The Obstetrician & Gynaecologist 2007;9:2:126
doi: 10.1576/toag.9.2.126.27314
Copyright © 2007 by the Royal College of Obstetricians and Gynaecologists.
Commentary
Julian Woolfson, LLM FRCOG, Consultant Obstetrician and Gynaecologist1
1. RCOG
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Obstetric haemorrhage: one common problem, two very different outcomes
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 Obstetric haemorrhage: one...
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Although the papers by Duffy and Paterson-Brown deal with the same condition, obstetric haemorrhage, they highlight the huge disparity in the way in which they are managed in two very different hospitals: one in impoverished, rural Ethiopia and the other in affluent London.
Healthcare professionals all over the world know how obstetric haemorrhage should be prevented and treated but the disparity remains. This is not the result of ignorance or neglect on the part of the doctors, midwives and birth assistants but of the lack of resources, human and otherwise. In the United Kingdom there are many good local hospitals and an excellent emergency ambulance service, whereas in rural Ethiopia there are few facilities and those that do exist are often very difficult to reach. In London hospitals there are skilled staff, blood transfusion services and a good supply of equipment; in Gimbie, just about everything is in very short supply. In London, so few women die as a result of obstetric haemorrhage that they can be individually counted; in Gimbie the number is high enough to be expressed in percentage terms. In every respect the inequalities between the two places are enormous.
The well-worn phrase ‘Something must be done’ springs to mind. The problem, however, is that so much needs to be done: improving the local economy and education, providing healthcare facilities, elevation of the status of women, family planning and better communication. All are interlinked but one has to start somewhere.
As Duffy rightly says, developed countries have a responsibility not to actively recruit the scarce numbers of health care staff from developing countries. On its own, though, this cannot and will not remedy the situation. Nor, for that matter, is it just a question of money, for in the absence of a proper infrastructure it is unlikely that those who desperately need better health care will receive it.
So what can be done? As another well-known saying goes, ‘The longest journey starts with a single step’. The RCOG has recognised this by creating an International Office, led by the Senior Vice President, which is charged with improving women's health and maternity care in those countries that so desperately need it. Together with the Liverpool Associates in Tropical Health (LATH), the RCOG has taken this first step, bringing basic lifesaving skills courses to those countries that most need them. More information about international initiatives can be found on the RCOG website: www.rcog.org.uk/index.asp?PageID=1485
There is much to do and, sadly, it is likely that many women will die as a result of obstetric haemorrhage before the inequalities of health care are truly eliminated. Nevertheless, every single step brings the destination closer; one day, papers like Duffy's will become historical narratives.
