Cama Hospital’s neo-natal ICU provides quality care

MUMBAI: The unborn baby was in distress. Doctors at the government-run Cama Hospital for Women and Children monitoring the eightmonth-old foetus realised that it was not getting enough blood and oxygen supply.
Its survival was in jeopardy, warranting a caesarean section.
Five years ago, this medical emergency would have put the doctors in a dilemma.
The lack of adequate intensive care facilities could have compromised the baby’s survival, even after the operation.Not any more. Over the past few years, the hospital’s neonatal intensive care unit (ICU) has demonstrated high standards of quality care through low-cost technology.
In the case above, which occured two months ago, the baby—though weighing only 1,500 gm—was saved. He is now thriving.
Cama Hospital, which primarily provides pregnancyrelated services, is emerging as a success story in the city’s public health system. It has become a refuge for the poorest patients of the city who are at high risk because of the twin maladies of malnutrition and anaemia.
The success comes from its declining graph for perinatal mortality—a category that clubs figures related to still births and newborn babies who die within a week of being born.
In this hospital, which assists on an average of 4,000 births a year, perinatal deaths used to account for more than 70 per 1,000 births.
In the past five years, however, the figure has dropped to around 57 per 1,000 births. The decline appears to be consistent, and is taking place with minimal additional inputs.
The hospital’s declining perinatal mortality graph is a trend seldom seen in government-run hospitals. It provides compelling evidence of how standardised treatment protocols along with innovative and caring management by ward staff are often the elements missing in public hospitals.
Ashok Anand, obstetrician at Cama Hospital, explains how supportive paediatric services can make a difference in enabling timely obstetric interventions.
“In normal pregnancies, no incubator is better than the mother’s womb. But if that environment turns hostile to the foetus for a variety of reasons, then the baby has a better chance outside—provided a high quality of paediatric service is assured. Timely action can reduce long-term damage (such as hypertension or heart disease) that affect low birth weight babies,’’ he said.
The development of supportive services at Cama Hospital enabled obstetricians to take more “liberal decisions’’, Dr Anand said.
For instance, a decision to go for an immediate caesarian operation in a situation where the benefits outweigh the risks was made with the security of knowing that supportive paediatric care was assured, ensuring the premature baby’s survival.
“While gadgets and technique play a part, tender, loving care is the most important factor at work in this field,’’ he said.
In the struggle to achieve quality health care despite the resource crunch plaguing public hospitals, Cama Hospital has also developed a new way to measure quality.
Infant mortality, or death in the first year of life, is deemed the most sensitive indicator of a country’s development and the quality of its health system.
But the Cama Hospital experience shows that an improvement in perinatal figures is the true indicator of pregnancy outcome, where the baby’s survival is assured despite complications suffered by the mother.
The measurement of perinatal mortality also reflects the performance of a hospital and the concern of the community, say hospital doctors.
Subhash Daga, associate professor of paediatrics who is in charge of the neonatal ICU at Cama Hospital, explained,
“The tendency of only taking into account the infant mortality rates, without considering perinatal mortality, is smudging the true figures, and the hospital’s evidence of an efficient response.’’ Quality care has not always been a part of Cama Hospital’s routine.
In 1994, it made headlines for scandals related to poor services and high mortality rates. The hospital’s records reveal the abysmal state of affairs that existed upto 1995.
But it made an amazing turnaround after 1998,when a committed team of doctors began trying out newly emerging thinking related to low-cost technology and standardised protocols in treatment interventions.
Improvements focussed on simple, low-cost interventions in the neonatal ICU. The management decided to keep the ICU warm, using simple room heaters.
The doctors evolved standard procedures for feeding babies, particularly in the first few hours of admission, and providing oxygen supply. Protocols were also laid down on how medicine dosages were to be worked out according the weight of the baby.
These provided staff members with a rapid check-list at the time of an emergency admission. These measures paid dividends.
The poor felt confident of their children’s survival and admission and bed occupancy rates improved.
In the past, junior doctors and nurses had often been confused in their response. The teamwork of members from two medical specialities has helped, said Dr Daga.
Timely interventions by obstetricians has led to a better paediatric response, which in turn has ensured survival of the baby, breaking the earlier cycle of inadequate intervention and coordination, he added.