March 2018 — Guljamal*, a mother from the village of Chobaash in Afghanistan’s Jowzjan province, arrived at the local health clinic in shock and bleeding. Bundled in a blanket, she had given birth just hours before at home and without a skilled health provider at her side. In a panic and fearing for her life, Guljmal’s family brought her to the health center. They also feared for the future of her newborn and four other children.

Fortunately, the midwife on duty, Sabera*, recognized immediately that this unconscious mother of five could be suffering from postpartum hemorrhage (PPH), a heavy and life-threatening bleeding that most commonly occurs after giving birth. PPH is a major cause of death among Afghan mothers that has kept the country’s maternal mortality rate among the highest in the world.

Sabera examined Guljamal closely, looking for the potential causes of the excessive bleeding. She had learned to do so in early 2017 during comprehensive training on the prevention, detection and management of PPH conducted by the USAID-funded HEMAYAT project. The mother had been anemic prior to and throughout her pregnancy, but attended only one antenatal clinic appointment.

Sabera identified the cause of Guljamal’s excessive bleeding — the placenta had not been fully expelled. Sabera administered oxytocin, an injectable medicine that increases the amplitude and frequency of uterine contractions, reducing uterine bleeding and inducing cervical dilation to pave the way for manual removal of the placenta. She kept Guljamal at the clinic, monitoring her condition through the night.

“Guljamal was not completely healthy; I regularly checked her vital signs,” said Sabera.

By the following morning, Guljamal was feeling much better. She was released to return home but Sabera also referred her to the provincial hospital for a blood transfusion because she had lost so much blood. Her family, relieved that Guljamal had survived, gladly took her to the hospital.

Midwife Sabera attributed her successful management of Guljamal’s condition to her participation in the HEMAYAT training. “That has enabled me to save Guljamal and many others’ lives. This is a time of real happiness for me!” she said.

Since receiving the training, Sabera has delivered 227 babies and has managed eight cases of PPH.

“If it were not for midwife Sabera’s training and fast action, I would not be alive today. She safely delivered my baby and saved my life by stopping the bleeding,” said Guljamal.

Over 160 midwives like Sabera have updated their skills on managing PPH through the HEMAYAT project since mid-2015 as part of an effort to strengthen the skills of Afghan midwives and the delivery of quality health services to Afghan mothers and babies across the country.

The HEMAYAT project, in partnership with the Afghanistan Ministry of Public Health, addresses disparities and high mortality rates in women and infants by supporting the introduction, scale-up and sustainability of high-impact interventions to families in rural and difficult-to-reach areas in 23 provinces. Specifically, the project works to increase access, use and demand for high-quality, gender-sensitive and sustainable services provided by the Ministry of Public Health’s Basic Package of Health Services and the private sector. To access higher levels of care, HEMAYAT strengthens referral systems to hospitals through the Essential Package of Hospital Services at the provincial level. The project runs from 2015 to 2020.

*Many Afghans use only one name.

LINKS

Follow @USAIDAfghan, on Facebook, on Flickr, on YouTube