Working to reduce neonatal mortality in Najaf: A challenging mission
March 19, 2012
Since October 2010, Shinjiro Murata from Japan has been working with MSF in the city of Najaf. He has stayed there for more than one year working as a field coordinator with the main task to set up a new project for MSF with the aim to improve perinatal and obstetric care in one of the largest referral hospitals in the region. In this text he shares with us his experience working in Iraq.
“I arrived in Najaf more than a year ago, in October 2010, to start an MSF project in the Al Zahara District Hospital. Najaf is located 160 km south of Baghdad. It was not an easy task, but surely a challenging experience to be working in such a different country. My previous experience with MSF was in Africa, so when I started working in Najaf I realised that I would need to see things in a different perspective and adapt to the reality of a country that used to have a very well organized health system, but due to decades of conflict and international sanctions, has seen a rampant deterioration in the health care provision.
After the US-led invasion in Iraq in 2003, most of the nursing teaching structures (faculties and universities) were closed. This has lead directly to a huge gap and shortage of specialized staff and a lack of training. Most of the nurses and the medical staff in the Iraqi health structures are under-trained and even less updated on latest technical and material medical developments. According to the Iraqi Ministry of Health, since February 2006, due to the aggravation of sectarian violence, over 70% of medical staff has fled the country, while hundreds of them have lost their lives. The insufficient capacity of the Iraqi health system to respond to the medical needs of the population has contributed to an unprecedented increase of maternal and infant mortality rates in the country. In 2007, WHO estimated the Maternal Mortality ratio to be 300 per 100,000 live births. According to the latest UNICEF State of World’s children report, Iraq presents a neonatal mortality rate of 64, while the neighbouring Syrian Arab Republic and Jordan present a neonatal mortality rate of 7 and 16 respectively.
MSF has decided to start a medical programme to support the main Ministry of Health referral hospital, the Al Zahara District Hospital, for obstetrics, gynaecology and paediatrics in Najaf city. The hospital is one of the largest hospitals in the region, with a 340 bed capacity, and deals with approximately 1,950 deliveries per month. These account for almost 50% of the deliveries carried out in the whole Najaf Governorate that has a total population of 1.2 million people. It is most of the time overcrowded with patients and the quality of medical services provided is sometimes not adequate.
According to the medical data we have collected in the hospital during 2010, although maternal and paediatric mortality rates were low, the neonatal mortality rates were remarkably high. Almost 70% of the new born babies admitted in the paediatric intensive care unit have lost their lives, while 26% of new born babies admitted in the sterilized unit have died. What is also very worrying was the fact that caesarean sections amounted for the 37% of all deliveries carried out in the hospital and about 60% of all babies admitted were born by caesarean section deliveries. Almost half of the babies who have died in the sterilized unit were premature. In our effort to improve this situation for new born babies in the hospital, we have had frequent meetings with hospital authorities to work together with our teams. It was a big challenge!
Together with my MSF colleagues, we have worked a lot during the last year to improve the quality of the medical services in both the neonatal and obstetric departments of this huge hospital. MSF paediatricians have provided hands-on bedside trainings on how to receive babies in the baby reception rooms and how to resuscitate them in the paediatric intensive care unit. MSF obstetricians and gynaecologists have been implementing the standard operational procedures for antenatal care, delivery care, caesarean sections indications and timing, and anaesthesia. And MSF nurses and logisticians have tackled some important transversal issues in the hospital like, improving infection control measures, bridging supply gaps of essential equipment and renewable items, and improving maintenance by the hospital.
For me, working for MSF in Al Zahara District Hospital was an interesting experience. MSF´s work in this hospital, mostly directed towards capacity building, training and the participatory approach, is not the typical work that MSF usually does in its projects. Although it was very challenging, I think it is worth the effort. After more than one year in Najaf I have seen that medical needs in the country are still very high. Until peace is restored in Iraq, MSF needs to continue supporting these pregnant women and newborn children. MSF is one of the few international medical humanitarian organisations working inside Iraq thanks to its independent, neutral and impartial nature.”