Atsede Clinic

Vision

A rapid response service run by highly-trained midwives designed to manage maternal and neonatal emergent and critical cases.

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The Situation

Despite the steps that have been taken over the previous decades to reduce maternal and neonatal morbidity and mortality, childbirth in Ethiopia still remains one of the most dangerous times of a woman's life (lifetime risk 1:27, WHO, 2017). Government initiatives such as the maternity waiting homes and the IESO (integrated emergency and obstetric surgery) training programmes have contributed to the level of care high risk women receive during labour and delivery, but out-of- hospital emergency situations still pose a huge challenge. More than two thirds of the world’s maternal deaths occur in Sub-Saharan Africa, and many of these are preventable, if timely and appropriate interventions are available (WHO, 2018). There has been a plateau in the success of reducing MNMMR (maternal and neonatal mortality and morbidity rates) across sub-Saharan Africa, despite it remaining a core component of the SDGs, and at the forefront of many Ministry of Health policies. Discussions with medical and midwifery staff across the area have identified that it is now pre-hospital care that needs to be the target for intervention and improvement.

The lifetime risk of dying from childbirth in Ethiopia is 1:27.

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In Cheha woreda, Gurage Zone, with a population of almost 250,000, there are just two government “ambulances”, although more accurately these are simple transfer vehicles. They are not stocked with any equipment or medication, and are not staffed by paramedics, but by a driver without any clinical knowledge. Whist patients are sometimes accompanied by a referring nurse, even they do not have the appropriate training or expertise to manage the specifics of maternal and neonatal emergencies. Significant morbidity could be avoided were the knowledge and equipment readily available for interventions.

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The Project

 

Objectives

The Clinic now seeks to fill an important gap in service provision, with the creation of The Midwives’ Ambulance, a custom designed and equipped ambulance specialising in stabilising and transferring critical or deteriorating maternal and neonatal patients.

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The Land Rover (because of the difficult terrain, the vehicle would have to be of this calibre) would be fitted out with the clinical equipment and medication necessary to manage all major emergencies. For women and babies not well enough to transfer, it will also be able to serve as a immediate treatment unit. The midwives would be able to perform a thorough assessment of the situation, initiate life- preserving treatment, and call ahead to the accepting hospital so preparations can be made. The Clinic already operates with close ties to the referral hospital.

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As well as providing specific maternity services, the creation of this ambulance would then also free up the government ambulances to respond to general calls.

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Operations

The Midwives’ Ambulance is a specficially designed and equipped ambulance specialising in stabilising and transferring critical or deteriorating maternal and neonatal patients.

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The Midwives’ Ambulance would be run from the Clinic, where we already have office space for call handling/ administration, and a secure place for the ambulance to be kept when not in use, but would respond to calls from all over the area. The Clinic midwives would initially staff the ambulance on a rotational basis, giving training to two midwives who would then become the full-time ambulance midwives. Unlike the government ambulances, the driver of The Midwives’ Ambulance would also be a trained paramedic, able to assist the midwife where necessary. We have already identified a young man who wishes very much to become a paramedic-driver, and has been accepted for experience in Addis Ababa.  The Clinic has assembled a panel of midwives and obstetricians who, between them, have over a century of experience working in low resource settings. The panel will be responsible for drafting and maintaining the clinical protocols and guidelines that will guide practice.

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We are now seeking 25,00 supporters to each give just £10. This will be enough to bring The Midwives' Ambulance to life. This will cover the cost of buying a Land Rover in the UK, customising the inside, shipping it to Ethiopia, and stocking it with equipment and medication.

For each £10 donated, the donor's name will be painted on the wall of offices.

For each £100 donated, the donor's name will be painted on the ambulance itself.

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Every donor will also receive regular updates, newsletters, photos, and notes from the staff at the Clinic, and will be invited to join a Facebook Group just for donors, where further information will be available!

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