Truci Benu woke up in the middle of a stormy night in January to her pregnant 22 year-old daughter stumbling into her bedroom.
“Yanse was horribly pale and started to vomit,” Truci said. “She didn’t respond to me and her body was constantly shaking. It was 3am in the morning, pouring rain, and no transportation was available – we were terrified.”
Yanse remembers getting headaches two days prior that felt like “a knife stabbing her forehead.” At first the headaches came and went, but that night the headache was unbearable and she went into her mother’s room. It was the 12th of January 2013: her baby was due on the 25th.
|Yanse Silla (left) and her mother inside their house. Yanse is holding her baby boy that was delivered by the PONEK Team at RSUD Soe.|
“My mother tried to comfort me – I remember seeing her crying and praying,” Yanse explained. “That’s all I remember until I woke up in the hospital on January 19th with a new baby boy.”
Unbeknownst to Yanse or her mother, Yanse was suffering from severe eclampsia; a life-threatening complication of pregnancy characterized by seizures and usually preceded by pre-eclampsia, which may involve nausea, vomiting, headaches and vision problems. Along with hemorrhaging, eclampsia is one of the main causes of maternal deaths in Nusa Tenggara Timor (NTT), Indonesia, a province with one of the highest rates of maternal and neonatal mortality in Southeast Asia.
According the midwife in Yanse’s village, she only went for one antenatal visit during her pregnancy and showed no indication of any complications; however, pre-clampsia cannot always be predicted.
Fortunately, Yanse was referred quickly enough from her village in Timor Tengah Selatan (TTS) to the local health clinic to the District Hospital (RSUD) in Soe, where her eclampsia was managed – and her life saved - by the team of doctors, midwives and nurses there.
This team had been trained to handle emergencies and complications (PONEK) like Yanse’s through support from The Australia Indonesia Partnership for Maternal and Neonatal Health’s (AIPMNH) Sister Hospital Program.
Through this program, AIPMNH supports 11 district hospitals to contract teams of specialists from renowned hospitals in Indonesia to manage emergencies and develop the technical capacity of local hospital staff in NTT. The teams provide training in areas such as advanced life-saving skills, anesthetics, blood transfusion and infection control. By developing and training on standard operational procedures (SOPs), the Program aims to achieve higher clinical standards and strengthened medication and medical equipment systems.
|Midwife Tamu Ina Tangkoda (Ina) takes care of a newborn at Soe District Hospital|
Mery Dambuk, one of the midwives on duty at the Hospital described how she handled Yanse’s case.
“I followed the SOPs to prepare the patient before surgery,” she explained. “I gave her the anti-seizure injection and checked for the baby’s heartbeat while the doctor was preparing the operation room.”
Thirty minutes later, the doctor performed a caesarean section on Yanse. Although she was in a coma for five days after the surgery, she and her baby survived.
Dr. Adriyani (Ani) W. Ottu, the General Practitioner managing deliveries at RSUD Soe, says “the program has definitely saved mothers and babies.”
“Before the Sister Hospital Program came, Soe District Hospital was only a transit point,” she explained. “Patients from the puskesmas were brought here just to be transferred by ambulance to Kupang [the capital of NTT and a three hour drive away].”
“We are proud now because we don’t have to refer patients to Kupang anymore - we can handle complications here, which means more lives are saved,” she said. “Treating women here also puts less financial strain on them and their families – imagine how much it costs a poor family to travel and stay in Kupang?”
“We are much better equipped in terms of skills and equipment since working with the specialists from the Dr. Sutomo Hospital in Surabaya,” said Tamu Ina Tangkoda (Ina), the Midwife in charge of the PONEK Unit at RSUD Soe.
“Before Sister Hospital, we didn’t know how to handle complications - we would just take in the patients and wait for instruction from the doctors,” she said. “Now, we are confident to perform the emergency care while waiting for further treatment from the specialists.”
Mery, Ina and Ani are three of hundreds of health staff trained by AIPMNH in normal delivery care, comprehensive emergency obstetric neonatal care and emergency first aid, care for low birth weight babies, family planning and infection control. The increase in their skills and confidence is making a notable difference.
Before the Sister Hospital Program began in 2010, RSUD Soe was handling around 200 deliveries during a six-month period. This number has steadily increased as the PONEK Team’s skills have improved. From July – December 2012, the Team handled more than twice that number at 537 deliveries. Furthermore, the hospital was previously incapable of performing caesarean sections, whereas 182 of those 537 deliveries in the second half of 2012 were by caesarean section. Without access to this surgery, these women or their babies may have died.
|Dr. Ani W. Ottu (striped-shirt) with midwives at Soe District Hospital. Ani is a general practitioner who has been trained in the Sister Hospital Program and is able to perform C-section, and other live saving skill in obstetric and neonatal emergencies.|
These numbers also reflect a strengthened referral system, which AIPMNH supports through its Clinical Services Program, which trains staff at health clinics, or puskesmas, on antenatal care (ANC), basic delivery care, postnatal care, family planning, counseling skills and managing emergencies.
This work in turn complements AIPMNH’s Community Engagement Program, which strengthens non-clinical service delivery (including standard operating procedures, ethics, transparency and team-building) at puskesmas and builds Alert Villages, or Desa Siaga.
The Desa Siaga Program supports communities to build finance, family planning, transportation and blood donor networks that ensure women give birth safely at health facilities versus at home with an unskilled birth attendant – one of the main factors contributing to high mortality rates of mothers and newborns in NTT.
Midwife Maria Adelheid (Adel), Head of the Family Planning Unit at Puskesmas Panite where Yanse showed up in a public bus her parents managed to get at 6am, has been handling births in this area for more than 20 years. She says that the referral system here is working “very well” with midwives and an ambulance on call “24/7.”
According to Adel, who accompanied Yanse in the ambulance, “The PONEK team at the Hospital was brilliant.”
“While listening to my explanation, their hands were busy helping Yanse,” she said.
“I felt a sense of relief when they took her to the operating room – I knew my prayers for her would be answered.”