The Role of Paramedics in Community Maternal Health in Developing Countries - Research Paper Example

? The Role of Paramedics in Community Maternal Health in Developing Countries The Role of Paramedics in Community Maternal Health in Developing Countries Abstract: Paramedic services form a major aspect of health care sectors of the region because first aid and initial treatment services are based on paramedics' role at the hour of emergency. This study aims to discuss the role of paramedic staff in developing countries, where resource problems impose crucial challenges for the practitioners and patients both. Conceptual framework of the study based on the studies and researches discussed in the literature review. In literature review five studies have considered to examine the efforts of past researchers and weaknesses of the study that have further helped researchers to identify the neglected areas. Also, for this research grounded theory has been considered to examine the outcome of study based on the space-control theory of paramedic scene management. This is a qualitative nature study in which data is collected through primary sources and data analysis is done through thematic analysis method to draw the outcomes of the research. Literature Review: Maternal health care service is most important aspect of societal services as it does not include only health and life of mother, but the lives of babies also depend on the health of mothers. In this context, paramedics services have a very crucial role of play in community maternal health particularly developing countries. Jamison (2006) and Abraham (2002) study shows that pre-hospital services play vital role to maintain standards of maternal health care provision in the region. However, pre-hospital care facilities and system of developing countries are not like those of technological advanced countries (Bell, 2008). In most developing countries paramedic services are equipped with simple first aid instruments, which could patients particularly mother during labor pain or other complex condition during conception (Agre & Rapkin, 2003). The study has found that in most developing regions paramedic services vary based on the availability of required medicines, instruments and performance of the paramedics. This study further suggests that in middle and low income continents like Africa and Asia paramedic services only play role to carry patients from home or any other place to the hospitals (Sachs, 2001). There is no appropriate concept of treating patients in ambulance through first aid services. A study conducted by Anantraman, (2002) reflect upon the fact in some rural setting of India handheld-based electronic gadget system is used to treat child and mother health issues. Researchers of the study have found that concerned authoritative bodies have shown efforts to establish EMRs to meet the demands of technical challenges in order, to provide health service benefits to local communities (Anantraman & Mikkelsen, 2002). This structural method is considered very effective for the transference of databases, along with a digital database for the paramedics necessitates (Fong BC, 1997). This system also provides cost effective advantages for delivering maternal and child health. The designed plan includes provision of GPS for epidemiological researchers, technologically advanced camera for tele-dermatology and other similar beneficial services (Anantraman & Mikkelsen, 2002). Additionally, this system seeks to expand in developing countries to provide parental health care benefits to low or middle-income states (Fong BC, 1997). Syed (2006) research discusses the influences of infants' care interventions at local level in the Saving Newborn Lives project localities. The researchers have studied samples of approximately three thousand mothers and their newborn babies. The research has revealed the statistics of those infants who are dried and wrapped immediately after birth (Lawn JE, 2005). Along with those who are put for postnatal check-up within few days after birth. Further, the study discusses that availability of post-natal check up system can efficiently contribute to reduce chances of complex health conditions for mother and child both (Syed & Asiruddin, 2006). Additionally, health related awareness programs have also been set up for the education of patients and to provide them chance to understand the importance of preventions. In developing countries, improvements in paramedic services are needed to reduce maternal death. The author has further highlight that in developing nations there is an emerging need of making improvements in emergency care system specifically for pregnant women (Mitra SN, 1997). Collymore (2003) study revealed that improper maternal care services lead mothers to death in developing countries and improvement in paramedic services will contribute to decreased morality rate among pregnant women (Collymore, 2003). Study indicates that emergency services including transport facilities should be made easily approachable. Another study conducted by Parkhurst and Raman in 2007 shows that the researchers are needed to examine the participation of alternative health practitioners for parental health care in Bangladesh (Afsana, 2004). This research analyzed experiences of labor and efficiency of decision-making processes along with the contribution of concerned individuals responsible for delivering good health care services (Parkhurst & Rahman, 2007). These individuals play role to provide health care benefits to women of low income or rural areas, who seek to have medical assistance at the hour of need (Blanchet, 1984). Conceptual Framework: Conceptual framework of the research based on the shortcomings of the present literature. It has noticed that in the current literature no study