An easily manageable complication of pregnancy in Ireland can rapidly become a matter of life or death for a woman living in a remote part of the southern Tanzanian region of Mtwara. Access to hospital care there is poor, as is uptake of ante-natal care, and training in obstetrics and midwifery can be inadequate.

The neonatal death rate in Mtwara has been cut by 30 per cent due to a programme by Voluntary Service Overseas (VSO), the international development charity, but the high level of neonatal and maternal deaths remains a major challenge facing the East African country.

Dying needlessly

The national mortality rate for

Tanzania

is 450 per 100,000 compared to nine per 100,000 in Ireland.

The Mtwara region, which has a population of 1.2 million, has only one obstetrician and women are dying of complications that could be easily managed.

Founded in the UK in 1958, VSO works in 22 countries across Africa, Asia and the Pacific to break the vicious cycle of ill health, poverty and social exclusion in the developing world.

Since its foundation in 2004, VSO Ireland has sent professional volunteers to these regions to share their skills with local partners.

VSO's work revolves around the four development areas of health, HIV and AIDS; participation and governance; secure livelihoods; and education. The organisation depends on funding from a wide range of sources to keep their work going, including the Irish Government via Irish Aid.

Master of the National Maternity Hospital Dr Rhona Mahony has recently returned from a short-term placement in Tanzania with VSO where she helped train healthcare workers at Mtwara.

Her work with the Mtwara Regional Health Management Team targeted a number of areas including training doctors in emergency obstetric care, highlighting symptoms that arise for surgical interventions, and supporting doctors in prescribing medication.

The VSO programme in Mtwara will benefit over 100,000 pregnant women and newborns through new processes and practices and outreach messaging and support.

Good start

There are many challenges facing Tanzania in reducing its neonatal and maternity mortality rate, says Dr Mahony, not least the lack of family planning and culture of having big families.

Many women live miles away from a hospital in very remote areas with no ambulance service meaning that when complications arise, they do not make it to hospital on time.

Dr Mahony says: “Another big issue is that women do not come to the ante-natal clinics. Ante-natal care results in a significant reduction in maternal mortality and morbidity, but only one in five women in Mtwara come for the first visit, where they are given a prophylaxis to prevent malaria. There is a high malaria rate in the region and pregnant women are more susceptible.

“We need to look at ways to encourage women to come for that first visit because that is a great chance to educate them and get the pregnancy off to a good start.”

Other challenges include a lack of specialist obstetric and midwifery training among staff in the community facilities, lack of blood supplies, a high rate of teenage pregnancy and elective Caesarean births and the regular “stock-out” of vital, inexpensive drugs such as oxytocin (for inducing contractions), antibiotics, painkillers and blood-pressure tablets.

“Simple interventions can make a real difference. People have a sense of hopelessness about Africa, a sense that there is so much corruption that nothing can be done but actually there is a lot that can be done. We need to look at what’s working in other areas and replicate it, always staying mindful of the local culture and customs,” says Dr Mahony.

Short-term placements like Dr Mahony’s are the exception to the rule for the VSO, says James O’Brien, Research and Advocacy Officer with VSO Ireland. Dr Mahony was sent as part of the new Eminent Volunteering initiative for people with high-level experience. VSO is hopeful she will return to continue her work.

Volunteer shortage

VSO Ireland send up to 30 volunteers overseas each year, the majority for a year. One-third of the Irish volunteers are healthcare professionals, one-third are teachers and other education professionals and the rest are a mixed group of business people, town planners, vocational trainers and others.

Most of the Irish volunteers are either recent college graduates or recent retirees and VSO Ireland finds it more challenging to get volunteers now than five years ago due to fewer career-break opportunities and less confidence about having a job to return to if people go overseas for a year.

“In the last few years through our partnership with Irish Aid, we have been focusing on three countries – sending doctors to Ethiopia, teachers to Uganda and governance people to Zambia to support the Government’s decentralisation scheme there,” says O’Brien.

“We are increasingly sending doctors to Tanzania and, through our new fellowship with the RCPI [Royal College of Physicians of Ireland ] , we will be sending three paediatricians to Tanzania and one to Uganda early next year.”

There is a big push for volunteers to go to Nepal following the earthquake in April and O’Brien says that there are lots of openings there, particularly for obstetricians, gynaecologists and paediatricians (details of those as well as other openings are on vso.ie).