Fernando Gonzales Salguero
Fernando Gonzales Salguero was the country director for Bolivia for the Population Council.
The man arrived at the health center sweaty and tired and his face showed concern: his wife had been in labor for two days and was bleeding. I asked the auxiliary nurse to help bring the woman inside.
Earlier that morning we had reached the health center in Surima, a community located about 80 kilometers from Sucre, the constitutional capital of Bolivia. Surima is a small community located in the Andes, home to 70 families. Most of the population are Quechua Indians engaged in subsistence farming. The community has a small school and a health center with very few resources.
Because of the poor condition of the road, it had taken us three hours to get to Surima. I was conducting a study of the ability of health centers to provide child health and maternal services.
The trip to the health center had also taken the woman and her husband several hours because the trail was difficult, and the men who were helping to transport her had to take turns carrying her. She moaned in pain and was bleeding continuously. I tried to do an examination to determine the baby’s position and the volume of lost blood, but she did not let me touch her. I realized that an accurate diagnosis made no difference. She required care in a hospital that had the equipment and trained personnel to treat her. The local health center did not have the right equipment or medicine, so there was no possibility for treatment.
A woman who ran a small store in town told the man not to allow his wife to go to the hospital because they were going to cut her and she was going to die. I insisted he take his wife to the hospital or she would die. Finally he decided to take his wife. Because there was no other transportation in town, I asked a driver and the auxiliary nurse to take the couple to the hospital in Sucre. I stayed in Surima to fill in for the nurse during his absence.
The next day when the nurse returned to Surima, he told us that the woman had been successfully treated at the hospital. Her husband had suffered because as soon as they arrived the doctors told him that they had to operate on his wife, and he remembered his neighbor’s warning. The nurse explained the need for a caesarean section. Unfortunately, the child died but the woman survived.
Two weeks later, I learned that the woman had returned to Surima. This dramatic experience forced me to think about my responsibilities. I am working on projects that aim to reduce maternal and newborn death. I did what seemed appropriate. The referral and reception at the hospital were effective. But it was just a coincidence that we were visiting Surima that day. What would have happened if we had not been there?
This experience helped me to understand the complexity of reducing maternal deaths in countries like Bolivia, where a third of the population does not have access to health services. At present with the support from USAID, the Population Council and John Snow Inc. are conducting a program to improve maternal health by improving local management systems, increasing basic health care coverage, and obtaining essential equipment for health facilities.
The Council is conducting this work in 70 municipalities in four of the nine regions in Bolivia. We are working in ten obstetric networks that extend from the community to the highest level of care for pregnancy complications. We are helping to incorporate improved clinical practices, such as the active management of the third stage of labor, that can prevent maternal deaths from hemorrhage. We are also improving newborn care. These efforts are accompanied by the delivery of basic equipment, the training of health providers, and the establishment of systems for continuous quality improvement.
Our work also includes social interventions to ensure the formation of community networks that allow the transfer of obstetric emergencies in remote locations with little access to health services to better-equipped facilities. Our goal is to improve quality and increase health coverage for rural women and indigenous communities, so that we reach the most excluded and vulnerable populations in Bolivia.