International Midwife Assistance

UGANDA

"Uganda's northern war has been called the most neglected humanitarian crisis in the world." - Ken Burnett, The Guardian Weekly, April 2007

Surrounding the eastern Ugandan city of Soroti, thousands of internally displaced persons (IDPs) live in makeshift homes, surviving with little more than the clothes on their back. These people endure untold hardships in sprawling camps to escape the violence and persecution of the Lord's Resistance Army and the Karamojong Cattle Warriors. Unreliable water sources, uncertain food supplies and frequent disease outbreaks make IDP camps a logistical and health nightmare. While little is known about health statistics among IDPs, local medical facilities report being overwhelmed by the sheer number of people in need of help.

Overall, estimates of the number of IDPs in Uganda range from 1.7 million to more than two million. (UNICEF/Internal Displacement Monitoring Centre, May 2006). According to UNICEF's September 2006 Situation Report, women and children comprise 80 percent of IDPs. Although there are no statistics, gender-based violence and sexual exploitation, as a result of the dire poverty in the camps, is assumed to be widespread (Refugees International, Dec. 2004). This violence leads to the spread of HIV/AIDS, other sexually transmitted diseases and unwanted pregnancies, increasing an already desperate need for quality maternal/child care.

Some common maternal/child problems in the country of Uganda include high incidence of malaria during pregnancy, high maternal mortality rate (lifetime risk of maternal death is one in 13 according to WHO), obstetric fistula or serious injury resulting from prolonged and obstructed labor (Engender Health, May 2005) and lack of access to modern contraceptives. Seventy percent of all Ugandan mothers give birth for the first time by age 19, and only 38 percent of women has a skilled attendant at her birth (Engender Health, May 2005).

With such dire statistics overall for the country of Uganda, IDPs face even worse conditions. Partnering with local nonprofits based in Soroti, the Teso AIDS Programme (TAP) and Pilgrim, IMA is establishing prenatal, vaccination, family planning services and a birth center, to help thousands of IDPs in the Teso region of Uganda. IMA midwives will help local practitioners provide quality prenatal services to increasing numbers of women from IDP camps. Through these services, women will receive the assistance they need to help ensure safe, healthy pregnancies.

A birth center will allow IMA to offer special assistance to women during childbirth, increasing the capacity to ensure safe delivery and quick and efficient response to complications during childbirth. Feasible, low-cost health interventions are all that is needed to save countless lives of women and babies in Uganda. Together IMA, TAP and Pilgrim can bring these services to thousands of women in IDP camps surrounding Soroti.

AFGHANISTAN

Afghanistan is a country in desperate need. The maternal/infant health statistics are among the worst in the world. According to UNICEF, it is estimated infant mortality in Afghanistan is 165 per 1,000 live births while under-five mortality is as high as 257 per 1,000. Access to healthcare for women was severely restricted during the Taliban era. A recent study undertaken in four Afghan provinces indicates the country still has one of the highest maternal mortality rates in the world, estimated at 1,600 deaths per 100,000 live births. Afghanistan suffered more than 20 years of war, and its infrastructure was demolished. Taliban rule was especially brutal for women. They were not allowed to work or attend school. Since men cannot attend women in childbirth, this restriction had a devastating effect on the health of pregnant women.

In April 2004, along with members of the Afghanistan Relief Organization and IMA's future executive director, two midwives from Colorado traveled to Afghanistan. The IMA midwives provided two weeks of skills workshops for village midwives in Paghman. They also provided visiting nurse services in Kartay Char neighborhood, conducted family planning workshops, and spent two weeks conducting deliveries with midwives and students in two Kabul maternity hospitals. IMA staff also traveled to Bamiyan Province, one of Afghanistan's two poorest provinces, which became the site of IMA's most-recent project beginning in March 2005.

Bamiyan City was the site of one of Afghanistan's Community Midwife Training Programs. This curriculum was designed to train the country's rural midwives. The school, supported by Aga Khan Health Services, began classes in fall 2004. Each of the 22 students was nominated by leaders of her rural village to attend school in Bamiyan City.

The students did all their practical training at Bamiyan Provincial Hospital, training that prepared them to deal with working solo in a rural area. IMA midwives provided technical support to the delivery of maternal/child health in the hospital, and they provided the students with high-quality clinical experience. These 22 new midwives graduated from the program in March 2006 and returned to the rural and under-served areas from which they came. IMA is confident the intensive training the 22 midwives received has led to an improved standard of care for the women of Bamiyan Province.