February 4th, 2013

Fresh Air Matters... with Capt. Yaw

There is no doubt that we all learn something new every single day – it is just that some people take note of it, and share it more, than others. In aviation we must be conscious of our need to learn, and to share, as well as being proactive in that learning, including the sharing of our knowledge.

As part of our work at Kpong Airfield, we are involved in health projects for rural Ghana, and with that we learn all sorts of things above and beyond that of airframes, engines and aerial manoeuvres! We operate a small clinic for non-life-threatening-trauma, and it is getting used more and more. Teaching people the basics of simple wound care has changed the way that they consider a cut, and with it, we are improving lives and reducing complications. It always amazes me that so many people have little concept of what ‘antiseptic cream’ is, what it does, and how relatively inexpensive it is. (A triple action cream that really works is about GHS3 across Ghana). We still come across wounds where ‘various natural products of a non-sterile nature’ have been applied, complicating the case. I still hold to the fact that educating every person in this country in regards to minor cuts and grazes would save many ‘person-years’ of productivity each year, reduce the amount spent on travel to and from medical centres, reducing the overall burden on the health services and creating better lives in all parts of the country. I also believe it can literally save lives. Complications from a simple soft-tissue wound can lead to permanent disfigurement, gangrene, septicaemia, amputations and all the complications that come from these – even death. If you think I am exaggerating, it is estimated that many tens of thousands of people die every year from Septicaemia (an infection in the blood, generally from an infected wound) and related complications.

Education about health is key to many aspects of our lives. In aviation there are rules about pregnancy. (Every single person reading this is a direct result of a pregnancy – so take good note of what is coming up here!)

For passengers: airlines have strict rules about pregnant women, one states that ‘For travel after the 36th week for single pregnancies or after the 32nd week for multiple pregnancies, we can only carry you for urgent medical or compassionate reasons, and only on approval from our medical advisors. We may also ask that a suitable medical attendant accompany you.’ The same airline requires ‘a doctor to fill out a Pregnancy Information Form’ for all travel after the 28th week. These rules are to protect the mother, and the unborn children – as well as the airline!


 For women pilots: there is a ‘rule of thumb’ related to not flying past around 28/32 weeks into the pregnancy. The issues of harnesses and ‘full and free’ controls come in, as does the issue of possible ‘early labour’. Some airlines impose ‘no fly’ conditions on their commercial pilots for specific weeks of the pregnancy. Each country has its own Aviation Authority rules in relation to this matter. All the same, despite it being technically possible for a woman to fly at the controls of an aircraft up to the very day of her delivery; practicalities, risk assessment and common sense must prevail – especially if flying passengers or there are complications in the pregnancy! The same goes for driving.

I knew a flying instructor who only took a few weeks off before her delivery, and was back in the left seat a few weeks after – and she was a wonderful mother too! Kudos to any woman who loves their job and their children so much!

Giving birth has its complications, and death is more common in our part of the world than we may at first want to believe. Maternal mortality is defined as ‘the death of a woman while pregnant or within 42 days of termination of pregnancy’. We are all painfully aware of the maternal mortality rate in Ghana at 350 deaths per 100,000 live births. This is better than Chad and Somalia, where 1,000+ women die per 100,000 live births. However, if we compare this to much of Europe, that rate is generally lower than 10/100,000.

What can we do to improve the situation of our women? Better ante-natal, delivery and post-natal care is the key.

The best option to reduce maternal mortality is to enable women to attend ante-natal clinics, have their babies in suitably equipped conditions, and to make regular follow-up visits to medical practitioners, with their babies, after giving birth. Already, I can hear somebody saying ‘That is not going to happen in Ghana, people here can’t afford it.’ If you believe that, you need to read the rest of this column NOW...

As I said earlier, education is key. So, let us all be educated about the actual situation in Ghana today. Since the 1st July 2008 a different approach to maternity care under the NHIS was introduced. Let’s look at the changes, made to improve the lot of women, together…

The ‘official-available-today’ benefit package for pregnant women is defined as follows:

‘All pregnant women not currently registered with the NHIS will benefit from the following:

Exemption from payment of the NHIS premium
Exemption from payment of the registration charge
Waiving of the waiting period between registration and accessing services

In addition:

any woman who presents at an accredited health facility with a pregnancy-related complication resulting in, or arising from, miscarriage or abortion will be entitled to the same benefits.
Any woman who, having delivered at home or in an unaccredited health facility, and who subsequently presents at an accredited health facility with post-partum complications during the six week post-natal period will be registered.
However, any woman who presents in good health during the six week post-natal period, having failed to register during the pregnancy or delivery period, will be assumed to be registering solely for the purposes of obtaining a free card and therefore she will not be registered.

The package of entitlements under NHIS registration has been established by law. While the initiative is specifically designed to increase uptake of antenatal, delivery and post-natal care, pregnant women will be entitled to access all services under the NHIS benefit package, as long as these are provided by accredited health facilities.

In addition, as children have been de-linked from the registration of their parents, the newborn is automatically covered by NHIS. As a separate NHIS card will only be issued at three months, however, the infant is included under the mother's cover for the first ninety (90) days after delivery after which s/he will be provided with his or her own card.’

Yes, I was as pleasantly surprised as many of you reading this now. Being pleasantly surprised is not good enough. Help to spread this knowledge – education can change lives – and in this case, up to 350 lives per 100,000 live births. Share this knowledge back to the families and especially the women in our communities and let us all encourage healthier pregnancies, healthier children and better future for us all.

Capt. Yaw is Chief Flying Instructor and Chief Engineer at WAASPS, and lead Pilot with Medicine on the Move, Humanitarian Aviation Logistics (www.waasps.com www.medicineonthemove.org e-mail capt.yaw@waasps.com)