Weekend Reading

Friday, October 29th, 2010 by Christopher Lindahl

This week on the MHTF blog:

  1. We heard from Maria Laura Casalegno, a Young Champion working in Mexico
  2. Young Champion Martha Fikre Adenew wrote about maternal health in Louisiana
  3. The Maternal Health Policy Dialogue Series streamed live on the Wilson Center’s website
  4. Young Champion Anna Dion updated us on her work in Argentina
  5. Former MHTF staff member, Kate Mitchell, wrote about her work with community health workers in India
  6. Young Champion Onikepe Oluwadamilola Owolabi wrote about her first month of work in India

Some weekend reading:

  1. Ugandan President Yoweri Museveni says maternal health is a priority
  2. An evaluation of women-led community mobilization intervention (PDF) for maternal and newborn health
  3. A gel to replace the pill?
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Catalyzing Change in the Slums of Bombay

Friday, October 29th, 2010 by Sue

This blog post was contributed by Onikepe Oluwadamilola Owolabi, one of the sixteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.

BombaySlums
I can finally confirm that the Ad-line is true—India is incredible, and Mumbai, fondly called Bombay by its inhabitants, is incredibly intense. A vibrant city with incredibly long rush hours, its streets are filled with a never ending stream of people of every kind—so many I wonder how it can fit them all. And everywhere there are towering apartment blocks (how else can so many people find living space?), with so much ongoing construction to make space for more. Modern clubs and malls stand side by side with indigenous food stalls on streets where a huge variety of cars, auto rickshaws, motor bikes and people wearing kurtas, suits and jeans jostle for space. My 26 days here have been a rollercoaster of emotions for me. I have loved living in such diversity and hated being stared at so blatantly. I struggle with rolling my R’s in my sparsely acquired Hindi to survive the streets, and have experienced such love and help from total strangers. It’s amazing. I’ve learned to wade through crowds, longed for my friends at home, and experienced such heartache at the co-existence of abject poverty with such wealth and development.

Amidst Bombay’s entire splendor, beside service apartment blocks, on pavements outside the beautiful Taj hotel there are makeshift structures of cardboard and rubber sheets. In larger areas, these materials are mixed with cement and roofing sheets—characteristic slum building things. And everywhere I’ve visited they exist. Sprawling unplanned slum communities, from the Dharavi of movie fame to smaller growing ones which seem to grow like weeds wherever space exists, account for almost half (statistics say) of this city’s housing. And visiting them, talking with the people who live there, and seeing their health statistics all scream of unmet need!

Countless women who can’t access health care, scrawny visibly malnourished kids, no electricity, one source of water for 10,000 households…the baseline data on these communities are alarming and the experience when you visit much more. SNEHA, the organization in which I’ve been placed, has been doing fantastic work in improving the health of women and children in Mumbai slums for years. Founded by Ashoka Fellow Dr. Armida Fernandez, their projects for this vulnerable group have developed and implemented various interventions that involve the community, municipal authorities (such as health providers), and their expert team to create ongoing awareness of the need for women and children’s health. They work to address underlying social factors and improve the quality of service delivery from providers while fostering strong referral pathways between demand and supply ends of the spectrum. This all sounds very concise, but in 3 weeks I’ve learned being a catalyst for change is a much more herculean task.

after a few hours of learning
My project with SNEHA is to help start community resource centers in our slum areas to be hubs out of which all of these interventions can roll out, and to give each community a space to work on these problems together. It’s been a whirlwind of meetings, of reading about previous projects, of visiting the people and available health services in these communities and wishing I could do some magic and give them everything at once. It’s been a battle of talking through a translator, and hoping that I can, through my work, create lasting change. Of paying attention to every detail including the planning process so that we can recreate this change in the thousands of other communities where we want and need to operate.

It has been 3 weeks of Mumbai’s splendor, of my host family’s overwhelming kindness, of working with a group of passionate women dedicated at every level to every infinite detail and determined to keep up a change that many would deem impossible, of missing my young champion family, of wanting so badly to help change things, of wanting to learn to speak Hindi, of a new life… And it’s the start of an incredible journey.

