Dr. Idara Umoette is a medical doctor and the founder of BirthSafe Nigeria, a maternal healthtech company focused on improving the survival rates of women and babies in pregnancy using digital antenatal services. In this interview with ANIEFIOK UDONQUAK to mark this year’s International Women Day which is on ‘inspiring inclusion’, she spoke on a number of issues. She said that technology could be used to reverse the persistent high maternal mortality numbers; emphasised the importance of including proactive measures in safe motherhood conversation, among others. Excerpts:
How does proactive care help in effective healthcare delivery?
If you’re complaining that women don’t show up in hospitals for antenatal care till it is too late, the solution is not to sit down and wait for them to come. You have to be proactive by finding out the root causes, why the women are not coming for antenatal services in health facilities. What are the factors that are keeping them away from coming? Is it infrastructure? Is it culture? Is it religion? Is it a lack of funds? Is it the lack of quality care in the hospital? These are the non-tangible things you can do that will yield tangible results.
When did you realise the importance of proactive care in healthcare?
I have been a big proponent of proactive health care for as long as I can remember. When I started practicing, doing the rotation from department to department, I was given the responsibility of overseeing, alongside other doctors, operations in the newborn unit. That was the first time I had the opportunity to implement proactive care. This is because I noticed that we had children from well-to-do families and babies from families that were not so well-to-do. Now a lot of the issues that these children faced, they required prompt medication intervention.. A minute delay was too costly, so I told them that no child was going to die under my care. I saw that for some children, their parents could provide more than enough medication , meanwhile the child in the course of treatment did not need that much, and there were other children that did not need any at all. I sat down with the nurses and told them what we were going to do. We were going to gather all the medication, both the ones that were bought in the exact amount and the ones that were bought in excess and make sure it covered everybody. Since these children had unique sizes – meaning that one child could use less of the medications while others could use more, instead of wasting them,we gather everything in the bank and serve the children, and then make a list of those that did not buy and put pressure on them to get their prescribed medication. So we created that system, every medication went round, no child was left unattended to but the mothers did not know. Some of them would actually bring, others would not bring. However, those that brought were always more than those who did not bring. Until I left, we did not have a single case of fatality. That was the first time I combined the theory and the practical aspect of saving lives through proactive health care, because every child got the medication they were supposed to get. So, I’ll say that proactive care is cheaper, faster, easier, time saving and produces results.
If proactive care is so important and critical, why is it not being implemented?
This is what BirthSafe is all about. BirthSafe will disrupt the way antenatal and maternal care is accessed. We are democratising access to antenatal care. I have been on both sides of the divide. I have been the doctor with 70 patients’ to attend to and I could barely tell a patient ‘good morning’ because I was pressed for time. These patients need to understand why they are asked to do certan things. ‘What is the implication for me and my baby? How often should I do it?’
They need more explanations than they are getting in the hospital, and I’m not talking about Nigeria only, I’m talking about Nigeria and the diaspora because we are serving thousands of women across 16 countries and the complaint is the same: “I am not getting enough information.” You know that Nigeria is not the only country where doctors are in short supply. Doctors are in short supply in so many countries and the available ones are overworked and underpaid. There is no time for most doctors to catch a patient and sit her down, give her an hour and say, “You will do this and so on.” It is ne impossible.
How does obstetric care come into the picture?
Obstetric care is unique. A woman is expected to see a doctor when she is pregnant and a hospital would accept her for antenatal care. If the hospital is benevolent, antenatal care could start from 13 weeks. If not, It may start from 14,15,or 16 weeks, During this time frame, a lot of things could have already gone wrong. For instance, black women are about 40 percent more prone to miscarriage than white women because of their genetic makeup. They have unique problems like fibroids,sigh blood pressure in pregnancy etc. These are the things that can take out pregnancy from the first trimester but you are not seeing that woman in her first trimester, you are telling her to come when she is sixteen weeks gone. So, if she loses her pregnancy and you tell her “Oh madam sorry, try again” without investigating and finding out why she lost the pregnancy so that the cause can be attended to next time, she still has no clue as to what to do right.