has been conducted to study the relationship between role of paramedics and improvements in health conditions of mother in developing countries (Conrad, 1993). Studies highlighted in the literature review show that there is no such closely related study that could evident the role of paramedics in maintaining complex health care issues among expecting women (Babbie, 2012). Additionally, conceptual framework of this research considers the facts that have been ignored in the previous researches and as it has noticed no research has been conducted to calculate the role of paramedics in developing countries. So this study will mainly focus on paramedic services specified for maternal health care in rural and low-income regions (Babbie, 2012). Also, this study aims to highlight the areas of paramedic health care service that can contribute to improve the health care standards of the developing countries (Marshall & Rossman, 2006). Moreover, in this study space-control theory of paramedic scene management will also be considered to compare and contrast the outcomes of the research with respect to the standard theory (Jensen, 2011). Methodology: For this study qualitative research method has been adopted, which implies researchers' own interpretations of distinguishing facts and relevant information related to emergency health care services. It is also noticeable that for qualitative research approaches qualitative data has been collected through sources that are also qualitative in nature (Newman & Benz, 1998). Additionally, as the research is qualitative in nature so the researchers have made use of inductive approaches as this method is very useful to recognize particular facts, trends, medical practices and implementable strategies in the environment (Merriam, 2009). Qualitative research method includes a systematic procedure of planned strategic rules designed to conduct qualitative research and derive out results efficiently (Ospina, 2004). Data Collection: For qualitative research data was collected from online libraries with ethical affiliations including articles, books, journals and other credible and relevant websites (see appendix 1). Participants: Now with appendix 2, semi-structured interviews were conducted with those who are associated with paramedic practices in the developing states. Information gathered from these participants has been used to gain insight into practitioners' behavior and dedication towards the profession (Marshall & Rossman, 2006). Data Analysis: Analysis of unstructured data through manual methods was quite challenging, but still researchers have conveniently derived out final outcomes of the study (Marshall & Rossman, 2010). Moreover, it is noticeable that thematic analysis method has been use to examine the information gather via interviews of participants (Braun, 2006). Thematic analysis helped researchers complied and understand the general views of the participants and their experience of working in the paramedic health care services. As for this study, four participants have been interviewed (see appendix 4 and 5). Result: Thematic analysis of the data collected through primary source i.e. interviews shows mixed perceptions of the interviewees. First description tells that the emergency health care works show responsible attitude towards their profession and assigned task. These professional are sometimes considered as slow down in their services, but they are not responsible for their declining or unsatisfactory performances. It is mainly because their efficient performance broadly based on the availability of the equipments and necessary surgical instrument needs at the hour of emergency. Another description highlights that midwives form the major maternal service module for medical help during labor pain, deliveries or postnatal care (see appendix 5). An interviewee further informs us that normal vaginal deliveries are usually assisted by midwives and nurses. Additionally, it has noticed that poverty and illiteracy contribute most to create health related issues among women that make them require paramedic assistance. Also, unhygienic conditions, poor education and health situation along with improper transportation system contribute to generate health issues among uneducated individuals who increase need to proper and balanced approached for paramedic services(see appendix 5). For thematic analysis researchers have categorized the topic theme under four heading to note down diversified viewpoints and health condition in different regions. Four interviewees have been asked four questions each related to different theme. First they were asked about emergency staff and lack equipments. It is found that paramedic services are effective and well-organized in India. Despite quick services and efficient performances by the professionals, their health maintenance standard decreases due to use of outdated methods of treatment (see appendix 5). Additionally, in India there no modern technology or advanced methods are available to assist patients during emergency. Emergency works are honest and hardworking in India and they tend to perform their duty with complete dedication, but due to lack of proper equipments and technologies most emergency cases are not handled properly and some are even left unattended. Such situations contribute to influence health service standards of the country (see appendix 4 and 5). Moreover, when an individual from Vietnam has been interviewed regarding emergency staff and lack equipment, he pinpointed that in Vietnam the emergency workers are well-trained, experienced and skilful. However hygiene and sanitation abilities are quite inadequate due to which patients have to suffer. Also, insufficient medicinal resources, transportation system and understaffing are big issues here that further increase