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Maternal Health Issues? In the USA?! My First Two Weeks in New Orleans

Thursday, October 28th, 2010 by Sue

This blog post was contributed by Martha Fikre Adenew, one of the sixteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.

New_Orleans
I have been in New Orleans for two weeks trying to adapt myself with the time and culture difference. When I was selected as one of the Young Champions of Maternal Health and placed in US, I was surprised and wondered how I would be able to learn from a developed nation with ‘no public health problem’. I have already figured out that we all have problems which need solutions based on the context we are in.

The situation in some parts of US is not as what I originally imagined it to be. For example, 70% women in Louisiana are on Medicaid which means that they cannot afford to cover their own health insurance. So the government is covering for them. There are rural areas in US where there is limited infrastructure like medical services, transportation, etc.

There is also disparity in infant mortality between African American babies and other races. For example, the number of African American babies that die before they reach their first birthday is twice that of white babies. That is how Ashoka Fellow Kathryn Hall-Trujillo’s organization, The Birthing Project, began—to work to save those babies. The Birthing Project USA is the project I am involved during my placement. Besides learning from other projects in Mississippi and Malawi, I am going to be deeply involved in the organization’s New Orleans project.

Birthing Project USA is the only national African American maternal and child health program in the USA. The goal of the Birthing Project is to keep more babies alive by recruiting, training and supporting community “Sister Friend” volunteers to provide direction, emotional support and education to the mothers (Little Sister Friends). This support continues for one year after the birth of their babies.

During pregnancy, the primary focus is on obtaining, understanding and complying with prenatal care and development of resources necessary to maintain a healthy lifestyle. This includes identifying and coordinating services offered by agencies such as the health department, criminal justice, children’s protective service and social services. It also involves attending childbirth preparation and parenting classes and being a birth partner, if appropriate.
Project participation continues through the child’s first birthday. During this year the Sister Friend supports her Little Sister Friend (her extended family) in obtaining the parenting and life skills, identifying and pursuing education and employment goals and, most importantly, understanding that she is part of a community which cares for and values her.

So far I am only in the introductory phase with the program, but I am learning a lot about how the project is going on and I’m excited for what the next 8.5 months hold.

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Fostering New Emergency Care Capacity in Mexico

Wednesday, October 27th, 2010 by Sue

This blog post was contributed by María Laura Casalegno, one of the sixteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.

It’s been a month since I got to San Miguel de Allende in Mexico. San Miguel de Allende is a very beautiful colonial town surrounded by mountains and where the arid weather turns the landscape into a painting. Here the people are very friendly and nice and everybody has a reason to be happy and to have fun. They love their national days and they pay great tribute to their historical heroes.

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MEXICO 007
Here I am working with an organization called PACEMD where the director is Dr. Haywood Hall, my Ashoka Fellow. PACEMD is a Continuous Updating Program in Emergencies and is intended to educate health staff such as emergency physicians, general physicians, obstetricians, gynecologists, nurses and other specialists in this field, as well as personnel involved in pre-hospital care and the community in general, in addressing medical emergencies. PACEMD organizes several courses, including: First Aids, BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support), BLSO (Basic Life Support in Obstetrics), ALSO (Advanced Life Support in Obstetrics), PALS (Pediatric Advanced Life Support) and FAST (Focused Assessment with Sonography in Trauma).

The main objective of my work with PACEMD is to collaborate with the ALSO program (Advanced Life Support in Obstetrics), developing and maintaining the ALSO network of providers and coordinating activities both amongst the PACEMD training sites and with other similar organizations in Mexico and internationally. I also have to implement the ALSO program in rural areas throughout Mexico. And the major, long-term objective will be to scale the program throughout Latin America.

I’ve participated in some ALSO courses. ALSO is a course that provides practical tools and systematized knowledge to resolve obstetric emergencies. All participants are very satisfied and the course has been very helpful to them to resolve issues quickly and accurately, based on reported experiences for themselves.

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I must say that I am very happy to be in this wonderful country and working with an extraordinary team led by Dr. Hall, who is someone I admire as a tireless seeker of altruistic goals. I am grateful for the opportunity he is providing me to learn with him.

