Making Progress In Global Health

The Optimist

Palm tree and mountain landscape
 

Solving crowded hospitals and inadequate maternal care are keys for reducing infant mortality

Stored on her desktop computer, Dr. Anita Zaidi keeps the photo of a grandmother holding her baby grandson at a community clinic on the shores of the Arabian Sea in Pakistan. For Zaidi, the image has a sad, but deeply meaningful provenance.

It was taken in 2002 at a clinic Zaidi started through a Save the Children program called “Saving Newborn Lives.” The baby was sick with sepsis but the woman had refused the offer of medical transport for the boy to a hospital in a nearby urban center. Twenty-four hours later, the baby would die at home.

Zaidi can still recall the feelings of frustration and sadness that came over her from knowing the baby surely could’ve been saved if he had been taken to the hospital. After all, she had founded the clinic precisely to help babies like him - to triage the serious cases in the rural community and help get them safely and swiftly to nearby hospitals for additional care.

Dr. Anita Zaidi with Dr. Asad Ali and Dr. Chris Damman
Dr. Anita Zaidi (third from left), director, Enteric and Diarrheal Diseases, with Dr. Asad Ali (left) Director Research, Department of Pediatrics and Child Health, AKU (Aga Khan University) and Dr. Chris Damman (2nd left sitting) program officer, Enteric Diarrheal Diseases, observe weight measurement process of Yasir (6 month old) conduct by AKU field team in Faiz Mohammad Samo village, project site in Matiari district, Sindh province, Pakistan on November 30, 2016. The Sindh province is participating in the SEEM project, a study of environmental enteropathy and malnutrition sponsored by the Gates Foundation and Aga Khan University. Through the project field officers calculate the weight-for-age Z scores (WHZ) of newborns in the province and monitor their progress. Enrolled cases are tracked on a weekly basis and nutritional supplements are given to combat malnutrition.


“It was a shock to my system,” Zaidi says. “I had spent a lot of time advising the grandmother that this was very important or the baby would die. She kept saying, ‘What’s the point? He’s going to die in the hospital anyway.’”

Afterward, Zaidi asked around in the community and learned that a lot of parents felt the same way. Too often, people would make the long, costly journey to a hospital, only to wait in an emergency room crowded with other sick babies. After two or three hours, a doctor would evaluate them and, if they were one of the lucky few, admit them for treatment. Otherwise, they would be sent back home with an expensive medical bill and a baby that might end up dying, anyway.

“Given the environment, I realized the grandmother had made a logical decision not to go to the hospital,” Zaidi says. “That launched me into this work of improving quality of care in primary settings so families around the world can believe they’re making a good decision when they take their babies to the hospital.”

Sixteen years later, Zaidi continues working to make that happen as program director of Vaccine Development, Surveillance, and Enteric and Diarrheal Diseases at the Bill & Melinda Gates Foundation, as well as co-lead of the Maternal Newborn Child Heath Discovery and Tools program.

The Optimist sat down with Zaidi to learn how she sustains her courage in the face of the stark realities of working in countries with some of the world’s highest rates of infant mortality.

There Is No Infant Care Without Maternal Care

A problem I saw a lot in Pakistan is hospitals that don’t take into account the needs of babies and their mothers. The mother is a newborn’s only source of nutrition. In overcrowded hospitals, I’ve seen two and three mothers standing around the same crib containing their babies. The women had nowhere to sit or lay down to rest. The hospital didn’t provide them with food. If they were hungry, or needed to use the bathroom, the women had to leave the hospital to take care of it themselves. A lot of times, that’s what drives mothers to take their babies home, or not go to the hospital in the first place.

Traditionally, health care providers do not think of the mother and baby as a single unit. Improving newborn health is only possible if we also improve maternal health. We need to build out the services for the mothers and mothers-to-be, so she gets the right care when she’s pregnant, when she has the baby, and after. If that baby is sick, you need to remember that baby and mother will need a bed, otherwise they can’t stay overnight if a doctor wants to admit the baby.

Children Make the Best Patients

I knew from an early age I wanted to be doctor. My mom was a pediatrician and I was one of those kids who thought I didn’t want to do exactly the same thing as their parents. In medical school, I thought I wanted to be a plastic surgeon. Then, during my rotations, I loved working in pediatrics. When a child gets better, you know because they smile at you. It melts my heart every time and my optimism is reborn. For a lot of people, going to the doctor makes them feel tortured. So I decided to become a pediatrician after all. My mom was delighted.

Educational session in the village of Al Jabail, Egypt
Women of all ages participate in an educational session in the village of Al Jabail, Egypt. The session is coordinated through the "Mabrouk!" ("Congratulations!") Initiative, which was designed to raise awareness and discussion among young married couples in Egypt. The initiative uses education and counseling to address health challenges for pregnant women and their babies, including malnutrition, hypertension and neural tube defects. Since the start targeted villages have experienced dramatic improvements in maternal and child health.


Primary Care As A Way to Relieve The Pressure On Hospitals

Improving the quality of care in primary settings, like community clinics or outposts, can help families avoid the need of going to the hospital in many cases. Vaccines are a great way to keep children healthy and out of hospitals. For example, vaccines against rotavirus diarrhea and pneumococcal pneumonia are keeping millions of children from getting sick.

Another problem is infection control. If there are multiple ill babies in the same bed, they are undoubtedly sharing germs with one another. So, even if a baby came in with something mild, they might end up leaving with an even worse bug. Fixing that requires looking at the system, not singling out individuals who did something wrong. That’s why newborn health is a big focus for the Gates Foundation. We want to have quality indicators and to get governments and health care providers to improve their quality of care across the system.

Ensuring Dignity in Death

One of our research projects, CHAMPS, is working to fix some of these problems by taking minimally-invasive tissue samples from deceased babies. The samples have to be taken quickly, within 24 hours, or the body will decompose. This is a difficult thing to ask of the parents. Recently, when we expanded our pilot research project from South Africa into partner hospitals in Mali and Kenya, the foundation wanted to make sure the researchers in those new facilities were treating families with dignity and respect. I traveled there last year to see for myself.

As part of the trip, we visited families who had lost their babes and consented to minimally invasive biopsies as participants in the studies. They were full of grace to have people from Seattle visit with them and try to understand what had happened to their babies. In one of the meetings, the grave was right there in the backyard of the house, a little mound with white stones around it. The parents’ reasoning for participating in the program was because they wanted to know what had happened to their baby. One remarkable feature of humanity is that your biggest risk of dying is on the day you’re born.

RELATED: Under the microscope: Learning more about childhood mortality

In Mali, I learned the story of a mother who had given birth at home, then brought the baby to the hospital because she had a respiratory illness and a birth weight of only two kilograms. But the mother hadn’t received any prenatal care, so the health workers had no way of knowing if the baby was premature or malnourished. They treated the baby for the respiratory disease and sent home. A few days later, the mother came back because the baby had another illness. Again, it was treated and sent home. It happened a third time, then the baby died.

In Pakistan, I watched babies die all the time. It still upsets me. But most doctors and nurses are working to the best of their abilities, with the resources they have. Sadly, deaths aren’t unusual in overcrowded hospitals. There isn’t enough room to admit everybody. It’s basically luck of the draw for who gets in and who doesn’t. When the resources aren’t available to take care of everyone, it’s like playing dice with people’s lives.

About the Author

Ryan Bell
Ryan Bell is a journalist whose pieces have appeared in publications such as National Geographic and NPR.

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