Bangkok--11 Oct--Spindler & Associates
Narathiwat — In addition to being one of the three southern Thai provinces experiencing civil unrest, Narathiwat also has the country’s highest rate of death among premature babies as people in the area still lack adequate knowledge and understanding of prenatal self-care.
Mrs. Suhaining Waehama , whose baby was delivered prematurely, has had to face additional burdens due to complications with her child’s birth. “I’ve got many children and family problems. My husband had to go work in Malaysia. He’s been away for three months but has sent back only 500 baht to me. My last child was born before it was due. The doctors at Songkhla Nagarindra Hospital said it had a number of ailments and there are a lot of expenses — baby formula, meals, medical fees, travelling expenses. I don’t have money for any of those. It’s really a big problem. The hospital is also very far away. I don’t know what to do.”
Not only do the patients have problems, the doctors also have more than their fair share. Dr. Jeaiddress Duereh, M.D. an obstetrics specialist, head of the Ob-Gyn work group at Narathiwat Rajanagarindra Hospital said, “Some of the equipment has started to wear out and then the repairmen are not willing to come and fix them because they are afraid of the unrest. Sometimes, we place an order for some equipment and it is delivered only as far as Hat Yai. We need to pick it up there ourselves. At the moment, we need life-saving devices and surgery equipment, for example.”
Dr. Amara Duereh, M.D., a specialist in pediatrics, said that with problems piling up, they cannot just wait for people to come help and need to go out and seek help for themselves. According to 2009 statistics, there were 598 critical premature babies born in Narathiwat. The number went up to 819 and then 1,051 in 2010 and 2011 respectively. The current figure for this year is 1,081. A passive approach is seen as being impractical as it is difficult to get trained doctors and additional medical equipment quickly. In addition, the current hospital cost for delivery and care of a premature baby can be as high as 100,000 baht.
The repercussions of this issue may be reflected in several ways. Dr. Virul Pornpatkut, M.D. Director of Narathiwat Rajanagarindra Hospital, stated that the problem could hinder the intellectual development as well as the health of these babies leading to a host of hidden problems for society in the future.
The situation has prompted the hospital to participate in “the Thai Maternal and Child Health Network Project for Thai children” under the royal patronage of Princess Srirasmi, the Princess Consort of the Crown Prince, which has been managed by Associate Professor Dr. Tharathip Kolatat and Ms. Chantima Charastong since 2007.
One important aspect of the Thai Maternal and Child Health Network project is that it does not merely provide financial aid, but instead has been offering new concepts of knowledge management utilizing the experience of those working in the project. Project managers have also been providing consultation and helping identify problems so that they are better resolved over the past several years.
In the beginning, the first thing that was needed was to get the Obstetricians and Pediatricians to agree on a course of action. Then cooperation from the nurses group was required. At the same time, information was disseminated to the public, although that takes time to filter down to the grass roots level.
Later on, after the hospital joined the project, many parties took part in trying to solve the problem. “Village volunteers” have helped spread the information to communities, with the “Hospital Health District” acting as base. Well-trained staff are available there to help register pregnant women for prenatal care. In addition, the Traditional birth attendant “Tohbeedae”, well-respected locals who act as traditional midwives, have joined the network to persuade patients to get prenatal care and learn to take better care of themselves.
In cases of emergency, such as for those who live in remote areas, who are without access to transportation, or who are unexpectedly about to give birth, the traditional midwives will be with the mothers and report over the phone. If the mother is in critical condition, Narathiwat Hospital will send out the “EMS” or the emergency van to fetch the patient. The hospital was the first to use such emergency transport in maternal and child health work.
The hospital has established treatment standards and has taken an aggressive approach, providing care information from the teenage years on. At the same time, there is Muslim premarital training. The percentage of the country’s premature babies is around 6-7%, but our hospital’s number is now at 4%, sometimes going as low as 2%. Before we joined the project, the gestational age was generally 30 weeks. We try to make it 34 weeks so that the babies can be raised more easily. We would like to see premature babies grow without complications or infections, especially ones that could harm the still not-completely-developed retina. At 34 weeks, the babies will be safer and healthier.
“The government’s expenditure will go down and it is believed that if we do good preventive work, the risks will go down too. It is better than only buying expensive medical equipments. The expenses are high, everybody is tired, and the problem is unending. What we need from the project is a strategic plan. That will let us hit the right target, bringing good results,” stated Dr. Jeaiddress Duereh, M.D. in explaining how the assistance of the project can lead to success in addressing the problem. Dr. Penkae Dangsuwan, M.D. an obstetrician at Narathiwat Hospital, talked about preventive obstetrics. “Before, I only taught doctors and nurses in Narathiwat Hospital. Some patients arrived already in critical condition. We needed to help deliver the baby to save both the baby’s and the mother’s lives. There was no choice. Such problems continued. So I’ve decided to take an preventive approach working here at the Kok kian Hospital Health District”
“At first, it was exhausting as it was additional work. Then I found that every pregnant woman registered for prenatal care was well-taken care of by the team of doctors, nurses, and public health volunteers resulting in fewer problems. Patients are also happy they don’t need to go into Narathiwat province to see doctors”, Dr. Penkae Dangsuwan, M.D. related happily and proudly.
The doctor added, “In the old days, there was limited equipment. We had to refer a lot of patients to Hadyai and Songkhla, but now we don’t have to do that. We take care of all of them. The family’s relatives are also happy as it means they do not have to face the burden of travelling long distances to hospitals. Moreover, now several hospitals refer their patients to us.”
“I think deeply about what I got from the project. It has taught me how to effectively identify the problems, analyze the causes, and develop solutions so that we get better results. Health prevention and promotion takes time and yields results in the long run. You can look at the numbers and you can say that this is our work. We did it. Everyone is very happy. Most of all, people have better health and better quality of life.” Dr. Amara said hopefully and happily.
Mrs. Sunee Aaruesa is expecting. As she is 37, doctors told her that there were risks including premature birth. She is nervous and thus getting prenatal care at Kok Kian Hospital Health District. “I don’t have to travel to go to Narathiwat Rajanagarindra Hospital. There are also a lot of patients there. I would have to wait for a long time. It would take me the whole day and now I can’t get leave from work very often either. So it’s good to have this Hospital Health District. They provide both pre and post delivery services. They follow up and make sure both the mother and the baby are in good health. The doctors and the nurses here are great.”
One thing that is very useful is to provide knowledge for people in the community. However, as some villagers cannot read Thai, it would help much more if the knowledge is in the local language said one Narathiwat resident.
These are reflections from all parties concerned that we gathered from our brief field visit with Associate Professor Dr. Thrathip Kolatat.