Celebrating a Year of Zigama Mama

 by Rachel

Many of you will remember that about a year ago, Eric and I helped launch a public health program for pregnant women in our district called "Zigama Mama."  The idea was to identify women with previous C/S and bring them in for a consult and ultrasound, with the end goal of improving care, decreasing uterine rupture, and decreasing maternal mortality.  Well, a lot has happened this year but we are really excited to say that despite everything else, we completed a full 12 months of ZM at the end of June.  I visited 16/17 health centers in our district (some QUITE a journey over rough roads) and we did exactly 500 ultrasounds, about double what we had anticipated.  

We invited all the head nurses from the health centers to come to Kibuye last week to present our first year of data and celebrate the intervention.  Some day we hope to publish this in a medical journal as well but here's a "first look" if you're interested!  Because uterine ruptures and maternal mortalities are, thankfully, relatively rare, we instead looked at how many women who had a previous C/S actually received a scheduled C/S (less risk to her and baby) instead of just showing up in labor and receiving a C/S at that time (more risky).  The numbers aren't perfect, but there was a significant improvement.  In the first table, you can see that we did a lot more C/S this year than 2017-18 when we collected our initial data.  But, more of them were scheduled instead of urgent which is also good.  The pie graphs below show the percentage of urgent (unscheduled) C/S decreasing between the 2 time periods.  

Lots of improvement, but lots of room for more improvement.  Overall, we are really encouraged by the results of the program, and it was good to get such positive feedback from the health centers.  Many barriers remain, most notably the women's transport fees to get to Kibuye for their free ultrasound...but also lack of education at every level, mistrust in the system, and other "life factors" from family pressures and needs. We are continuing to work with the health centers and hospital admin to find solutions and continue to try to get appropriate care for every pregnant women in our district.  We are so grateful to all of the health centers, nurses, district health officers, and doctors who have been a part of making this happen.  Our district health officer hopes to present this program at a national level so it can be replicated in other parts of Burundi as well.

The other good news is that we've decided to continue to program for another year.  The first year was funded by grants from the NICHE project (a Dutch NGO working to improve global education) and the Butterfield Foundation.  In the end, the total cost of providing ultrasounds to these ladies is less than $2000, so thanks to our supporters, we'll continue to fund the project.  It's been such a blessing to so many women, so thanks for your support.