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Local facilities save lives.


 A pilot project that was instituted by the Ministry of Health in the Ivory Coast placed an obstetrician/gynecologist in the Divo City maternity hospital in October 1982. Prior to the appointment, 10 midwives handled normal deliveries in the 31-bed facility; obstetric emergencies were sent to the Cocody teaching hospital which was 190 km away. After the appointment, women who required caesareans and blood transfusions did not need to be transferred. Other hospitals also sent cases to Cocody, including one at Agboville where caesareans were not usually performed (although a gynecologist became available in 1984), and another at Yopougon where no obstetric surgery was performed. An investigation, which compared the number of maternal deaths in 1980 with those in 1985 for the 3 hospitals, showed that 8 of 65 women referred from Divo in 1980 died because they arrived too late for emergency treatment at Cocody. In 1985, no emergency transfers were necessary, and only 1 woman died at Divo; Agboville referred substantially fewer cases to Cocody, and there was a corresponding fall in the number of women who died; and at Yopougo, where facilities remained unchanged, the number of transfers and fatalities did not change significantly. Because of these findings and the scarcity of doctors, particularly in rural areas, midwives and nurses may be required to perform some of the essential obstetric functions. Nurses in the Rural Health Zone of Karawa, Zaire were trained to do ceasarean deliveries, laparotomies, and supracervical hysterectomies. Their case fatality rates were comparable to physicians.