She gets pregnant again and is fortunate that the pregnancy stays beyond 13 weeks and she comes to your hospital. You give her an appointment and you see her once every month till she gets to 28 weeks. You see her from 28 weeks every two weeks. Then you start seeing her from 36 weeks once every week. In all this time, she hasn’t gathered enough information. If anything goes wrong, no matter how good the hospital or doctor, she is the primary custodian of that child. The doctor cannot follow her home ( but now, BirthSafe can follow her to her home to monitor things.)
Due to the hyperdynamic nature of pregnancy and how the things you would least likely suspect can take out a pregnancy, these women have to be monitored more regularly. If you are talking about environments where emergency services are available, then these cases can be better managed. However in our society, just imagine the situation in Lagos, and you are calling for emergency care , that is an ambulance to get to you and there is a traffic gridlock, paint that scenario for me, how will it work? Or you are in a community that is three hours aways from a health facility.
Proactive care is the answer if we are going to beat this maternal mortality problem that we have. Since the cost of getting infrastructure is high due to other competing sectors like agriculture, education and many more, BirthSafe is already plugging in these gaps. What are the things that can cause a woman to lose her life in pregnancy and childbirth? What does she need to know? What does she need to do? How does she need to do it? When does she need to do it? BirthSafe is giving the type of antenatal care, training and preparation that even hospitals in the Diaspora are not giving because their patients are coming to us.
So how does Birth Safe work in reality?
It is a digital platform. For instance, If you want to travel by air and you can book your ticket online, you go to the airport, show your ticket and then you fly. That is the same way Birth Safe works, our women get the antenatal preparations and training, then they go to their hospitals with the right knowledge. The hospitals are so amazed that they are asking them; “How do you know these things?’’ They are looking at the papers and documents given to them at the hospital and they are no longer blank documents. These documents are now speaking to them because they know what to look for in their in their Blood Pressure, if their cervix is so-so number at this stage of their pregnancy, if their pregnancy is in danger. A woman with this knowledge has saved that pregnancy because of what she now knows, and the doctor would then agree with her on how best to manage the situation. It is a symbiotic relationship helping the hospitals to help the women better. We are helping our women get more value from the hospitals and we are saving the lives of both women and children.
Your services obviously seem to target the super rich families that can afford digital services.
No, that is why our mobile application platform is launching because this has been a concern to us. People who are economically challenged also need to have safe motherhood. They need to have safe pregnancy and childbirth too. Our app is bringing the cost of super antenatal care down. For less than the price of five cups of garri a month, a woman can access the antenatal training and guidance that she needs to take care of her for that particular month. I think it is very fair.
How are the women going to be aware of the services?
We have media partners. We also have to partner with governments across multiple levels and other media agencies to get the word out that women can do better in pregnancy, that they don’t need to operate blindly. As a pregnant woman, there are things you can know and things you can do to safeguard that pregnancy, and this does not need to interrupt your life. You know that women are very robust in terms of economic activities, they move from place to place. So while she is moving from place to place, all she needs is to have access to a smartphone and data- that’s all. Antenatal guidance on tap.
Also, it doesn’t matter if she doesn’t have a smartphone, she just needs to have an account with BirthSafe and she can access her account through a third-party smart device.
How serious is the issue of maternal mortality in Nigeria?
Nigeria is the fourth largest contributor to the maternal mortality numbers worldwide. Every two minutes, a woman dies because she tried to give birth. This is not a woman problem but a humanity problem. If we are talking about maintaining equilibrium in society, then we have to look at the family unit. What is the traditional family unit? It involves the man, wife and children. The woman is the primary caregiver, traditionally- in terms of nutrition, healthy living and moral education. If you take her out in the family, things will start to go wrong. If we are serious about achieving Sustainable Development Goals (SDG), we have to start with maternal care. You want to get immunisation scaled up? Let the mother live. You want to stop under five malnutrition? Let the mother live. How about out-of-school children? Let the mother live. Teenage pregnancy? Let the mother live. BirthSafe is here to let the mother live.
