I was reviewing some documents to spin up my knowledge and understanding of healthcare in Ethiopia. There were project field reports, lots of official documents, studies done by outsiders, and a set of PDF files showing blank forms from health registries. These included pages listing details on deliveries, immunizations, and family planning. As part of my review I was popping the files into a note and making comments based on what I read. The PDF registries usually needed to be rotated to help me read them, and I wondered why they were always in portrait view when landscape was clearly how they were read and used.
I had seen such registries in other African countries, usually in an office that doubled as treatment room. They were often in bound volumes where the clinician made entries for each visit, usually one row per patient. I asked what happened to the volume when it was full, and the nurse speaking with us gestured to a cardboard box on the floor saying that they went there. After that, she was unsure. Later I figured out that they were taken to the next higher level in the health system where some of the data was entered in a database. The idea was that these data would be used to understand the shape of health demands and services delivered. They used them for managing their limited human resources for health to have the greatest benefit to the largest number. One area that was high on the priority list was maternal and infant health.
So, it was not surprising that the document in Ethiopia would include a postnatal registry. The page included identification information, mother’s age, infant’s birth date, sex, postnatal visit number, and different aspects of the mother’s and baby’s health. But I stopped scanning when I read Column 17, headed “Dead (age in days)”.
A world of meaning crowded into that little cell on the page. My first thought was sadness that this was how the baby’s death was recorded. The joy of the mother cut short before even getting to know her baby. The father’s grief upon learning the baby’s fate. Then other thoughts stole in.
Easy to fill in.
Just a number is all that’s needed.
No cause of death.
Just fill in the number of days the baby survived.
They needed to print a column heading with “Dead (age in days)” at the top.
Statistics have meaning and mystery. They offer both information and emotion--at least when we let the feelings in.
The solutions to this daily tragedy are understood, but still not applied everywhere. Until they are, my thoughts will stop whenever I remember that page.