Dr. Narmadha Kuppuswami was a medical student on her first clinical placement when an expectant patient from a remote village in India arrived at the hospital. The patient had a ruptured uterus and needed an immediate surgery. While holding her hand, the patient told Dr. Kuppuswami that she has four other children at home who will not be taken care of if she dies. The patient begged doctors and nurses to save her and her new child but, in the end, neither the mother nor the baby survive.

Nearly half a century later, Dr. Kuppuswami is now a distinguished obstetrician and gynecologist based in Downers Grove, Illinois and is affiliated with Advocate Good Samaritan Hospital. She said she could still remember the face of that lady at times. After all, it was because of her that Dr. Kuppuswami decided to specialize in what she is doing now. 

According to the World Health Organization statistics published in February 2018, an estimated of 830 women die from preventable causes related to pregnancy and childbirth every day. Of which, maternal mortality is higher in women living in rural areas and among the poor communities. In the recent AIMed webinar, Dr. Kuppuswami attributed part of the death causes to the lack of facilities, delay in providing care for acute obstetrical emergencies, knowledge gap and other social-demographic reasons. 

The birth of WONDER 

Dr. Kuppuswami said in rural areas, there could be 40-50 patients in labor at once with only one doctor and two nurses to help. Often, there is an average of four to five patients which require Caesarean Section (C-Section) and keeps the doctor in the operating theatre for up to six hours. As such, Dr. Kuppuswami decided to tap on technology to overcome the challenges. She created WONDER or Women’s Obstetrical Neonatal Death Evaluation Reduction, a smart system which alert physicians when patients’ vital signs fall off the criteria, in order to prioritize acute care and resources. 

The vital signs captured by the WONDER system include blood pressure, pulse rate, temperature, respiration, and oxygenation. When either of them is not within the normal range, it will send out an alert in red. On top of the alert, the system also comes with a preliminary diagnosis and treatment guidelines. The guidelines will give healthcare professionals the order, the kind of medication that is required, its doses as well as the side effects. 

The WONDER system was co-developed with technology partners and several other non-profit organizations. Its primary aim is to reduce maternal mortality and morbidity in under-developed regions. Thus far, two pilot studies have been conducted in at least four general hospitals and five primary health centres, involving over 14,000 patients in India. Results showed that by leveraging on efficient triages provided by WONDER, most of the patients with normal vital signs are able to be managed by nurses or low-level providers. This creates room for skilled providers or doctors to attend to patients in an emergency

The inability to combat root problems 

Furthermore, the pilot studies also indicated that WONDER is capable of lowering the percentages of in-hospital eclampsia, convulsions take place in women with pregnancy-induced hypertension, which happens to be the second most leading cause of maternal death around the World. This suggests that highlighting abnormalities facilitate in the success of early identification and treatment. 

In spite so, the system was not well-received by the local government, who refused to financially support the project to be widely implemented in the country. Likewise, the workload for local healthcare professionals is so high that most of them are reluctant to try out a new solution, in fear that may disrupt their daily tasks. These professionals also fail to have adequate time to read up, research and find out more about what new technologies can do to their practices. In fact, during the developing phase, the WONDER project team had to hire computer literate students to be trained in the system and assisted in the data-entry process. 

Dr. Kuppuswami believes there are fundamental problems which hinder the WONDER system from exercising actual wonders on women in need of obstetric care. Like the challenges which we have mentioned in the earlier AIMed article. At the same time, Dr. Kuppuswami is not giving up; she is appealing Worldwide for support, hoping more people will know of the WONDER project’s impact in the near future.

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Hazel Tang

A science writer with data background and an interest in the current affair, culture, and arts; a no-med from an (almost) all-med family. Follow on Twitter.