Friday, December 21, 2012

Numbers Man

Its supposed to be bad luck to use the “Q” word when talking about work, but it has been surprisingly quiet so far. I am always interested in Statistics and Outcomes, so with time on my hands, I have been through the birth register and extracted all the information for this year up to a few days ago. The Birth register is a very wide flat book with 14 rows and innumerable columns on each page to record multiple details about each woman giving birth. Its not too dissimilar to the ones in use in Australia – though in some places there nowadays its all recorded electronically, depriving interested parties like myself of the opportunity to do mini audits and reviews, something I enjoyed doing and presenting to the Registrars at Royal Darwin Hospital. Audit and Review is an essential part of the continuous process called Clinical Governance whereby suboptimal outcomes can be identified, quantified and responded to with improvements for the future.
Unlike the Australian Birth registers, the Ethiopian one has columns for maternal death, stillbirth and neonatal death, and for the HIV status of the mother and baby, conditions which are so rare in the west they are not given separate columns. I’ve digressed somewhat – all I was going to report was that all year long there was never a page of 14 where all births were normal – until last week! A Tick in the NVD (Normal Vaginal Birth) column all the way down the page! Most pages of 14 had a Caesar and few instrumental deliveries, a stillbirth or neonatal death at least!
A typical Page from the Birth Register
Ive started to feel a bit redundant – in nearly three wweeks Ive done a coupple of caesars and a few forceps deliveries and not much else. To make me feel even less useful, twice last week when I went in for the round at 8.30 I was informed there had been a Breech birth overnight, and once, Twins! And no one felt the need to call me ! These midwives are remarkably confident and adept at most of these things- back in Australia its not uncommon for younger midwives and even trainee Obstetricians to have never seen, let alone conduct a breech birth! And if they did, it would always be under the direct supervision of someone “Senior”.
But then I should perhaps say, as I do to the midwives here, tongue in cheek, that this particular group of midwives have been wonderfully well trained - by me and Myrte last year, when they were students at Motta! None of the midwives who was here last year is still here - but four of the replacements are our former students. I must write to Myte and let her know that all her hard work was not in vain - I am continuously impressed at how good they are, and keep telling them and encouraging them to be proud of thier work!
When the stats are all in I shall post about them. It should make interesting reading.

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