November 8, 2016 | ,

A life saved while planning for the unexpected

After the delivery of her son, a mother’s loss of blood puts her life in danger, but a simple kit and quick thinking come to her aid.
A man with a small child on his lap, sits next to a woman on a couch.
Kefa Abeni Nyaburi stayed with his wife Everlyne through the night when she lost consciousness to postpartum hemorrhaging soon after the delivery of their son. Ernesto, now just over a year old, is healthy and happy after the successful management of his mother’s postpartum hemorrhaging. Photo: PATH/Celina Kareiva.

Editor’s note: A wide-reaching project in Western Kenya is having a profound effect on the lives of children and adults by tackling a complicated web of health issues. Meet some of the individuals benefiting from the PATH-led APHIAplus Western project, short for AIDS, Population, and Health Integrated Assistance, which is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

Everlyne Nyasuguta Aben had no reason to suspect that the delivery of her fourth child would be any different than her previous three. After a normal and relatively easy pregnancy, Everlyne felt well prepared for the new arrival. She and her husband had made the four recommended antenatal care visits at Beacam, a private clinic several kilometers from their home and planned to give birth at Nyamusi, a government hospital well regarded for its delivery services.

Last August, shortly after the delivery of Everlyne’s son, the young mother started bleeding severely.

“She was unconscious,” remembers her husband, Kefa Abeni Nyaburi.

A “water balloon” to the rescue

The Every Second Matters UBT kit assembled.
A uterine balloon tamponade saves lives with items that can be found in a pharmacy. Photo: PATH/Patrick McKern.

Postpartum hemorrhaging (PPH) is the leading cause of maternal mortality, killing about 130,000 women every year, the vast majority in sub-Saharan Africa and India. PPH usually occurs within 24 hours of delivery, and can be the result of many factors, including lack of emergency obstetric care. In developed countries, blood transfusions and the ready availability of surgical staff ensure treatment. But in Kenya, PPH often has serious consequences.

Fortunately for Everlyne, a relatively easy-to-use and efficient treatment is available courtesy of the APHIAplus Western project, which is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).  The uterine balloon tamponade, or UBT for short, is a simple device made with materials that most facilities already have on hand. A condom (the “balloon”), attached to a rubber tube and syringe then filled with water, applies pressure to the uterus until the bleeding stops.

Massachusetts General Hospital, in collaboration with Kisumu Medical and Education Trust, developed the kit, which is one-tenth the cost of most UBT treatments in developed countries. Furthermore, it is simple and easy to use in high-stress and often understaffed health facilities where a mother’s condition can rapidly deteriorate.

To date, more than 441 health care workers from across Western Kenya have been trained on UBT, dramatically reducing the number of referrals to higher-level facilities. Maternal health outcomes reinforce those trends.

Effective application of the UBT can stop hemorrhaging and reduce the likelihood that a mother will require surgical interventions and blood transfusions, each of which has its own set of costs and risks. Even if UBT isn’t able to control severe PPH, it can dramatically reduce blood loss until the patient is transported to a facility with more resources.

Illustrations of two line graphs, titled "Maternal mortality ratio" and "Maternal Hemorrhage Survival."
(Left graph) The facility maternal mortality ratio (a measure of maternal deaths per 100,000 live births) has steadily declined over the lifetime of the APHIAplus Western project. Between 2011 and 2015, it declined from 202 to 98, well below Kenya’s national average of 362. Graph data: 2014 Kenya Demographic and Health Survey.
(Right graph) While there are many more cases of antepartum hemorrhage than postpartum hemorrhage, in APHIAplus Western facilities the survival rate of these events is very high. The light blue line shows how, since 2011, maternal antepartum hemorrhage survival rates have increased from 87% to 91%. The dark blue line illustrates that postpartum hemorrhage survival rates have increased from 59% in 2011 to 94% so far in 2016. APHIAplus Western data compiled by Emily Beylerian. Graphs: PATH/Sara McSorley.

The need to act quickly

A woman stands outside under a canopy of banana and coffee plants.
Everlyne spent several days in the hospital, her husband Kefa at her side. She was transfused six units of blood and was taken to an operating theater where she was nursed back to health before being discharged on her third night. Photo: PATH/Celina Kareiva.

When Everlyne began bleeding profusely, Kefa feared for her life. The young mother slipped into unconsciousness as she was transported by ambulance from Nyamusi to Nyamira County Hospital. The hospital staff, recently trained on UBT through APHIAplus Western services, responded immediately, inserting and inflating the small balloon to effectively halt the bleeding within 15 minutes.

“If it was not for the UBT, she would have died,” explains Heryne Ayiemba, an APHIAplus Western program officer for PATH. “With the rough roads [in Nyamira county] . . . the more likely she was to bleed.”

A son who will know his mother, a family intact

A man with a child on his knee sits with a woman on a couch and a small child in the foreground.
Ernesto bounces on his father’s knee next to Everlyne and one of their three older children in the family’s modest living room. Photo: PATH/Celina Kareiva.

Everlyne proudly passes around the clinic book, displaying her son’s healthy weight and vital signs. Outside, her three older children play between the family’s rows of banana and coffee plants.

Everlyne’s experience is a success story for two reasons. After an efficient referral, she was transferred to a neighboring facility with prompt and free ambulance services, courtesy of APHIAplus Western. UBT was administered without complications in a largely rural and underserved community that previously had no means of combating PPH.

For Kefa, the experience changed his outlook on government facilities. He’d heard from neighbors that patients were mistreated and often overseen by medical students instead of trained health personnel. But the attentiveness of the staff at Nyamira and Nyamusi transformed his opinion.

“I would tell others to go to the government hospital,” says Kefa. “There are a number of services there. . . . and we didn’t pay anything.”

Kefa and Everlyne are role models in their community, beneficiaries of a simple yet effective innovation. Not long after Ernesto’s birth, while the new mother lay recovering in the referral hospital, the couple decided to evaluate their family planning options. Everlyne knew that the older she got, the risk for complications in pregnancy would increase, and with four children, the couple felt ready to explore more permanent methods of family planning.

“I’m so grateful,” says Everlyne with a smile. “UBT saved my life.”

The AIDS, Population and Health Integrated Assistance (APHIAplus) program is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

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  • Celina Kareiva is a project coordinator on both the Menstrual Health and Applied Behavioral Communication work teams at PATH.
  • Emily Beylerian is a data analyst and an associate in the Results Management, Measurement, and Learning department at PATH.