health complexities for the patients. Similar, conditions have been noticed in Ho Chi Minh and Bangkok, where handicapped patents suffer most due to inadequate provision of equipments and services of health professionals, who are unable to perform well due to insufficient provision of technologies and other facilities (see appendix 5). Next theme of the study was midwives and nurses, which reflected that in India midwives play crucial role and they are responsible to assist women during deliveries specifically in rural areas. In rural areas, mid-wives are uneducated, but they have experiences and their abilities are undoubtedly appreciable. In Vietnam mid-wife concept has not been noted, but it has found that mother and women education is greatly emphasized in the regions to aware mothers about most suitable techniques of nourishing their new born kids. In Ho Chi Minh and Bangkok mid-wives and nurses perform their duties during normal vaginal deliveries (see appendix 5). However in critical cases obstetrician are called for deliveries via operative method and nurses are allowed to observe only. Moreover, it has found that lack of education and poverty are other major issues of developing countries that impose crucial challenges for health services regulatory bodies to provide efficient paramedic services to the patients. An interviewee from India highlighted the fact that he has noticed maternal issues are mostly the outcomes of lack of education and sense of family planning among illiterate population. Similarly, in Vietnam illiteracy and lack of social sense within the growing population create hygiene and sanitation problems for expecting mothers and paramedic staff of the hospital (see appendix 4 and 5). Additionally, in Ho Chi Minh lack of health education impose challenges for mother and children both particularly in rural regions. However in Bangkok infection control measures are mostly neglected due to lack of awareness among masses and also paramedic staff contribute to give rise to some maternal health issues due to time management. Last theme of study was to analyze the contribution poor hygiene and limited staff. Interviews of four different individuals show that inadequate equipments level and limited staff along with unsatisfactory hygiene play crucial role to create barriers for health care services in emergency cases. From the thematic analysis of the outcomes some commonalities have been noticed in different developing countries. It has found that in developing countries like India, Bangkok and Vietnam emergency services encounter many limitations mainly in terms of their resources and availability of staff members (see appendix 4 and 5). Additionally, it has noticed that in developing countries nurses and other paramedic staff members lack proper knowledge about infection control preventions and other preventive measures needed to be taken by expecting mother during and after pregnancy. These developing countries need assistance and attention to resolve traditional and new emerging health related issues in the regions where most people are uneducated and unaware of hygiene and other important measures needed to prevent health complexities (see appendix 4 and 5). Discussion: This research aimed to study and highlight the role of paramedic staff is assisting mothers and pregnant women in the developing countries. It was aimed in the research that study that performances and resource are not sufficient in the developing countries to meet the demands of uprising maternal health related issues in developing countries. Outcomes of the study reflected that that lack of basic necessities impose various challenges for health departments of the developing countries to fulfill the potential demands of the patients (Jamison, 2006). It has been noticed that in all developing countries sincere efforts and dedicated performance of the professionals were common. Further, it is noticeable that we have only one research question for the study that helped us identify the role of health professionals and health standards of developing countries, which lack behind in every sector of life. But, crucial health issues form major part of complex situations that give rise to other problems in local areas (Jamison, 2006). Additionally, it is important to understand that paramedic services form even more important part than the hospital services because in emergency cases life of a patient depends upon the first aid services. It has mentioned in the conceptual framework that a space control theory of paramedic scene management has been considered to examine the findings. According to this theory developing regions need attention in context of health services mainly for emergency cases. It is because for efficient paramedic services it is highly important for the professional to judge the environmental situations and condition of the patients to treat them with appropriate method in emergency (Babbie, 2012). This theory suggests that paramedic staff members are responsible to coordinate with the limited availability of resources, space and control to save the life patients. They are trained to tackle perplexing situations, but outcomes of the study show that in the developing countries it is relatively more challenging for the paramedic professionals to handle the critical conditions of the patient (Babbie, 2012). It is mainly because along with the limited availability of resources paramedic staff also lacks professional skills in some regions due to illiteracy and improper knowledge. Therefore, the existing theory suggests that attention is needed to repair and amend the improper maternal health care system of the developing countries. In comparison with the outcomes of other studies that have been discussed in the literature review of the research many difference