When you’re in a four-wheel drive vehicle threading its way through rocky mountain passes in the Andes, it’s hard to imagine getting around any other way. But people do. Our driver slows on a narrow curve to make way for a teenager herding sheep. From time to time we squeeze over to the edge of the impossibly narrow road to allow a bus packed with passengers pass in the other direction.
Few people here in the highlands of central Peru own automobiles and it’s hard to know exactly when the next bus is going to rumble by. Villagers are a long way from the nearest health clinic, even further from a fully equipped hospital. Imagine entering the final weeks of pregnancy knowing if there were problems in labor and childbirth, you were hours, sometimes days, from the nearest medical help.
Peru’s maternal death rate has historically been unusually high. Official figures put the rate at 185 deaths for every 100,000 live births. UNICEF estimates put the rate even higher, at 240 maternal deaths for every 100,000 births. Either way, it was one of the highest rates in the Americas, even as Peru posted healthy economic gains year after year. The country’s medical infrastructure was simply not up to the task of adequately treating pregnant women.
Ray Suarez’s series on Peru’s growing economy and health challenges will air on the NewsHour this week. Watch a preview of Ray’s report below.
In most cases, deliveries happened without incident. Rural Peruvians were commonly born at home. If there were complications — if the baby was presenting in the birth canal feet first, if the mother began bleeding heavily, if labor failed to progress and fetal distress began — the baby might die, and there was a good chance the mother would, too.
Enter international agencies, foreign governments, and a government in Lima anxious to lower the rate of maternal death. A high-cost, high-tech solution was not in the cards. Peru has one of the smallest public sectors in the hemisphere. Instead, health officials, obstetricians, nurses, and community activists looked for ways to make better use of existing resources and connect expecting mothers with them.
To lower the number of women who run into medical problems during labor, they are now encouraged to move to a medical facility before they go into labor. Women in rural areas run into trouble at a higher rate when they deliver at home rather than the hospital, so there is a push to teach women about the benefits of hospital delivery.
The NewsHour team headed out to the remote rural town of Vilcashuaman, high in the Andes mountains, to see the new approach at work. We visited a Casa Materna, a mother’s house, where three women from communities far away waited to deliver. In a nurse’s office was a felt bullseye map, with the name and due date of all the women in the region known to be pregnant, along with the approximate distances and travel times to their homes.
Now a woman in difficult labor isn’t asked to walk for hours to get to a clinic, raising the chance of death for mother and child. Remote rural communities stay in contact with Vilcashuaman by two-way radio. An ambulance sits in the forecourt of the hospital, financed by international organizations, ready to bring people who can’t be treated in the small facility to the regional hospital hours away in Ayacucho. That’s where we headed next.
Home to more than 200,000 people, Ayacucho is a provincial capital, the site of one of the climactic battles in South America’s wars of independence, and has a university founded in 1677. The city sits at 9,000 feet, surrounded by a striking necklace of even higher Andean peaks.
The hospital is about to embark on a massive rebuilding project, with an expanded labor and delivery area. It needs one. On a Sunday morning, women on gurneys waited patiently for their turn in the delivery room, in line like jets outside O’Hare airport on a crowded summer evening. When the wail of a newborn came through the swinging doors, another mother was moved to recovery, and the next gurney rolled in.
Once ready to deliver, a woman can choose a conventional Western delivery table with an elevated bed and leg stirrups, and as part of the new approach traditional birthing chairs are also available. Women who use the chairs do not have to completely undress, very important in a culture in which modesty is prized. The upright posture helps when it comes time to push, and often shortens labor.
For those women who come to the Ayacucho hospital from traditional, rural, indigenous-language speaking communities, an altar carries herbs and figures important to new mothers. The medical professionals in the area know bringing delivering mothers to the hospital can mean the difference between life and death, and are now prepared to be as accommodating as possible to lure women from home delivery.
The women we spoke to were healthy, as were their babies, and happy to have delivered in the hospital. The doctors and nurses know every successful delivery is a victory in the battle against maternal death because a healthy new mother goes home and tells the women of her village about her positive hospital experience.
The Ayacucho district has cut its maternal death rate in half over the last five years. The deep satisfaction that comes from those numbers is apparent both in the Casa Materna and the obstetrics ward in Ayacucho.
The hard-working, and a little harried, delivery team in Ayacucho is trying to get better results while working with a population that is chronically medically underserved, coping with bad nutrition, difficult physical labor at altitude, and the challenges that result like chronic anemia. Anemia raises the chances of uncontrolled bleeding with delivery of the newborn and the placenta.
Cultural competence, a welcoming atmosphere, and low-cost, high-result treatment strategies. It all seems pretty smart and straightforward. Peru’s new approach to prenatal and perinatal care is one that can easily be emulated in communities around the world.
The people we met in Peru don’t sugar-coat their situation. They know their lives are hard, and hope for something better for their little babies, like people anywhere in the world do. As terrible a tragedy as a dead newborn can be, all too common in the developing world, a dead mother shatters families in a very different way. Again and again, we heard stories of families put into severe distress and threatened with dissolution when a partner, co-provider, caregiver is suddenly gone.
Economic success has given Peru a new confidence (Read Ray’s earlier blog post on Peru’s economy here). The problems facing the country are seen as soluble, rather than overwhelming, and “just the way things are.” A virtuous cycle has set in, with early success encouraging everyone involved to push that maternal death rate down even lower.
Watch the coverage of maternal health on the NewsHour broadcast and online this week.