I recently had the opportunity to visit the two new neonatal clinics in Kumasi, Ghana, built as part of the Millennium Cities Initiative’s efforts to create models capable of reducing maternal and infant mortality in the Millennium Cities. MCI partnered with Israeli neonatologists from Ben Gurion University who, with support from Israel’s Ministry of Foreign Affairs, designed and built these “mother-and-baby” units as triage units that can save infants’ lives and decompress the dangerously overcrowded Intensive Care Unit at Kumasi’s federal teaching hospital. Abenaa Akuamoa-Boateng, MCI Project Manager for Ghana, has spearheaded this effort for MCI, arranging training workshops both in Kumasi and in Israel for pediatricians, pediatric nurses and other medical staff; identifying responsible contractors and supervising construction together with Israeli engineers; and securing commitments from the City of Kumasi to support every stage of this effort with necessary infrastructure upgrades.
During my rounds of the facilities, I discovered that one of the units is flourishing, with enlightened professional leadership, SRO occupancy rates, use of state-of-the-art resuscitation and warming equipment. As an integral component of this low-tech approach, both units also offer training in Kangaroo Mother Care, a simple, focused approach to nursing, warming and stimulating neonates, proven effective in saving the lives of premature babies. Already, the ICU at the teaching hospital is 47% less crowded, as doctors there have begun to refer stable patients out to this neonatal unit when they require less intensive care – exactly what we had hoped would happen. Nevertheless, this unit – known as the Suntreso Mother and Baby Unit, as it is attached to the Suntreso sub-metro, or neighborhood hospital – remains severely constrained in what it can accomplish. Despite the new facilities, Suntreso still lacks an operating room, an adequate maternity ward and safe blood storage equipment. Expectant mothers, therefore, must continue to deliver their babies at the tertiary care center, meaning that infants in distress are unlikely to find their way back down from there to the neighborhood clinic.
This finding is, of course, frustrating – to Suntreso’s able medical director, to the Israeli experts, to Abenaa and to me, as we had hoped to be chronicling the intervention’s unambiguous success by now. It reflects, though, some of the innate development challenges we face when working in one of the world’s poorest regions. Each new input – whether in the form of improved seeds and fertilizers in the Millennium Villages, specialized professional training in the Villages or Cities or the neonatal clinics in Kumasi – pushes each project up against the next set of deficits to be overcome. For instance, these may include improved water harvesting, retaining well-trained professionals, and, in the case of Suntreso, something as obvious as an operating room and safe blood. It seems incredible, but sometimes, intent on filling an immediate gaping hole, we are oblivious to the surrounding gaps in supporting infrastructure and services, which also must be resolved in order for the first set of solutions to succeed.
In contrast to Suntreso’s quiet, yet busy hum of activity, the second neonatal unit, at another sub-metro hospital in Kumasi, stands nearly empty, despite having the same equipment, the Kangaroo Mother Care training and a real operating room and maternity ward. The difference? Reportedly, what is missing from this second unit is effective and responsible leadership that can guide and motivate staff and persuade those at the tertiary hospital to refer mothers and babies out to this facility. Without this vital component, this state-of-the-art new facility stands underutilized, and absurdly, despite the investment in excellent equipment and staff training, mothers and babies continue to die needlessly.
Fortunately, during last months’ visit to Kumasi, the Mayor and the Kumasi Metropolitan Authority informed MCI and Suntreso’s medical leadership of its plans to remedy the infrastructure gaps still impeding Suntreso’s effectiveness. The Mayor has committed to building three new wards for Suntreso, including a lying-in ward for expectant mothers. This should greatly improve the situation; now all that is needed are the operating room and the safe blood storage equipment, for which MCI is seeking funding. Once the leadership gap can be addressed at the other facility, MCI can begin to chart the anticipated decrease in maternal and infant mortality resulting from the two new facilities, as well as the expected improvement in conditions and performance at the ICU.
Appropriate and adequate maternal and infant care remains a critical issue across much of sub-Saharan Africa and in all of the Millennium Cities. Our sincere hope is that these clinics, and others like them, will soon be making a significant contribution toward decreasing maternal and infant mortality.