Ivory Coast: A Maternity Unit for Emergency Care

Jean-Christophe Nougaret/MSF

In Ivory Coast, years of instability have severely weakened health services and led to a lack of both facilities and trained staff. The dearth of options available to expectant mothers and their babies has resulted in particularly high levels of maternal mortality. In July 2014, Doctors Without Borders/Médecins Sans Frontières (MSF)—already working in maternity units in Duékoué and Abobo—opened a program to care for pregnant women and newborns at Katiola Regional Hospital Center (RHC), north of Bouaké. The program is run in partnership with Ivory Coast's Ministry of Health and the Fight against AIDS.

Madeleine and the medical team caring for her at Katiola hospital have spent a long and anxious night, but she can relax now. Madeleine was designated a "code red" emergency surgery case because of suspected umbilical cord prolapse, which could have resulted in her baby being asphyxiated. But, in fact, the cord was wrapped around the baby’s neck. Luckily, the French and Ivorian MSF surgical team were able to perform a Caesarean section in the brand new operating room that had been re-opened just a few days earlier, at the end of April 2015.

“This region has a really high infant mortality rate," explains Dr. Olivier Dro, deputy manager of MSF programs in Ivory Coast. "Over 600 women in 100,000 births die, compared to less than 10 in France. These numbers testify to the lack of obstetric and preventive care and treatment of complications that can occur during pregnancy, delivery, and postpartum. While close to six deliveries in ten are assisted by qualified health staff, due to the shortage of medical facilities and an uneven distribution of health care personnel, medical assistance is still not only insufficient but also unevenly spread over the country.”

Exemplary Cooperation

Nurse and medical coordinator Cécile Brucker spells out the priorities: “To enable women in the region to give birth in complete safety—mothers and babies alike—we deliver emergency gynecological, obstetric, and neonatal care. A major renovation program that included constructing buildings and equipping specialist departments was implemented along with support and training for the hospital’s staff.”

Obstetric and neonatal emergencies can now be treated in the neonatal unit, which will open in July 2015. Previously, patients able to afford transport and drugs were referred to the University Hospital in Bouaké.

“We took the time to work with our associates from the Ministry of Health and the Katiola RHC to build a common project that truly addresses mother and child health, which is a public health emergency in the region,” adds Brucker.

Jean-Yves Bailly, the hospital’s administrator, welcomed this cooperation. “We liked MSF’s approach because it was innovative," he says. "We participated fully in the decision-making process and our procedures were taken into account. This project has come at just the right time, as Katiola recently became [the] referral hospital for the Hambol region. It has given us the opportunity to improve still further the quality of our technical platform, from construction and equipment through to staff training."

A Large-Scale Program of Renovation and Training

The program included completely renovating and re-equipping the operating rooms and sterilization unit. The medical test laboratory and blood bank, facilities essential to responding to surgical emergencies and hemorrhages, have also been refurbished. "The rest of the work—upgrading the electrical installation, setting up a system for recycling and hospital-waste treatment, drilling, storage, waste-water treatment, and supply—will be finished this summer," adds Beatrice Wibaux, construction project coordinator. "The final phase of the construction work and refurbishment involves fitting out the laundry, biomedical logistics/maintenance department, kitchen and visitors’ washing area, and renovating the maternity department which will have a neonatal kangaroo care unit and a 20-bed hospital for postpartum mothers."

Years of crisis have also resulted in an uneven distribution of health workers and an aging technical platform. As such, providing much-needed training to health staff is an important element of MSF's work.

"In Katiola, staff already have basic training and often some experience working as care assistants, nurses, or midwives," says Muriel Durand, the nurse in charge of training. "My role is to refresh certain routine practices, like hygiene, and address essential issues such as early identification of at-risk babies. When there are complications, every minute counts.”

Next Step: Providing Support to Peripheral Health Centers

The last step after upgrading the technical platform at Katiola hospital was the launch in May of a support program for a network of peripheral health centers. The aim of this program is to decentralize access to quality medical care for mothers and infants. “Centers will receive support with renovating infrastructure, medical equipment and staff training," says midwife Cécile Chesneau, who is in charge of the project. "This support is both strategic and complementary to enhancing capacities at the Katiola HRC so as to decentralize access to health care and reduce maternal and infant mortality. Around half of babies continue to be born at home in this region of Ivory Coast, and, when there are complications, the distance to health facilities poses a real problem for the health of both mother and baby.”

In one of the maternity wards, Sidonie is recovering from childbirth. At 16 years old only, this is her first baby and she listens to Dr. Pierre-François Dupré, surgeon, gynecologist and obstetrician. He explains the tests that will be carried out on his little girl. She has a hip dislocation at birth. MSF will support the reference to the University Hospital of Bouaké located about two hours away. Dans une des salles de la maternité, Sidonie se remet de son accouchement. A 16 ans à peine, c’est son premier bébé et elle écoute le Dr Pierre-François Dupré, chirurgien, gynéco-obstétrique, lui expliquer les examens qui devront être pratiqués sur sa petite fille. Elle souffre d’une luxation des hanches à la naissance. MSF prendra en charge la référence au CHU de Bouaké situé à près de deux heures de route.
Jean-Christophe Nougaret/MSF