By Alisha Horowitz
Maimouna Sow has seen firsthand the devastating consequences for women with no access to family planning methods. During her six years as an auxiliary nurse at the Hospital of Macenta in the West African country of Guinea, she has saved the lives of women seeking care from complications of miscarriage or induced abortion, including those who have taken drastic measures to end unplanned or undesired pregnancies. Sow, 41, is among those at her facility leading the charge to ensure that women receive lifesaving care.
In rural health facilities such as Macenta, nurses are often called upon to do a range of tasks–from attending to a sick child to performing surgical procedures. Sow has learned to perform C-sections, for example, and to provide post abortion care (PAC), family planning services, and linkages to other reproductive health services through training supported by Jhpiego, an affiliate of Johns Hopkins University.
In Guinea, abortion services are provided only “to preserve health,” according to “The World’s Abortion Laws 2012” by the Center for Reproductive Rights. Women who lack access to family planning methods may take measures to terminate a pregnancy by going to an unqualified provider and end up at clinics like Macenta. “This is really about taking care of an emergency situation and saving a woman’s life at the frontline,” says Ricky Lu, MD, Jhpiego’s director of reproductive health and family planning. But the family planning counseling begins as soon as she is stabilized. “After the emergency and before she goes home, it is important to ensure that the woman does not find herself in the same situation–at the brink of death again.”
Jhpiego’s initiative in Guinea began in 1998 in the country’s Forest Region, and has since expanded nationwide in collaboration with the Ministry of Health. Macenta–a two-and-a-half-day ride, generally by privately owned village taxi, from the capital of Conakry–is among 37 sites now providing PAC services in Guinea. “The introduction of PAC services in Guinea was important because complications of abortions contributed to a 17 percent maternal mortality ratio [according to a 1999 Demographic and Health Survey],” explains Yolande Hyjazi, MD, Jhpiego’s Guinea country director.
The surgical procedure most commonly used to treat complications of induced abortions, sharp curettage, is not easily accessible, given the limited number of physicians in Guinea. As part of the introduction of PAC services, Jhpiego has taught the technique of manual vacuum aspiration to providers such as Sow, allowing for task-shifting to other health care cadres, including nurses.
Sow has put her Jhpiego training into action daily. She recounts the case of a woman who came to Macenta with serious complications from an induced abortion. Sow was part of the team that operated on her and provided follow-up care. “With the help of all providers and relatives, we were able to save this young woman,” Sow says with pride.
The Guinea initiative is funded by the U.S. Agency for International Development’s global flagship Maternal and Child Health Integrated Program, which is led by Jhpiego.
“She has confidence in what she does,” says Tsigue Pleah, MD, senior technical advisor at Jhpiego, who trained Sow.
“Thanks to this training, we’ve perfected our skills,” Sow says.