The well-paved roads of General Santos City hint at its steady progress toward development. The city’s slogan, Magandang Gensan, strategically hoisted throughout various spots in the city and government buildings stand both as a constant reminder of the city’s collective desire for a good quality of life and testaments of the paths it has taken to get there. “The people of Gensan are very competitive but in a manner that is laid-back. It’s a paradox but perhaps this is why General Santos is a little bit more open to new practices,” Mayor Darlene Magnolia R. Antonino-Custodio. This openness to change has been key to inroads made by EINC in the city of General Santos. Also worth mentioning is the local government’s commitment to Millenium Development Goals to reduce maternal and infant mortality by the year 2015 that has made EINC the new standard of care for mothers and their newborns in the city and nearby areas. Such that some mothers giving birth even at the lying-in centers proudly remark, “na-Unang Yakap ako.” After only four months since EINC training was held in General Santos City, the infant mortality rate at the General Santos City Hospital has already dropped to 0.96% as of July.
Upon training, the General Santos City Hospital (GSCH) immediately embraced the program. While it had to contend with the usual challenges of convincing the hospital’s private consultants, its staff and the whole hospital is eventually learning to imbibe a sense of ownership and pride in the program. Determined to set a precedent for the region, GSCH is working hard to maintain its >90% performance of complete EINC core steps in all of their deliveries. By end of July, 90.79% of all deliveries have been performed with complete EINC.
The GSCH opened its doors in 1975 and became LGU-operated since 1991. A Level II hospital with tertiary functions, GSCH has a 100-bed authorized capacity but has 261 implementing beds. It caters to approximately 261 in-patients and 100 outpatients daily. Newborn deliveries comprise 22% of the total admissions in 2010. Being the only government hospital within “SoCCSKSaRGeN” (South Cotabato, Cotabato, Sultan Kudarat, Sarangani and General Santos) area with better facilities, it also caters to patients from other neighboring municipalities such as Sarangani Province, South Cotabato, Sultan Kudarat and Davao del Sur. Likewise, it also serves as a training facility for six affiliated nursing schools and six midwifery schools across the region.
“We embraced it (EINC) right away, the hospital has since been following the protocol. We’re having some difficulties in convincing our colleagues from the private practice but little by little, they are learning to embrace it too,” Dr. Charlie Alcaide head of the OB department shares. Dr. Connie Lu adds that it’s only normal to expect some resistance at the beginning since “you’re challenging their comfort zones.” But as soon as the benefits of EINC program were fully appreciated, the nurses, doctors, and midwives eventually learned to adjust. Dr. Alcaide adds, “You really need to convince them that what they’re doing is a serious matter.”
Since implementing EINC in April, new hospital policies, physical arrangements, staff reorganization and revised doctor’s orders have been put in place to reflect this new standard of care. For instance, wooden wedges have been custom-made and fitted under the delivery beds to allow mothers to comfortably deliver in semi-upright position. As a result, by end of July already 85.93% were able to deliver in semi-upright position. Despite the limited space of the labor room, 79.01 % of patients had position of choice during labor while 87.65% of the deliveries during the same period were allowed to have companions of choice during the 1st stage of labor. And if space were not an issue, companions would be allowed to join the patients even at the delivery room. Additionally, the cribs at the ward have all been put away as babies are now directly roomed-in with their mothers.
Dr. Lu further adds that since EINC, the staff had been eased of some the tedious workload as unnecessary interventions such as cord-care with alcohol, routine prophylactic injections and bathing have all been done away with. As a result attention has now been reallocated to strengthen breastfeeding support and monitoring of the mother-baby dyad.
“When EINC came, I was so relieved because it solved all ‘my problems’ with regard to enforcing breastfeeding in the hospital,” remarked Dr. Lu. While, GSCH has already been an advocate of mother-baby friendly practices prior to EINC, it was only after implementing the program did they manage to put this advocacy into practice. By simply following the time-bound and sequenced four core steps of the EINC, breastfeeding was easily and successfully enforced. In the past for instance, Dr. Lu experienced difficulty in initiating early breastfeeding through skin-to-skin contact mainly due to uncoordinated procedures of the OB and Pediatrics Department. “We used to be on the passive, receiving end,” Dr. Lu adds but now with a better working relationship between our departments established, breastfeeding is easily enforced without much effort.”
Meanwhile, as notable improvements in the OB practices such as 100% IM administration of oxytocin and checking of placenta has been observed in all deliveries some challenges remain –growing pains when instituting change. “They say it’s easier to learn but harder to unlearn,” says Dr Alcaide, when asked of the challenges that they continue to face. Routine intravenous fluid administration is still commonly practiced; while hospital policies have already been issued to reserve its use only for true indications, midwives and private consultants have yet to internalize its benefit. As a mid-way strategy the Team EINC suggested the use of “heplocks” to ease the eventual non-routine IVF administration. Likewise, GSCH is also working on decreasing routine performance of episiotomies in deliveries. Dr. Alcaide hopes that eventually the staff would better appreciate the benefits of no episiotomies to the patient.
The encouraging progress made by GSCH in implementing EINC would have not been possible if not for the strong commitment of the GSCH EINC Working Group, close supervision of Team EINC in General Santos, and more importantly the solid support given by the local government. Dr. Caksy Domingo and Dr Sheena Elago, Project Staff of Team EINC, share how pivotal the support of the LGU was in helping GSCH to comply with the recommended practices, “what’s good with the LGU set-up is the steady provision of EINC supplies… one reason why we were able to comply with use of antenatal steroids in managing preterm deliveries is because the hospital is well-stocked with dexamethasone. “Equally commendable is the LGU’s confidence in the capacity of its health practitioners in improving maternal and infant healthcare services.
The results are so inspiring that hospital director Dr. Ben Pagarigan is bent on cascading the knowledge and program to the seven lyingin centers strategically spread across the city, which are also under his supervision. These lying-in centers (LIC), established by the city government, serve the primary health needs of people such as medical consultation, simple emergency cases, and simple diseases for observation and/or three day admission. Dr. Pagarigan reiterates that they also function as birthing centers applying principles of Basic Emergency Obstetric and Newborn Care (BEmONC). He adds that since these facilities are already present, it is but logical to utilize these also as extensions where EINC can be implemented, “by doing so we can ensure that our commitments to the MDG 4 & 5 are achieved and cascaded even outside the hospital setting.”
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