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MH Policy Dialogue Series Streaming Live Today at 3:00PM

Wednesday, October 27th, 2010 by Christopher Lindahl

Please join the Woodrow Wilson Center’s Global Health Initiative, the Maternal Health Task Force, and the United Nations Population Fund (UNFPA) today at 3:00PM for the eighth event of the series on Advancing Policy Dialogue on Maternal Health: New Applications for Existing Technologies to Improve Maternal Health. For event details, click here.

If you are interested, but unable to attend the event, please tune into the live or archived webcast, which will begin approximately 10 minutes after the posted meeting time. You will need Windows Media Player to watch the webcast.

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Putting it into Practice: Building Local Capacity to Improve Maternal Health

Tuesday, October 26th, 2010 by Sue

This blog post was contributed by Anna Dion, one of the sixteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.

It has been a month since I arrived in Argentina. I am based in Pilar, a town at the northern border of the municipal boundaries of Argentina’s capital city, Buenos Aires and the Province of Buenos Aires. For the next nine months, I have been matched with Ashoka Fellow Alberto Vázquez who founded an NGO, SAHDES, which works in several of the rural communities outside Pilar. Their work focuses on training community-based health promoters, linking them with the local health system and other social systems, most often in collaboration with primary and secondary schools.

My work with SAHDES takes places in a community of about 2,000 people. The local population has a long history in the community, with an increasing number of migrant farm laborers, primarily from Bolivia, working and living on segregated plantation farms, and other migrant laborers working at one of the many large plants in the neighboring industrial park.

Resource
Within this dynamic, we are working with a small, but committed group of women—some mothers, others not—who are being trained as community health workers. They are currently three quarters of the way through their training and last week, I met with them last week to define and refine how they will apply what they have learned in their community. To help our thinking about our work with this group, I have been relying on a couple great reference manuals from the Hesperian Foundation, mainly “Where there is No Doctor –For Women” and “Aprendiendo a Promover la Salud”. They have been great resources to keep me on track and reinforce some of the directions that we are moving in together.

This first meeting was the beginning of part of my project to help structure the ‘putting into practice’ of what these soon-to-be health promoters have been learning over the past 3 months. We began by trying to define the focus issues, to which there were many answers and generated a lot of discussion in the process of clarifying topics and trying to group common themes.

Anna Dion
What we ended up with is an ambitious list of topics to address in this diverse community, however, the most common concern that came up within the group was the lack of contraceptive use. They explained that many people have insufficient or wrong information leading to misuse, while other reasons included social pressures to have many children and uneven power dynamics within couples. It was impossible not to start thinking about the best ways to share and implement some of these ideas, however, thinking about the ways that different groups in the community learn and take-in information will be one of the topics for an upcoming session. My next session with them will focus on uncovering some of the root causes of some of the challenges in their community.

For those that are interested, this is final (working) list that we ended up with:

Anna Workplan

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Community Health Workers Compete to Develop Creative Slogans and Images to Improve Maternal and Newborn Health in Jharkhand, India

Monday, October 25th, 2010 by Christopher Lindahl

Written by: Kate Mitchell

This post was originally published on Kate Mitchell’s blog, Maternal Mortality Daily. Reposted with permission.

On Wednesday, September 29th, nearly 300 community health workers from 174 villages in the rural Seraikela block of Jharkhand, India came together for an interesting event that involved plenty of art supplies, a flurry of creative ideas, a tangible passion for and dedication to improving rural maternal and newborn health, and a little bit of healthy competition.

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The gathering, part of the Maternal and Newborn Survival Initiative (MANSI), was an effort to develop effective behavior change communication tools for four maternal health interventions being implemented through MANSI– by tapping into the vast knowledge, experiences, and creative capacity of the newly identified community health workers.

KMitchell2
Holding the belief that there is no better source of ideas for effective slogans and images than the community itself, MANSI staff coordinated a contest that called on community health workers to develop slogans and images to explain the importance of the MANSI health interventions. The thinking behind the contest was that if the artistic representations of the health interventions and the key messages come from within the communities, then the images and messages will be more likely to resonate with the community members—and ultimately the health practices will be more likely to be widely understood and adopted.

