Saving Our Mothers and Our Futures
This essay was selected as Gold Scholar essay in the NEJM 200th Anniversary essay competition. It was published on April 16th 2012, at now closed website: https://nejm200.nejm.org/essay/saving-our-mothers-and-our-futures/. The archived version of the website is available at: https://web.archive.org/web/20120623205507/http://nejm200.nejm.org:80/essay/saving-our-mothers-and-our-futures/
According to WHO, globally 7.2 million under-5 children die every year, of which around 40% (2.9 million) die during the first month and 273,500 women die of obstetric causes. Most of these deaths in developing world occur from delivery-related complications and happen at far-off places, with no access to road and the nearest health facility at a distance of few days walk. But an interesting phenomenon is occurring in many of these remote parts of many developing countries. Mobile services reach them even before roads and other infrastructural facilities do. For instance, in my country Nepal, in 2008 CDMA mobile service was available in all of the 75 districts (1) but 12 of them were yet to get connected by road.(2)
There are no roads to reach the dying mothers in these remote communities, but there is mobile-internet to reach them.
In these remote places, the delivery is assisted by traditional birth attendants or like in Nepal by trained or partially-trained Female Community Health Volunteer (FCHV). These traditional attendants and volunteers have seldom received support from the government, but with easy availability of mobile-internet, they could get the much needed assistance. Suppose each of these birth attendants is provided with an internet and multimedia capable mobile phone with free data calls facility. A website with chat and video conference service, for doctors to remotely advice or guide them, is launched. Images and videos of pregnancy and delivery-related problems and their solutions are also added. These birth attendants are then trained to use this service. In this way the help from the doctors will be just a push of button away!
Let us take an example, suppose a FCHV is assisting a delivery. The baby’s head is delivered but the shoulders get stuck. The head is pushed out during contraction and retracts with relaxation. The SBA waits for a few minutes and seeing no progress, logs on to the video-conference service and gets connected to a doctor. When she points her camera towards the mother, the doctor knows that it’s a case of shoulder dystocia (remember the ‘Turtle sign’). So, she advises the FCHV to perform McRoberts maneuver with suprapubic pressure and voila! the baby is delivered. The baby cries but is blue. Suspecting intra-partum asphyxia, the doctor advises her to keep the baby warm, breastfeed it and take it to a health center as soon as possible.
Aforementioned situation may be too ideal. Nevertheless it’s not too difficult to achieve. Except for the cost of buying the mobile phones and training the birth attendants, the initial setup cost of this system is not too high. The infrastructures are all in place, we just need to use them innovatively.
There could be many other applications of mobile-internet based health service delivery. It could be used to inform and instruct the community health workers on recent advances, or to provide specialist service in remote villages, and so on. But before moving on to such experiments, we could start with a simple task of assisting the deliveries with the cyber-doctors. The virtual presence of doctors can never substitute their physical presence. But until we can send real doctors to every remote village, cyber-doctors could go a long way in helping save our mothers and our newborn futures.
References
1. Nepal doorsanchar company limited- Nepal telecom [Internet]. Nepal: Nepal telecom; c2010. CDMA wireless telephone service: CDMA network coverage; [cited 2011 Dec 24]. Available from: http://www.ntc.net.np/CDMA/cdmaCoverage.php
2. District headquarters not connected with road [Internet]. Kathmandu: Department of road; c2009; [cited 2011 Dec 24]. 1 p. Available from: http://www.dor.gov.np/road_statistic_2008/Report%20Pages/tables/6.pdf
