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

IMA funds a nongovernmental organization in Soroti, Uganda. The Teso Safe Motherhood Project (TSMP) runs a health clinic/birth center for the most marginalized and vulnerable populations in and around the northeastern town of Soroti. Thousands of internally displaced persons (IDPs) have moved through squalid “IDP camps” around Soroti and are now struggling to relocate and rebuild their lives after having lost everything in a brutal civil war. Thousands of impoverished people, mostly women and children, have little or no access to basic medical care. They live in grass thatched huts with dirt floors. They don’t have access to safe water, and their subsistence agriculture has been disrupted by a drought-flood cycle. Sanitation is a serious concern, and malaria is the biggest problem of all. Malnutrition leads to anemia and other diseases caused by living in poverty.

Overall, Uganda’s maternal/child problems are serious and common. They include high incidence of malaria during pregnancy, high maternal mortality rate (lifetime risk of maternal death is one in 35 according to UNICEF), 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). At Teso Safe Motherhood Project (TSMP), it is not uncommon to see girls who are pregnant as young as 14 years old.

With such dire statistics overall for the country of Uganda, the population we serve faces even worse conditions. Through the TSMP clinic, IMA offers general medical care, prenatal, vaccination, family planning services and a birth center, to help the poorest of the poor in the Teso region of Uganda. IMA midwives help local practitioners provide quality prenatal and birth services, as well as general medical care, to increasing numbers of men, women and children from surrounding poor communities. Through these services, women receive the assistance they need to help ensure safe, healthy pregnancies. The clinic staff also conducts weekly mobile outreach clinics to remote rural areas.

Our birth center allows us 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.

HAITI**

Haiti is a country of extreme need. For more than a century, the small Caribbean nation has been plagued by political and social violence. More than 90 percent denuded of natural resources, Haiti has little to offer in the way of Teaching women about safer childbirth employment. The country is also vulnerable to natural disasters and disease. As the least-developed country in the Western Hemisphere and one of the poorest countries in the world, most of the nine million Haitians live a precarious life. Haiti has the highest rates of infant and maternal mortality, the worst malnutrition and the worst AIDS situation in the Americas.

In the country as a whole, one out of eight children will die before reaching the age of five. Among the poorest in the country, that rate rises to one out of six children. A quarter of the children suffer from chronic malnutrition.

The maternal mortality rate (680 out of 100,000 live births) is the worst in the Western Hemisphere, and there are complications in a quarter of the deliveries. Overall, health coverage is very low. Forty percent of the population has no real access to basic healthcare, 76 percent of deliveries are made by non-qualified personnel, more than half of the population has no access to drugs, and only half of all children are vaccinated.

IMA and CHP volunteers pose with some of their students In the fall of 2007, IMA was invited to join the Colorado Haiti Project in the Petit Trou de Nippes region – a rural portion of the country plagued by severe need for all basic services. This summer, an IMA volunteer accompanied a representative from the Colorado Haiti Project to teach 34 Haitian women information and skills to prevent and manage maternal and newborn problems. The plan is to create a training cascade that will engage women as health educators in all the villages in the Petit Trou de Nippes region. IMA is teaching Home Based Life Saving Skills (HBLSS) – a family focused training and community mobilization program that relies on community meetings, consensus building, and the use of demonstrations and picture cards to share information on measures to prevent and manage common obstetric emergencies at the home and community level.

** Facts taken from the U.S. Department of State, the World Health Organization, and the Pan American Health Organization

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.