I am just finishing up my 6th week (and 400th chart, hooray!) collecting data on post-partum hemorrhaging at Maputo Central Hospital (MCH).
To start, Maputo is the capital of Mozambique and is a large city. It has approximately 2 million people spread out over 130 square miles. MCH is the main public hospital serving all of Maputo City and Province and receives all of the most difficult cases. Therefore, as you can imagine MCH is huge! The hospital campus is approximately 4×4 street blocks and you can easily get lost within the hospital campus itself (its happened more than once). The maternity ward of MCH has an estimate of almost 10,000 births and serves all of the most complicated cases up to 100km away.
Post-partum hemorrhaging is a large problem throughout Mozambique and accounts for many maternal deaths. The ultimate goal of our study is to implement the use of Cryoprecipitate, a blood product full of clotting factors, and Tranexamic acid, a medication, to help prevent and stop bleeding. Cryoprecipitate is very easy to make, all you need is a centrifuge and a freezer, and we learned the only reason MCH has been unable to make cryoprecipitate is because their freezer has been broken. Therefore, Dr. Annette von Dryglaski, a hematologist at UCSD and PI of this study, was fortunately able to find funds to buy the hospital a new freezer to store Cryo.
Early in the trip we were able to meet with blood bank team at MCH and teach them about Cryo. They were excited to learn how to start producing it. We have also been working with Dr. Patricia, a Hematologist at MCH who has greatly helped implement this study. Dr. Patricia has many hemophilia patients who will also benefit from Cryoprecipitate.
However, before any of this can happen we have to determine how large the actual problem is. There have been virtually no previous studies done about rates of post-partum bleeding in Mozambique and there are no real records kept at the hospital. That is where I come in. For the past 6 weeks, I have been scouring as many charts as possible from the past 6 months for not only for deaths caused by bleeding, but also lab values, HIV status and any other factors that might contribute to post-partum hemorrhaging. However, doing a chart review here is really more of a full-on investigation. The first barrier is all of the charts are in Portuguese. I may not be able to have a real conversation on the street in Portuguese, but I can now tell you every Portuguese acronym an OBGYN would ever need to know. The second barrier, and arguably harder, is deciphering the handwriting. The stereotype of doctor’s having bad handwriting holds true in Mozambique as well. Lastly, getting the charts themselves and the correct charts can be a challenge. Thankfully, I have had the help of Momad, an OBGYN resident. Somehow, he finds time to help me request charts, decipher handwriting, and correct all my wrong google translations while also performing C-sections and seeing patients.
Sometimes charts come very organized… Other times they don’t.
Overall, I have learned so much in my short time in Maputo. I have learned a lot about not only research we are doing but also about working in a foreign country and staying flexible.