Low-Technology First-Aid Device Saving Mothers’ Lives in Rural Migori County: Non-Pneumatic Anti-Shock Garment (NASG)

Mothers attending under-five clinic at Lwala community hospital

According to the World Health Organization (WHO), approximately 358,000 women die every year from pregnancy complications and childbirth; most of these deaths occur in low-income countries. Factors such as previous Postpartum Hemorrhage (PPH), multiple gestation, and age predisposes women to hemorrhage. However, about two-thirds happen to women with no previously known risk factors to PPH.

The total fertility rate in Migori is approximately 5.3, which means women expect up to 5 children in their lifetime. This high fertility rate exposes mothers in Migori County to pregnancy complications.

Kennedy Obiya from Gem Genga Migori County narrates to us the ordeal his wife Dorothy went through as a result of pregnancy complication. “I am an early bird so by about 7:00 am I had set off to go till our farm. It was not long after that I received an emergency call to inform me my wife was sick and needed quick medical attention; this prompted me to rush home as fast as I could. On arrival, I found her writhing on the floor with pain. It took us roughly 30 minutes to get a means of transport — and another 30 minutes to get to the hospital. By this time, my wife was unconscious, and every passing minute felt like the last moments I was spending with her.”

“At Lwala hospital, we were received by a responsive team of nurses who began to examine her immediately. Despite the interventions by nurses at Lwala, her condition deteriorated, and she had to be referred to a higher facility. Amidst all the chaos and confusion in my head, I was most surprised to hear we were expecting a fourth child. And that my wife had complications resulting from her fourth pregnancy. Although we lost our child, I am glad my wife is alive because looking back at her condition. I thought I had lost her,” Kennedy sighed as he concluded.

Tom attending to a client at Lwala Community hospital

Research indicates that up to a third of births take place without skilled birth attendants in developing countries. Where there is skilled attendance, nurses and nurse-midwives are at the forefront in provision of delivery services in rural clinics, urban and tertiary referral hospitals. It, therefore, goes without saying that these healthcare workers are at the epicenter of PPH management. Postpartum hemorrhage can lead to shock or death within 2 hours if not controlled or treated. As a result, timely identification and management of PPH are what stands in between a mother and her last breath.

“As the most immediate medical facility tending to the needs of the rural community in North Kamagambo. We often receive cases of women experiencing hemorrhage or shock due to a pregnancy complication. The NASG plays a critical role in the management of such cases by moving blood to vital organs, thus reducing blood loss and reversing shock,” said Tom Magolo, a clinical officer at Lwala hospital. “The most recent case we handled was of Dorothy, who had a ruptured uterus from an ectopic pregnancy (pregnancy was growing outside the womb). Externally, there was no obvious bleeding, but other signs such as paleness, swollen tummy, and shock were indicative of blood loss. It is often easy to lose a mother when bleeding is concealed like in this instance.”

“When applying NASG, we follow the shock/hemorrhage protocols for the reason that NASG does not replace standard care. In the case of Dorothy, she was put on drips and oxygen. The NASG was then applied, and she momentarily regained consciousness to chat with her family (This was while other examinations continued). Through urine analysis, we determined she was pregnant confirming my suspicion though the family had denied,” he added.

Lwala community hospital ambulance

Health facilities at the tertiary level have options when it comes to treating a woman suffering from uterine atony and shock. As facilities dealing with Comprehensive Emergency Obstetric Care (CEmOc), in most cases they offer; bimanual compression; parenteral uterotonics; intravenous (IV) fluids; blood transfusions; and surgery including compression sutures, ligation of arteries, and hysterectomy. On the other hand, nurses and nurse-midwives working at the primary or community health facilities rely on referrals because they cannot stabilize and treat women experiencing obstetric hemorrhage. Rural health facilities experience challenges in transferring patients to higher-level facilities. In most cases, you find health facilities do not have blood, and it takes time to do referrals. The NAS garment buys time for transport until definitive care can be provided.

“Although we do blood transfusion at Lwala hospital. As fate would have it on this fateful day, there was no blood due to erratic supply. Frantic calls to the neighboring hospitals bore no fruit since they did not have blood group matching that of our patient. Our last resort was Homa Bay county referral hospital, which is 60 Km away,” Tom said. “At Homa Bay county referral hospital, it was their first interaction with NAS garment. The nurse at the gynecological section removed the garment to prepare Dorothy for surgical operation. Immediately she went into shock, but luckily I came back on time to reapply the garment. Within 5 minutes of application, she was conscious, and the nursing students gathered around puzzled and marveling at the magical garment.”

“There is a procedure of removing the garment which if not followed can send the patient back to shock or even cause other fatalities,” he continued. “The garment has six segments, and each should be removed 15 minutes apart, taking care of vital signs. The pulse must drop below 100, blood pressure to rise to 20 while checking whether the patient is gaining consciousness. It takes approximately 2 hours to remove the six segments of the garment. The NASG can be in place for vaginal procedures; for abdominal surgery, only the abdominal and pelvic panels stay open. The gynecologist at Homa Bay successfully operated on Dorothy with the garment on, and I am glad she is alive. The NASG garment saves lives, I have witnessed this not once, not twice but several times,” Tom concluded.

In 2012, the World Health Organization (WHO) recommended the NASG can be deployed as a temporizing measure for women with PPH until definitive care, blood transfusions, and surgery can be obtained.

“Although I cannot remember much apart from the sharp pain in my stomach before being unconscious. When I recollect the tale of my woe as chronicled by my husband, I feel the luckiest among mothers to have come back to my children,” Dorothy the ectopic pregnancy patient said. “Whenever I see sick people on oxygen mask I know they are going to die. And so when I was on oxygen, I knew my fate was sealed. “But I thank God for the quick response from Lwala and the green garment. This garment should be made available in all hospitals to help save the lives of other women,” she smiled as she concluded.

By Ombaka Oduor, Health Policy Fellow

Email: bombaka@lwalacommunityalliance.org

Lwala Community Alliance

Ombaka is an Epidemiologist specialized in Health Research and Policy development.