Infant mortality rate unacceptable

Dr Petronella Manning-Alleyne, head of the Port-of-Spain General Hospital’s Neonatal Unit, and Dr Jehan Ali, Head of the Gynaecology Department at the San Fernando General Hospital, put the blame on inadequate equipment. At the PoSGH, there are six monitors which are used to monitor the baby’s heartbeat, but only two of these are working — the other four need parts.

Dr Ali noted that, when the SFGH got new monitors, the rate of stillborn births and babies dying in the first week went down. In a country as wealthy as ours, it is absurd that a lack of proper equipment should be the cause of infant deaths. Yet we are not sure this is the whole story.

According to the Central Statistical Office’s Population and Vital Statistics Report 1999, our infant mortality rate is 18.6 per 1,000 live births. This is three times the average in developed nations, and among the worse of all Caribbean countries. Are we to assume that hospitals in Jamaica, Barbados, and St Lucia are better-equipped than ours? It may be so. It may be that these small island people understand that there is no greater tragedy than the death of a baby, and so modify their priorities accordingly.

But we suspect that the explanation is not in equipment, but in attitude. After all, ours is a country where the neo-natal ward at a major hospital had to be shut down. The reason was not a lack of equipment — it was because the staff did not keep the facilities as sterile as they should have been for newborn babies, several of whom died as a result.

The CSO’s report lists the following as the major causes of death in infants less than one year old, in ascending order: infectious and parasitic diseases; bacterial sepsis; congenital birth defects; intrauterine hypoxia and birth asphyxia; and respiratory distress.

Most of these deaths could probably have been prevented by adequate care during pregnancy and through more attention to basic procedures during delivery. Since the Patrick Manning administration has a particular liking for Cuba, the Government can take a page out of their book.

In the Cuban system, expectant mothers get family planning counselling, consistent care throughout their pregnancy, with doctors and nurses carrying out health education activities. Pregnant women also see specialists in obstetrics and gynaecology to evaluate and re-evaluate risk factors, at different moments during their pregnancy.

They receive a number of laboratory tests including haemoglobin, glucose screening, HIV, special tests for pregnancy-related disorders, and diagnostic exams to detect hereditary anomalies.

Furthermore, attention is paid to the nutritional status of pregnant women, who also receive counselling on childcare and breastfeeding. These measures have resulted in Cuba having an infant mortality rate of 5.8 per 1,000 live births, which is equal to or better than most developed countries.

There is no practical reason why Trinidad and Tobago cannot achieve the same. But we will have to change our attitude first, or else the babies will surely continue to die.