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Resilience of Prenatal and Maternal Health Systems-Case study Bluefields, Nicaragua & SWVA

All photographs taken by scholars involved with this project and used with permission.

The American health care system is in a transitional stage and becoming increasingly complex and technologically dependent. Recent natural disasters have prompted us to question how resilient our health system functions during disruptions. We chose to focus on the maternal and prenatal care in the American health care system, because it has historically been considered weak when compared to the rest of the world. With a maternal morbidity rate of 12.7 deaths per 100,000 live births in 2007, and an infant death rate of 6.81 per 1000 live births, the U.S. falls short of similarly “developed” nations. This trend makes it crucial that we should understand our system’s weaknesses and strengths. While we have emergency procedures built into our health system and facilities, our research has shown a lack of recent evaluations on how well these procedures mitigate the effects of stress to the system when functioning normally. Developing countries generally have less complex systems that are less technologically dependent, and sometimes have lower maternal and infant death rates. Often, their geographic locations put them in the path of more natural disasters.  Southwest Virginia has historically had limited access to standard health care and in some ways is similar to developing countries. It is in our interest to evaluate the resiliency of that system and compare it to a system with more limited health care access.

Our purpose is to observe and compare the resilience of the prenatal and maternal health care systems in Bluefields, Nicaragua and Southwest Virginia. As recently demonstrated by Hurricane Sandy in New York City, natural/unnatural disruptions have the potential to significantly disrupt a health system that is heavily dependent on technology. We will compare a maternal health care system with fewer resources, but greater self-reliance, with one that is resource-rich and reliant on modern technology.

How does a resource-rich, highly biomedical, and technologically dependent maternal health care system compare to one that is resource-poor and less technologically dependent, when both systems undergo similar disruptions? We hypothesize that the systems differ in their capabilities to adapt to and function in catastrophic environments. The less resource-full and less technologically dependent system may be more resilient in certain areas, due to dependence on independent individuals relying on their capacities to take effective action.