Israeli Defense Forces deliver a baby at field hospital in Haiti
In a landmark article in this months Green Journal, Israeli and Canadian Ob-Gyns who deployed with international relief efforts to Japan and Haiti earthquake areas have summarized the lessons they learned in the field there.
The objectives of this report are to emphasize the often overlooked need to include obstetrics and gynecology personnel among essential medical aid rescue teams and to provide recommendations and guidelines for obstetrician–gynecologists who may find themselves working under comparable extraordinary natural disasters.
The article includes a list of recommended supplies (and amounts) to bring, and a layout for an Ob-Gyn field hospital. While I urge you to read the entire article, here are excerpts from their 10 essential lessons learned –
1. An obstetrics and gynecology team is invaluable however scarce its resources, because the provision of even the most basic prenatal care plummets after a natural disaster. ..as many as 10% of the victims seeking medical assistance may need an obstetrician–gynecologist.
2. The mix of cases that the obstetrics and gynecology team will confront requires that they are highly trained specialists prepared for and trained in dealing with emergencies in a suboptimal environment. Miscarriages, premature deliveries, intrauterine growth restriction, low-birth-weight neonates, gender-based violence, and undesired pregnancies increase after natural disasters….Approximately 50% of the cases the Israel Defense Forces hospital team encountered in Haiti were complicated deliveries.
3. Preparations for treating extreme prematurity should be made before departure to the disaster zone. … increased seismic activity could increase delivery rates and preterm births up to 48 hours after an earthquake and a significantly higher rate of premature births was reported over a 7-month period in the wake of the earthquake in Japan.
4. Foreign aid relief teams operating in a disaster area will inevitably encounter unique and difficult ethical dilemmas, often arising from insufficient medical resources. … not every victim in need would be able to receive the necessary treatment. … the dilemma of whether to impose a minimum weight threshold for preterm neonates to receive treatment is an ethical issue, which obstetrics and gynecology teams operating in natural disaster conditions should be prepared to deal with.
5. Obstetrics and gynecology teams treating pregnant women under natural disaster conditions should be especially sensitive to the catastrophic environment’s effect on maternal mental health.
6. Indications for cesarean delivery in a field hospital … will differ from the typical paradigm. … For example, fetuses in breech presentation with estimated birth weight less than 3,500 g were to be delivered vaginally. …with only one available fetal heart rate monitor, monitoring had to be carried out intermittently, possibly meaning some abnormality might have been missed. Potential contingencies such as these must be addressed and discussed before the team is deployed.
7. The delivery “suite” should be prepared for emergent cesarean deliveries in the event that a designated operating room may not be immediately available.
8. The likelihood of quickly obtaining additional equipment and medications is remote once the team has arrived to the disaster zone; …a list of recommended essential equipment and medications for obstetrics and gynecology relief teams is provided.
9. An outreach obstetrics and gynecology team with a portable mobile ultrasound machine including vaginal and abdominal probes not only detects problematic pregnancies, but also provides enormous psychological comfort to pregnant disaster victims.
10. The team must be briefed by someone knowledgeable about local cultural sensitivities and taboos, including local volunteers who serve as translators.
Kudos to the authors for providing an essential global resource for disaster planning.
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Image from Wikipedia
Not ONE mention of the role of midwives?!