Basic Emergency Obstetric Care : EmOC

What was the concept of EmOC= Emergency Obstetric Care? Basic facility at sub divisional level. So far etilogy of Obstetric mishaps are concerned there are three “D”s . Such are A) D=Delay in decision by the family members that a laboring woman need transfer to PHC/BPHC , They were hoping for domiciliary confinement . That there was an indication to refer to a nearby hospital was ignored leading to Obstructed labour, Rupture uterus or IUFD,. Secondly in rural areas the dilemma starts so as to who will pay the fare of a private car(if motor able road is there) or charge of a boat / bullock cart if metal motorable road was unavailable ,. It so often happens that neither Father in law not her one father of the unfortunate woman agree to pay the transport expenses. I have seen this while working at Nitra PHC( 1970-72-near Diamond Harbour , the then undividec24 Pgs , WB ) and again at Basirhat (1976-80-surrounded by many islands ) & N Bengal (1989-92) too. It a cultural taboo . Admittedly these are present too in BIMARU states if India (BIHAR, IMPHAL, Madhya Pradesh, Rajasthan & Uttaraknhand) too. These states where MMR are still high have been declared by GOVt of India way back in early seventies. , The second D is = Delay in Transport. Even if transportation/ shifting is decided by family members it not always the Free ambulance report to her door step quickly .Not always ambulance comes even if motor able road is available. As such there is delay in arrival at hospital due to lack quick transport to a Primary Health Care facility(BPHC/PHCs Sub Divisional

Hospital) :: So second D=is - Delay in transport to higher centre where facilities exist for CS/ administration of Spinal anesthetist / Blood Tr . The third Dis unfortunately by Doctor concerned –Delay in diagnosis of the etilogy of delay of delivery (is it inertia, is it OP position, inordinate Ut action, or even incipient F distress) the case warrant intervention. Quite often theatre is Delay sin arriving at a diag so as to why there is delay . Not a suitable case for normal delivery .This concept of EmOC was a popular policy in early eighties when academicians’ and policy makers (planner) thought that this EmOC will minimize maternal death ,The components of EmOC are a) The concept of NISCHOY JAN(free ambulance services from her residence to nearby hospital where CS can be contemplated ). To remind dear members mobiles were not available in eighties ,As such some family members have to travel but cycle or by walking in hilly Ares to report to concerned PHC about sensing ambulance, Not all village are connected with motor able rads. In this central Govt plan formulated by FOGSI every State Hospital was supposed and in fact staffed with Obstetric surgeon , Anesthetist 24, 7, 365 days. But there was scarcity of anesthetist and to some extent qualified and competent anesthetists too. Leave for genuine cause as availed by doctor was also a short coming , Blood Tr was not possible also. However this was quickly followed by RCH programmes, programme in phases from nineties. Let’s hope & pray for the rural women who resides at islands / hill areas of India with poor communication.