have been observed. The theme of our study was to evaluate the role and contribution of paramedic staff in securing the lives of women in rural or urban areas. However, other studies have talked about the invention and implementation of new technologies to improve the health care system. For instance, in Anantraman study use of electronic medical record method has been highlighted along with the other cost effective approaches needed to assist maternal health issues in India (Anantraman & Mikkelsen, 2002). But, the primary role of staff members has not been discussed in the study, which is a major weakness of the research because more than digital gadget human services are counted at first place to safe a patient's life at an hour of emergency (Anantraman & Mikkelsen, 2002). On the other hand, Parkhurst and Rahman study (2007) has highlighted the role of alternative professional in emergency cases in Bangladesh. The outcomes of the study show that the paramedic staff members provide good services to patients in Bangladesh. The results of the study showed that health standard is maintained and all are satisfied with the provided health services. However, it is noticeable that Bangladesh is a developing country and like all developing nations it does also have to face financial complexities, which directly impact health sectors of the country (Parkhurst & Rahman, 2007). But, the researchers have not pinpointed the weaknesses of the maternal health care system. In comparison to this researcher, out research is more adequate and informative, as it has highlighted the crucial health sectors related issues of four different developing countries (Parkhurst & Rahman, 2007). The biggest strength of the study is that it will help practitioners and other concerned authorities to identify the major health related issues in the local regions. It might also help them design suitable strategies to overcome the shortcomings of the paramedic health care services to improve the health standard of the country. Although this study has helped professionals to identify the problems, but lack of proper recommendation and suggestions serve as the major limitation of the research. This study will help other researchers to conduct other closely related studies in future to bring better improvements in health care system with the identification of other major and minor problems. In the end, it could be concluded that the researchers have shown sincere efforts to highlight the increasing problematic issue in the developing countries. Also, they have successfully proven the hypotheses of the study, which stated that due to lack of resources and other availabilities contribution of paramedic services is not sufficient to meet the demands of the patients in developing particularly in rural areas. Therefore, attention and dedication of concerned regulatory bodies is needed to overcome the weaknesses of maternal health care sectors in the developing states. Reference List Abraham, J., & Reed, T. (2002). Progress Innovation and Regulatory Science in Drug Development The Politics of International Standard Setting. Social Studies of Science , 3 (32), 337-69. Afsana, K. (2004). The tremendous cost of seeking hospital obstetric care in Bangladesh. Reproductive Health Matters(12), 171–80. Agre, P., & Rapkin, B. (2003). Improving Informed Consent:A Comparison of Four Consent Tools IRB. Ethics and Human Research , 6 (25), 1-7. Anantraman, V., & Mikkelsen, T. (2002). Open Source Handheld-Based EMR for Paramedics Working in Rural Areas. AMIA, 12-16. Babbie, e. (2012). The Practice of Social Research. Belmont: Cengage Learning. Bell, R. (2008). The Ambulance: A History. North Carolina: McFarland. Blanchet, T. (1984). Meanings and rituals of birth in rural Bangladesh. Dhaka: Dhaka Press Limited. Braun, V. a. (2006). Using Thematic Analysis in Psychology . Qualitative Research in Psycology, 77-101. Collymore, Y. (2003). Improving Emergency Care to End Maternal Deaths. . From Asiapacificalliance.org: http://www.asiapacificalliance.org/hiv-and-srhr/264information-on-womens-issues.html Conrad, P. (1993). Health and Health Care In Developing Countries: Sociological Perspectives. Philadelphia: Temple University Press. Fong BC, D. D. (1997). Respiratory consultant: a hand-held computer-based system for oxygen therapy and critical care medicine. Int J Clin Monit Comput, 3(14), 155-163. Jamison, D. (2006). Disease Control Priorities In Developing Countries, Part 611. Oxford: World Bank Publications. Jensen, J. (2011). Paramedic clinical decision making results of two Canadian studies. Journal of Paramedic Practice, 186-194. Lawn JE, C. S. (2005). Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet, 891-900. Marshall, C., & Rossman, G. (2006). Designing Qualitative Research. California: Sage Publications. Marshall, C., & Rossman, G. (2010). Designing Qualitative Research. London: SAGE. Merriam, S. (2009). Qualitative Research: A Guide to Design and Implementation. San Francisco: John Wiley & Sons. Mitra SN, A.-S. (1997.). A, Cross AR. Bangladesh demographic and health survey 1996–1997. Dhaka: National Institute of Population Research and Training, 252. Newman, I., & Benz, C. (1998). Qualitative-Quantitative Research Methodology: Exploring the Interactive Continuum. Chicago: SIU Press. Ospina, S. (2004). Qualitative Research. New York: SAGE Publications. Parkhurst, J., & Rahman, S. (2007). Non-Professional Health Practitioners and Referrals to Facilities:Lessons from Maternal Care in Bangladesh. Health Policy Plan, 3(22), 149-155. Sachs, J. (2001). Macroeconomics and Health Investing in Health for Economic Development. Ganeva: World Health Organization. Syed, U., & Asiruddin, S. (2006). Immediate and Early Postnatal Care for Mothers and Newborns in Rural Bangladesh. Health Popul Nutr, 24(4), 508-518. Read More