PROFFERING SOLUTIONS TO POST PARTUM HAEMORRHAGE: THE STORY OF PROFESSOR HADIZA GALADANCI AT 78TH UNGA

Worldwide about half a million women die as results of complications of pregnancy and childbirth. Overwhelming proportions of these deaths occur in developing countries of the world where facilities are poorly developed and lack trained attendants at delivery. Majority of these deaths occur within few hours of delivery and in most cases are due to Post Partum Haemorrhage (PPH). Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide with the highest incidence in developing countries. According to the World Health Organization, 14 million women experience PPH yearly, with approximately 70,000 dying from it globally, and of course, Nigeria, the most populous black nation bears the highest burden of it all.

Postpartum haemorrhage is the excessive loss of blood per vagina after the delivery of the baby and up to forty-two days after. It can either be primary or secondary. Primary postpartum haemorrhage is the loss of more than 500ml of blood within the first twenty-four hours of delivery or loss of any amount that is enough to cause haemodynamic instability in the mother or loss of more than 10% of the total blood volume. Primary PPH is the most common form of post-partum haemorrhage. Secondary postpartum haemorrhage, on the other hand is defined as bleeding in excess of normal lochia after twenty-four hours and up to six weeks after delivery. In both cases the true blood loss is often underestimated due to the difficulty with visual quantification.

Bear with all my medical jargon. I promise you; it will be worth your while.

The greatest problem with bleeding after delivery is that it is often underestimated. The bleeding is often not detected until the woman starts pouring and then all protocols for arresting and correction of blood loss are implemented. Many a times the healthcare professionals are able to stop the bleeding, but when they are not, the effects are fatal.

Enter Professor Hadiza Galadanci.

Professor Galadanci is the first female consultant, gynaecologist, and Professor of Medicine in the Kano, Nigeria. She has dedicated her life to reducing maternal and child mortality rates, worked to combat gender disparities in health and has played a pivotal role in shaping policies relating to critical maternal health challenges worldwide. She has authored hundreds of publications and has trained and mentored over thousands of health students, enabling them to take on leadership roles across Nigeria and the African region.

As young medical students, our first contact with her was through an Obstetrics& Gynaecology textbook where she wrote on some topics. I remember noting that hers, was the only name recognisable from Northern Nigeria.

Later, from the periphery, we continued to follow her progress as she worked tirelessly to do her best for her country. On July 19, 2023, twelve women on the frontlines of health systems across the African continent including Ethiopia, Kenya, Burkina Faso, Senegal, Cote d’Ivoire, Malawi, Uganda, Nigeria, Togo and Ghana were declared winners of the 2023 Women in Global Health Heroines of Health Awards. From Nigeria, yours truly, the Director of Bayero University’s Africa Centre of Excellence in Population, Health and Policy (ACEPHAP), was honoured with a prestigious Heroines of Health 2023 award for her exceptional and selfless contributions to the development of health at national and global levels.

Two weeks ago, at the 2023 Goalkeepers event at the ongoing 78th session of the United Nations General Assembly (UNGA) in New York, she gave a wonder presentation about the result of a study her team had carried out in Nigeria.

In her five minutes, 41 seconds presentation to the global audience at the Sustainable Development Goals (SDGs) Pavilion, a sideline event, Professor Galadanci discussed the study called E-MOTIVE, which discovered that half of the women who have PPH were never even diagnosed. According to her, “That’s because health care workers are busy and struggling with blood loss. In a busy labour ward, this could be the difference between life and death”.

The study, which involved over 200,000 women in four countries, found that objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHOrecommended treatments—rather than offering them sequentially— resulted in dramatic improvements in outcomes for women. Severe bleeding—when a woman loses more than a litre of blood after birth—was reduced by 60%, and they were less likely to lose their life.

Prof highlights a surprisingly simple and inexpensive solution: Basically, if the woman lies on a plastic sheet with a small transparent pouch at the other end to collect the blood, the medical team has an immediate sense of how much danger she’s in and can take swift action.

The cost of the sheet-with-apouch: Between $1-2. Isn’t that fantastic?

The drape is complemented by an immediate treatment bundle where indicated, including uterine massage, medicines to contract the womb and stop the bleeding, intravenous fluid administration, an examination and, when needed, escalation to advanced care.

In the trial, the E-MOTIVE intervention was supported with an implementation strategy consisting of specific training, PPH trolleys or carry cases, engagement of local champions, audits and feedback. Most importantly, all components of the E-MOTIVE intervention can be performed by midwives.

Listening to Professor Galadanci discuss the findings of this novel study at the United Nations General Assembly (UNGA) made me prouder than I could ever imagine. I speak for a lot of us when I say that our hearts swelled with collective joy. On that stage, she was eloquent, purposeful and a force to reckon with.

And she was not alone. We were all with her in spirit; cheering her on as she inspired her mentees all around the world.

In her words “I could save one or two lives at a time as an obstetrician, while I could save 100,000 lives by becoming a medical researcher. So, I decided to focus my research on areas that affect the lives of women, such as PPH.”

Professor Galadanci has done so much for us in Nigeria. She is a wonderful representation of what it means to be a physician, academic and a female role model from northern Nigeria. She is many firsts, but most importantly, I hope she will be remembered as the doctor who worked to reduce the number of women who died from bleeding during childbirth in her country.

A Professor of Obstetrics and Gynaecology Professor Mahmoud Fathallah once said: “Women are not dying because of diseases we cannot treat; they are dying because societies have yet to make decision that their lives are worth saving.”

Well, it seems that the world has finally woken up from its slumber.

Thank you Prof !

The greatest problem with bleeding after delivery is that it is often underestimated. The bleeding is often not detected until the woman starts pouring and then all protocols for arresting and correction of blood loss are implemented. Many a times the healthcare professionals are able to stop the bleeding, but when they are not, the effects are fatal.