Mariam (not her real name) has always been an incredible older sister to her younger siblings. Since their mother passed away in a car accident, her father had made her the matriarch of the family and she was tasked with taking care of her younger sisters. From primary school through the university, she was always there. When they each finished NYSC, when they got their first jobs, when her youngest sister got married – she was always there. Supporting, cheering, and encouraging. She believed in the strength of family and never denied her sisters any help.
Then her immediate younger sister, Ruqayah, died just after giving birth to her first child. “She lost too much blood because something ruptured during the delivery and they couldn’t find blood to give her. That’s what the doctors told me,” Mariam told me, visibly fighting back a tear. “It was the most painful thing I’d ever experienced. She was the smartest amongst the three of us and she had such a bright future ahead of her.” Mariam became depressed and she would often cry for hours on end. She still mourns till this day, two years after.
Her sister’s death drove Mariam to dig deeper into the cause, especially when her youngest sister, Fatima, got pregnant. Mariam obsessed over what her sister ate, how she slept, antenatal care and even the kind of places she went to. “Her husband will call me aside sometimes when I go to their house and say I should relax; that Fatimah knows what she’s doing and that he’s supporting her,” she said, with a smile. “I know I was definitely intrusive and everybody was tired of me. But I just couldn’t imagine what happened to Ruqayah happening to Fatima too. Even my husband was complaining.” She laughed this time.
Despite her best efforts, Fatima still went into postpartum haemorrhage during the delivery of her child. Thankfully, Mariam was prepared. She’d found a blood bank and confirmed that they have her sister’s blood type so when the doctor told the family that Fatimah needed blood urgently, Mariam simply made a call. In no time, the blood had arrived and the doctors were able to save her sisters’ life. “I was so proud of myself,” said Mariam with a chuckle. “Of course my sister is one of the strongest people I know so that helped as well. I’m just happy that we left that hospital on a positive note.”
Postpartum haemorrhage (PPH – defined as blood loss of 500ml or above) is the leading cause of maternal mortality globally and ~99% of incidents happen in developing countries. It is often referred to as an “obstetric emergency”. PPH could be caused by loss of tone in the uterine muscles, a bleeding disorder or the placenta failing to come out completely or tearing. It’s hard to prevent (there are cases where Oxytocin, a blood clotting agent, don’t work) and even harder to predict.
Thanks to factors like poor healthcare infrastructure and insurance, insufficient blood banks and healthcare logistics systems, over 100,000 women are estimated to die from PPH yearly in Nigeria. Only about 34% of African births happen in a hospital and 5 in every 100 women is the global PPH occurrence rate. Meanwhile, the top 20 countries in the world with the highest maternal mortality rates are in Africa. Which means PPH as a factor in maternal mortality is a very serious problem that requires urgent attention.
There is a wide array of recommended techniques through which PPH can be managed (including oxytocin mentioned earlier). However, blood transfusion is still regarded as the most effective way to reduce maternal mortality through PPH provided it is detected early. This means that Africa needs robust healthcare logistics and infrastructure to be able to provide professionals and women access to blood and required medications efficiently when these cases arise. Lives literally depend on it.
How Is Technology Solving This Problem?
Startups like US-based Zipline and Nigeria-based LifeBank are already doing great work in the healthcare logistics space. Same with Nigeria-based blood bank locator app Redbank. In 2017, Lifebank announced it had moved 9,000 pints of blood to 200 hospitals and saved over 1,000 lives in 24 months of operation. That’s real life impact.
“It was clear that people were dying en masse in hospitals across Africa, and the developing world, simply because their caregivers could not find the products they needed on time and in the right condition. We thought that was unacceptable,” said LifeBank founder, Temie Giwa-Tubosun, in a seed round announcement in February.
I agree with her. Hundreds of thousands of women dying yearly before, during and after childbirth because they do not have access to needed remedies at the right time is unacceptable. And technology can help change that as the aforementioned startups have shown.
Unfortunately, there aren’t very many healthcare logistics startups in Africa, at least not enough to make a dent on the problem (in Nigeria, we could only find three). Africa needs better healthcare infrastructure and investment/capacity building in skilled entrepreneurs that can run successful and impactful healthcare startups. Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth worldwide, with Africa leading the chart. Meanwhile, maternal mortality dropped by 44% between 1990 and 2015 in the rest of the developed world. We can get there.
Government, the private sector, investors, healthcare professionals and entrepreneurs need to commit to building the Africa we desire for our unborn children. We have to pay attention to our most pressing problems and stop taking the lead in negative metrics. We need to pay attention to the startups, entrepreneurs and legacy businesses building great solutions and support them however we can. Only together can we overcome challenges of the past and shape the future.