Why maternal mortality is not easy to solve

My manager at GE healthcare and I went to Canje (pronounced Kanj), the "headquarters" of Zanmi Lasante (Partners In Health in Haiti).  It was truly exciting to get an opportunity to visit the place where Dr. Paul Farmer started his inspirational work.

On our way there, we encountered a group of 12 men who were carrying a women on a stretcher. Turned out it was a woman in labor, who also had eclempsia (caused due to hypertension, and one of the leading causes of maternal mortality globally). The lady was from a village on a mountain. She had gone into labor around midnight. Around 6am, somebody recognized the symptoms of eclempsia setting in, probably because they had seen it before: Haitians have a VERY high fertility rate - 1o to 12 pregnancies is the norm. They started gathering the family members and the neighbors, who all mounted the lady on a homemade stretcher (an iron bed with two big logs ran under, and a sheet to cover the lady). They had been walking for 3 hours, and had another hour to go when we ran into them.

The number of challenges that come up in that story are immense: detecting hypertension (cause of eclempsia) and other conditions early, educating the traditional birth attendants, providing a means for communication in case of an emergency, providing an ambulance/means of transportation, and facilities for operating and blood transfusion, etc. Many many things to think about, and that incident has definitely sparked a slew of conversation here.

The story has a happy ending. We turned around, offered the car to the lady and her family, who drove her to the Canje facility. When we got to Canje (after hiking a bit), we learned that the doctors had performed a successful c-section. The mother was being closed up when we last heardc, and was stable. We actually saw the baby being given oxygen. In the words of the pediatrician, the baby "was not crying as vigorously as we like".

I'll let the pictures do the rest of the talking:

Group carrying the stretcher - note the roads

Close up of the group carrying the stretcher - they had to come down moutains like the ones you see in the background

Mother in labor on the stretcher

Lifting the mother out of the stretcher

Loading the mother into the car

The "stretcher"

The baby being administered oxygen

Closeup of the baby boy

Of hummingbirds and mangoes

Pics from the very niceguest house area where we are being hosted for our trip. It is surreal that something this nice exists in rural Haiti.

The building in which we live

The lush greenery

Spring is fruit season

The dining room / patio area

Did I mention the mangoes that we pick off the tree and have for breakfast / night "supper" (there's no dinner in Haiti)

Beautiful hummingbird right outside the dining room

TO DO: Regain childlike wonder

So. A fantastic thing happened the other day.

I was chatting with an Indicorps alum who I haven't spoken to in a couple of years (it's a shame, I know). And as we get talking, she starts talking about how she's doing her PhD on how Australian lizards speciate. And how she keeps the spirit of service alive by teaching math to prisoners. And how she's learning the Banjo, just because.

The banjo. That's right, the banjo! And it totally rocked my proverbial socks off. It hit me right there and then like a burst of inspiration. THAT's what I need to do - I need to keep that childlike wonder alive. I wanna do things SIMPLY because I'm curious about them.

Like her, I can be (and am) serious about what I want to accomplish in this world. But I don't need to be serious all along the journey! I want to take little side tours, just because. I still want to look at the world with the eyes of a child, full of curiosity and wonder. 

Gibran captures this balance between duty and passion beautifully: 

Among the hills, when you sit in the cool shade of the white poplars, sharing the peace and serenity of distant fields and meadows - then let your heart say in silence, "God rests in reason." 

 

And when the storm comes, and the mighty wind shakes the forest, and thunder and lightning proclaim the majesty of the sky, - then let your heart say in awe, "God moves in passion." 

 - The Prophet by Khalil Gibran

First day of ultrasound training!

Yup - we got trained on GE's very cool LogiqI line of portable ultrasound machines today. Here's some videos from our first day of training! Note - these are taken by the two "students", as well as the teacher. a longitudanal spinal one is hard to get.

5/13/09 Update: To clarify, this is NOT my baby (thank you for the confused congratulatory notes, however). These are photos from volunteers who came to the ultrasound training.

31 weeks - baby "sucking"

31 weeks - foetus wagging tongue

20 weeks - face:

20 weeks - mouth open:

20 weeks - head and spine

20 weeks - hand 

20 weeks - fist

20 weeks - feet

20 weeks - yawning baby

20 weeks - baby moving

20 weeks - beating heart (wait for it)

Tackling maternal mortality

Cross-posted on http://mblog.lib.umich.edu/WDIGlobalImpact/archives/2009/ashish/index.html

As you may know, my WDI internship this summer is with GE Healthcare. I will be supporting GE healthcare's maternal and child health initiative for rural areas. Our goal is to serve the world’s rural poor by providing them access to low cost technologies that improve diagnostic accuracy & public health outcomes. Specifically, I will be working on the maternal and child health initiative, initially focusing on using diagnostic technologies (ultrasound and more) to reduce the maternal mortality rate (MMR). Maternal mortality is the one health outcome that has the most inequality in the world, with 99% of maternal mortality occurring in the developing world. Furthermore, reduction of maternal mortality (Millenium Development Goal 5) has been the most difficult Millenium Development Goal globally to tackle, with only around a 1% improvement on average worldwide.

With ultrasound technology becoming portable and less expensive, there is a definite opportunity to provide Obstetric screening to the last mile i.e. in rural villages of developing countries. To achieve this, GE is currently partnering with MCH groups around the world who have successfully "task shifted" to midwives, nurses & community health workers in order to improve access to maternal healthcare in rural areas. Our partners include Partners In Health (PIH) in Haiti, ISCISA in Mozambique (who started the award-winning midwife-surgeon program), and our flagship partnership is with Grameen Kalyan in Bangladesh.

Personally, it is truly an exciting opportunity to be able to conduct trials with these world-class partners around the world, and to work at a scale that only a corporate like GE can enable. Our approach is that of a social enterprise: we are exploring this opportunity both as directly affecting global health outcomes, as well as becoming a viable business for GE. There are many challenges to overcome: designing a viable technology platform, successfully task-shifting to midwives, nurses etc, completing the "value chain" by providing treatment options after diagnosis etc. I am confident that with a sincere effort from GE and their partners, this problem can be surmounted towards a very worthwhile social outcome.