Obstetric and gynaecology case and comentaries

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University of Dar es Salaam
Dar es Salaam has a population of about one million people and is served by three district hospitals, Temeke, Magomani and Mwananyamala. These three district hospitals cater for several dispensaries within their catchment area. There are also several private hospitals and dispensaries within the town which offer maternal and child health services. There is not domiciliary practice but with introduction of health for all by the year 2,000 it might become an important part of our obstetric services. Muhimbili Consultation hospital is a referral hospital for the East and Southern zone of Tanzania; it also serves the whole country for some special services that are not available in the other consultant hospitals of K.C.M.C. and Bugando such as radiotherapy. Muhimbili also serves as a regional hospital for the city of Dar es Salaam. The Muhimbili Medical Centre holds the New Materiality Block with 296 beds and two gynecology wards with a bed capacity of 73beds in addition to pediatric, surgical, medical and psychiatric ward. All women with normal pregnancies and have attended their materials clinics in the dispensaries deliver at Ocean Road hospital. All our statistics for the obstetric services in New Maternity Block usually include the Ocean Road hospital. Ocean Road hospital also provides outpatient care for workers in Government and Parasternal Organizations. It has two post natal wards and one ward for patients on cancer treatment. The New Maternity Block provides antenatal, delivery and postnatal services to all at risk patients referred to the Centre and also to all grade one patients. Patients in the New Maternity Block and Gynecological wards are attended consultants, specialists, residents and intern doctors. Most of the district hospitals have graduate general duty medical officers. The health centers and dispensaries are supervised by medical assistants and rural medical aids respectively. Facilities in our three district hospitals and the consultant hospital are far from adequate. The new facilities provided cannot be expanded to meet the increased demands brought by village exodus; due to overstitched budgets in developing countries. The New Maternity Block; has one labour ward with 20 bed, one theatre which is not fully untilised and a small laboratory. A sideroom in the labour war houses our ultrasound machine and other electronic fetal monitoring devices. Our obstetric services are very strained by inadequate blood bank facilities, lack of staff, transport and drugs. All the three district hospital rely on Muhimbili Medical Centre bank. Only two private hospitals, Aga khan and Hindu Mandal have their own blood bank facilities. The important of having a separate blood bank for the maternity block is realized through the implementation has already ancoutrered both financial and administrative constraint. 2. OBSTETRIC SERVICES Detection and screening for at risk factors is primarily done at the peripheral antenatal clinics. Those patients with risk factors on booking or who develop complications during the pregnancy or during delivery are referred to New Maternity Block. Ideally all referrals from the dispensaries and health centers should be directed to the district hospitals but the absence of surgical facilities at these hospitals necessitates direct referral of most of the obstetric emergencies form the dispensaries to New Maternity Block. Once these facilities are provided and a co-coordinating committee for material services in Dar es Salaam is formed the careening would be smoother and the congestion is New Maternity Block would possibly be lose felt.
Available in print form, East Africana Collection, Dr.Wilbert Chagula Library, class mark (THS EAF R5529.M33)
Obstetrics, Gynaecology, Cases, clinical reports, statistics
Mberesero, B. s (1977) Obstetric and gynaecology case and comentaries,Masters dissertation,University of Dar es Salaam, Dar es Salaam.