From the Field: Mnazi Mmoja Hospital – The First Visit
It was on the 4th of July, 2017, two days after landing in Zanzibar, that the PGHT team first visited Mnazi Mmoja Hospital (MMH), the only tertiary government hospital serving the entire island. The focus for the day was a visit to the maternity ward and a meeting local clinicians. A big white board with lots of numbers and the title “Key Statistics: Maternity Ward” caught the team’s attention upon first entering the ward. Rows tracking the number of admissions, elective C-sections, numbers and types of complications as well as still births and maternity deaths filled the board from top to bottom. Dr. Meguid greeted us with a big smile and sat us down for a conversation regarding the very last statistic on that board: the annual maternal death rate. This has been the key focus of the PGHT’s modeling team for the past year.
The statistics surrounding maternity deaths at MMH are alarming to say the least, but the true gravity of the situation was not felt until our conversation with the clinicians at MMH. Very roughly speaking, the maternal death rate at Mnazi Mmoja has hovered around 600 per 100,000. With the number of patients that the hospital receives, this rate means that the ward encounters around 1 maternal death per week on average. For relative comparison, most countries in Europe only average around 4-10 maternal deaths per 100,000. For a hospital in Europe that receives a comparable volume of patients as Mnazi Mmoja, it would see at most 1-2 maternal deaths a year, as opposed to the roughly 50 deaths per year that MMH encounters. As one of the clinicians we spoke with stated, “most of these deaths are ultimately avoidable” with a good maternal healthcare system in place. However, what makes addressing this issue extremely complicated is that there are a lot of factors at play when it comes to determining maternity deaths. Talks with hospital staff have brought to attention a host of potential problems – from shortages in nurses/midwives, doctors, specialists and medical supplies (including necessary drugs) to issues performing necessary lab tests due to broken equipment or lack of training among lab technicians to even a lack of a basic electronic medical record (EMR) system. What is not clear is which of these factors is contributing to what extent in the increased incidence of maternal deaths.
As one clinician pointed out frankly, these problems inevitably lead to a decline in the morale of the medical staff in the ward as each group thinks the other one is to blame for a problem that does not have any simple answers. The PGHT modeling group has decided to tackle this problem by attempting to develop a model of how the Mnazi Mmoja maternity ward functions as a system. With the goal of identifying patterns in treatment based on defined patient conditions, the modeling team ultimately hopes to discover any gaps in care that might be contributing to the high maternal death rate and how the system can be best optimized to address this issue.