Global Health and the Indian Health Service

1
Global Health and the Indian Health Service

• Improving Maternal/Child Health in Afghanistan
• CAPT Patrick OConnor, MD, FAAP
• Indian Health Service

2
Afghanistan Health Initiative

• History
• Setting
• Challenges
• Plans

3
Maternal Mortality in Afghanistan, 2002

• Ranged up to 6500 maternal deaths per 100,000
  live births (highest ever recorded)
• Averaged 1600 throughout Afghanistan
• Was considered a crisis in the USA when rate rose
  to 13 in 2004
• If a mother died after a live birth, 75 of
  infants would be dead by one year old

4
How HHS Got There

• 2002 Secretary Tommy Thompson
• 2003 First IHS Clinical Team
• 2004 to Sep 2007
• Sep 2007 Reassessment
• 2008 IHS Clinical Team Formed

5
(No Transcript)
6
The Setting
7
(No Transcript)
8
(No Transcript)
9
Rabia Balkhi Hospital
10
Rabia Balkhi Hospital

• Ob/Gyn, Surgery, Medicine
• 50 deliveries/day
• 18 Faculty, 55 residents
• 65 midwives
• 6 ORs
• 5-10 c-sections/day

11
Nursery
12
Labor Room
13
Challenges
14
DIAGNOSES AT RBH OVER 3 WEEKS IN 2008
15
The Resources
16
The Plan

• US-Style Residency Program
• Quality Assurance Collaborative on Cesarean
  Sections
• Medical Records!!
• Development of Mini-system/Referrals
• Public Health Infrastructure
• High Risk OB Fellowship
• Model system for Kabul/Afghanistan

17
IHS Involvement

• FTE Ob/Gyn
• FTE Medical Epidemiologist
• FTE Pediatrician
• FTE Anesthesia
• OR Nurses and Scrub Techs
• Midwife
• Rotating Ob/Gyns
• Pharmacy, Lab, Radiology

18
(No Transcript)