services in the country.”
Since it’s start in February 2018, the safe surgery project has trained 403 health workers and 111 clinical mentors.
“Before safe surgery training, once PPH management by using medication was unsuccessful, we had no other options than removing uterus,” said Buberwa. “But today, through this project, we have learned innovative, simple and quick techniques to control PPH [without disabling] a woman from child bearing.”
Following the B-Lynch procedure, Zainab received medications and a unit of blood and began to recover. After being closely observed for four days, and in good condition, she was discharged to go home—healthy and happy to care for her thriving twins.
Zacharia Mlacha is a Communications and Publications Officer in Jhpiego’s Tanzania office. Communications manager Maryalice Yakutchik also contributed to this story.
