Improving maternal health in Timor-Leste

Oecusse Referral Hospital’s on-call personnel who treated Maria displaying the non-pneumatic anti-shock garment (NASG). Photo: Tarcisio Amaral
Maria is a 35-year-old woman from Oecusse, Timor-Leste. She lives in the village of Sakato with her husband and five children. Like most women there, Maria delivered all her children at home, with the assistance of a traditional birth attendant. Until her last pregnancy, she never experienced any complications, during or after delivery. This time, however, Maria’s delivery took a life-threatening turn. But Maria did not die because JSI-led Timor-Leste Health Improvement Project (HIP) had given care providers at the local hospital the training and equipment to save Maria's life.

Maria gave birth at nine in the evening. The delivery was followed by a very serious complication; Maria had a retained placenta, which caused heavy bleeding. The family had been made aware of the danger signs that could occur after delivery through the health post’s outreach program. They knew heavy bleeding required the assistance of health professionals and when they realized the bleeding would not stop, they called the referral hospital’s ambulance services. A few minutes later Maria fell into shock.

Dr. Humberto, the hospital’s obstetrician, and Elizabeth, a midwife, were on call in the maternity that night. When Dr. Humberto saw Maria’s heavy blood loss and all vital signs in a life-threatening condition—he decided to apply the non-pneumatic anti-shock garment (NASG) on her. “When I saw Maria unconscious and the amount of blood on the sheet around her, I knew she couldn’t be saved if bleeding was not stopped. Only NASG could give me enough time to keep her alive until I got the blood supply she needed."

The NASG is a low-technology device that can slow excessive bleeding and stabilize a mother with postpartum hemorrhage. It provides compression on the lower part of the body so that blood can circulate in the vital organs. 

After NASG was applied, it took only a few minutes for Maria to stop bleeding and recover from shock. “When I woke up, I was dressed with this garment and IVs on both arms. I felt safer, I knew I was going to survive,” said Maria when we interviewed her a few days later. At the hospital, Dr. Humberto provided Maria with the appropriate treatment for retained placenta and she fully recovered in the following hours. “The NASG gave us the time we needed to treat Maria. Managing her case would have been much more complicated without the garment. In the condition she was when we received her, maybe she would have passed away without the NASG,” said Elizabeth.