Downton Abbey: Lessons for Today
It’s sad to think that more people may know what happened to one of the main characters on Downton Abbey during her pregnancy than know about the maternal health crisis in our modern world. I watch this TV show myself, and after a recent episode I was browsing internet news sites, shocked by how much talk there was of eclampsia, the pregnancy condition that killed Lady Sybil on the show. Eclampsia, a blood pressure disorder of pregnancy that causes severe seizures, still contributes to about 12% of maternal deaths worldwide (2005 WHO data). And yet, I haven’t seen eclampsia discussed so much in the news arena until this TV episode aired.
What some may not realize is that conditions that claimed the lives of pregnant women in the 1920s are still destroying families and communities in the poorest parts of our globe today. Hemorrhage, infection, eclampsia and obstructed labor were back then and continue to be the most common causes of maternal deaths worldwide. Sadly, most would be preventable with routine medical interventions that are simply unavaible or poorly utilized in impoverished communities.
In the 1920s, which is when this Downton Abbey’s heroine dies, doctors and scientiests did not fully undertand the roles of expedited delivery and magnesium in treating this disorder. Magnesium, which is used to prevent and treat eclampsia is a relatively low-cost and simple intervention that helps save thousands and thousands of women every day. In many countries, however, magnesium is not used routinely because of poor access, lack of understanding of how it works or other barriers. The WHO has reported that, as of 2002, only 45 countries listed magnesium sulfate on their “essential drug list” (Pisake et al, WHO Bulletin, 2007). A decade later, in 2012 another study showed that only about 50% of countries had magnesium sulfate listed on their essential medicines lists (Hill et al. PLoS One. 2012; 7(5): e38055).
While working in a remote hospital in Western Africa I came to appreciate the role of magnesium more than I ever had in practice in the U.S. When Abina came to the rural facility where I was volunteering, her liver was already failing from eclampsia. She was incoherent and I suspected from the story that the family related that she had already experienced one seizure at home and another in her neighbor’s truck that brought her into the hospital. The only devices we had at our disposal were equipment for an expedited delivery via cesarean and several bags of magnesium in the pharmacy. I was relieved that I had something to offer her and a chance to save her and her baby. Her infant was born several weeks prematurely, but was able to survive. Abina had a c-section and required blood which was donated by her family members, but she too was able to live. She stayed on magnesium for an entire day and night after delivery, and we used up every last drop of the hosptial stores. Luckily, the pharmacists were able to procure more from a nearby town in order to be ready for the next emergency which came less than a week later.
Such a simple thing, a relatively cheap medication that I take for granted in my daily practice, is one that all providers should be able to offer their sick patients. Making these drugs accessible and training personnel on how to adminster and monitor them is a priority for making sure women aren’t dying for the same reasons that we saw a century ago.