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Before the contest began, the MANSI team provided an overview of the four maternal health interventions that the health workers would be developing images and slogans for: Misoprostol for post-partum hemorrhage, intermittent preventive treatment for Malaria, Vitamin A supplementation, and deworming. (In-depth training on these interventions will take place in the coming months.) Craft supplies were distributed and the nearly 300 health workers spent one hour competing to develop the most creative, compelling, and scientifically accurate slogans and images to be used as behavior change communication tools throughout the MANSI project.

KMitchell4
A panel of judges made up of doctors, public health professionals, and government officials recently selected three winning submissions for each health intervention. The winners received prizes and their slogans and images are being incorporated into the final behavior change communication strategy for the MANSI project.

To learn about another initiative that is tapping into creative energy to improve maternal health, visit MDGfive.com. MDGfive.com is a global project that is uniting artists around the world to use their collective artistic abilities to develop multimedia maternal health advocacy pieces.

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Weekend Reading

Friday, October 22nd, 2010 by Christopher Lindahl

This week on the MHTF blog:

  1. We heard from CIESAS and their evaluation of a Mexican Ministry of Health program
  2. The Department of Community Medicine at Rajarata University of Sri Lanka told us about their focus on maternal morbidity
  3. CEDPA updated us on their project to integrate maternal health into HIV/AIDS programs

Some reading for the weekend:

  1. Health care professionals and the provision and use of maternal care in Vietnam
  2. Ugandan MPs want to legalize abortion
  3. Ugandan women and traditional birth attendants
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Ifakara Health Institute

Friday, October 22nd, 2010 by Christopher Lindahl

The following is part of a series of project updates from the Ifakara Health Institute (IHI). MHTF is supporting their project, Using Cell Phones for Obstetric Emergencies. More information on MHTF supported projects can be found here.

Written by: IHI

The Ifakara Health Institute (IHI) will seek to improve emergency care for pregnant women and newborns in Tanzania by providing free mobile phones and business-related service for mid-level health care providers, to allow better communication with senior medical staff at district headquarters. Cooperating with district councils and the ZAIN mobile telephone company, IHI will evaluate the cost, feasibility and implementation issues that arise if health workers at the district level have better access to long-distance counseling, faster referrals and resupply service and emergency clinical support.

A baseline assessment will help to guide the development of the system. It includes health facility visits; interviews with health workers, TBAs, and village and district officials; focus group discussions in communities and case studies with women who have experienced a complication in the last year.

Negotiations with the phone company ZAIN that began as project-specific opened a dialogue between Ifakara Health Institute and the company which resulted in a broad agreement that will also reduce the costs of communications for IHI staff.

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UK Launch of No Woman, No Cry

Thursday, October 21st, 2010 by Christopher Lindahl

Saturday, October 23 marks the UK launch of the film, No Woman No Cry, directed by Christy Turlington Burns, at the London Film Festival. Also, starting on Saturday, you’ll be able to watch the film online at www.brightwide.com. The film tells the stories of at-risk pregnant women in Tanzania, Bangladesh, Guatemala and the United States.

The film is directed by model, mother and activist Christy Turlington Burns and tackles the most primary of topics: maternal health. Complications following the birth of her child inspired the supermodel to find out more about the experiences of motherhood around the world and in this fascinating film she discovers that a woman dies every minute due to complications from pregnancy or childbirth – with 90% of these deaths being preventable. In her directorial debut, Turlington Burns shares the emotionally powerful stories of four at-risk pregnant women, each on different continents.

 

The event at the London Film Festival includes an introduction by Sarah Brown, Global Patron of the White Ribbon Alliance for Safe Motherhood, and a panel to discuss the state of maternal health in the developing and developed world, which includes Anthony Costello, Brigid McConville, Mabel van Oranje and Christy Turlington Burns and will be moderated by Livia Firth.

Watch the trailer now and be sure to check out the full film this weekend.

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