Why It Matters
"Brazil still has an unacceptably high maternal mortality rate. How many families still go through what my family and I experienced? It pains me to think that most of these deaths are preventable."
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Turning Grief Into a Fight for Improvement

By Paulo Borem | Wednesday, September 9, 2020
Turning Grief Into a Fight for Improvement Photo by Andrew Martin | Pixabay

Even now, 50 years after it happened, I get emotional when I think about the day my mother, Celme, died. It felt as though she disappeared from our lives in the blink of an eye.

I grew up in Brazil. Our home was full of music and poetry when I was a child­­. We were free to do whatever was beautiful and musical.

In 1969, my mother became pregnant with her ninth child. Celme was 38 years old. On April 9, 1970, after nine months of gestation, Virginia, my little sister, wanted to see the world.

My father, who was a doctor, attended all eight of our mother's previous deliveries. He took my mother to the hospital. I do not remember saying goodbye. I do remember I was thrilled that I had another sister coming soon.

Hours passed. My mother and father had left home in the afternoon, but the next day dawned and we heard nothing. More hours passed.

The next memory I have is of my father hugging his eight children and saying, “Your mother went to heaven.” How could he hug eight children at once?

Everything in my previously colorful life changed to black and white. There was no more music. The house became disorganized and a deep sadness invaded us.

Lessons Learned

Brazil still has an unacceptably high maternal mortality rate. How many families still go through what my family and I experienced? It pains me to think that most of these deaths are preventable.

As a physician and an IHI Improvement Advisor, I’ve learned some important lessons for maternal health care providers that may help other families from experiencing the pain of loss my family has had to endure:

  • Put the 4Rs into practice — Be prepared to Recognize, Rescue, Reassess, and Refer all mothers with life-threatening conditions, especially sepsis, eclampsia, hemorrhage, and thromboembolism.
  • Be prepared to recognize clinical deterioration and rapidly respond — There are various tools available to help with this. In our work in Brazil, we’ve been using the MEOWS (Modified Early Obstetric Warning Score).
  • Standardize care whenever possible — Care bundles are a great way to implement evidence-based care more reliably.

There’s a word in Portuguese that means grief: luto. There’s also a verb that means fight: luta. When I think of my family’s story, I still mourn the loss of my mother, but now I am turning my grief into a fight against maternal death. My hope is we can spare other families from needless suffering.

Paulo Borem, MD, is an IHI Senior Project Director and Improvement Advisor for the Latin America region.

 

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