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August 11, 2014

We have been following PACE-MD with great interest. They focus on Obstetrical First Responders as the first link in the chain of survival in Mexico. We have long believed that the analogy to an EMT might be a better way to get beyond the long-standing disputes over what traditional birth attendants versus midwives versus others, including community health workers, can handle as far as maternal health emergencies. PACE-MD focuses on handling obstetric emergencies starting at the first contact with a health worker.

Through this successful model of community oriented, manikin based simulation, mnemonics (¨ABCs¨), and competency based certified SKILLS courses, PACE has trained and certified almost 16,000 health providers in various emergency conditions. Let us repeat: 16,000 health workers. This includes over 8,000 health providers in emergency obstetrics (through the Advanced Life Support in Obstetrics program-- ALSO) in underserved urban and rural communities throughout Mexico. What we like about this model is that it builds on the health providers who are already working on the frontlines, honing skills and building capacity to respond to obstetric and neonatal emergencies. PACE MD’s workshops in Mexico include Vacuum Assisted Delivery, “FAST OB” Ultrasound and Neonatal Resuscitation, and other basic and advanced surgical workshops. ALSO training finishes with a “Mega Delivery” Stress Test, something that every midwife, obstetrician and obstetric team should...

Northern Nigeria and the story of Traffina
August 11, 2014

One of our recent customers was the Traffina Foundation. Like some other groups we so admire, this non-profit was entirely conceived of, developed and run by a female obstetrician from Nigeria. And the funds that finance the non-profit are largely raised from donations by Nigerians. Traffina has created an enhanced birth kit-- the kind we wish we could have waved a wand and created ourselves. The birth kit includes the usual clean razor, cord clamps and plastic sheet but also misoprostol (to prevent postpartum hemorrhage) and chlorhexidine (a new gel for better cord care). Through careful sourcing, research and production the team has already distributed over 6000 birth kits. Demand in Northern Nigeria is immense.

As it turns out this enhanced clean birth kit, coupled with the competence of the staff, is yielding impressive results for women in Northern Nigeria. At one Traffina-run clinic, the number of births per MONTH was a paltry three. Why? The women preferred to give birth at home and saw nothing that would draw them to the clinic. Once the enhanced birth kit was introduced, change did not come immediately. The pink bundle of goodies seemed too good to be true and it took some time before the staff could convince the community women that if they came to the clinic the contents of the kit would be theirs, for free.

As word spread, and the bundles of key medical supplies were provided just as promised, trust grew in the clinic. The most...

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July 18, 2014

What explains the enormous more than 50 fold difference in maternal mortality rates across this river? Both areas of Tajikistan and Afghanistan are "in geographically contiguous poor, post-conflict, highly conservative, mountainous countries." How can the obstetric risks for women be so different? To continue our review of this fascinating study, we take a closer look at the differences between the Tajik and Afghan sides of the river as reported in the study by Kylea Liese.

The Tajik side has a large Soviet era hospital, some basic equipment and some medical personnel. And the Tajik women have a maternal mortality rate 50 times lower than the Afghan women, who have little to no medical care. So it stands to reason that the presence of the emergency obstetric care and medical facility explains the difference, right? Not so fast says our anthropologist/nurse/midwife Kylea Liese. Instead, her observations reveal that the Tajik hospital is large, but poorly equipped. Even the physicians who may be working there do not actually have training in emergency obstetric care. The author says "Expecting a physician to provide emergency obstetric care was like starting to bake a cake with all the right bowls and pans but none of the right ingredients."

Liese makes a bold argument saying:

" I will argue that advanced obstetric care to treat complications is an insufficient strategy to reduce high levels of maternal mortality because it does not address...

maternal mortality | Afghanistan | violence against women
July 03, 2014

“Even on a mountain, there is still a road.”
Pashto proverb

Why are women just over the border of a small 60 foot river, in Tajikistan, about fifty times less likely to die in childbirth as compared to women in Afghanistan?

Words have been spilled generously attempting to describe the difficult terrain (both topological and political) of Afghanistan. Less has been devoted to the deep-boned stubbornness, a defiance, which living in this gnarly terrain has forged in its people. It is stubbornness to outside rulers (whether Alexander the Great or the Soviets), stubbornness with traditions, and stubbornness in both friendships and enmities. Wars have laid waste to a land that was once a geo-economic fixture on the Silk Road and a central post of the Mughal Empire, but stubbornness has allowed a people to survive.

Conflict is an eternal presence. Within this patchwork nation of tribal allegiances of Pashtuns, Tajiks, Uzbeks, and Hazaras. Out of this unending clashes emerged a truly horrifying state of affairs for women, especially under Taliban rule. Today, abuses and subjugation are regular features of nearly every woman’s life. The threat of violence is an everyday reality for those who dare to advocate for the rights of women. 87% experience domestic violence, women earn 25 cents to every man’s dollar, and the life expectancy for women is under 50 years old.

It’s without doubt the worst country on earth for women.

Maternal mortality...

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July 01, 2014

Technology is neither good nor bad; nor is it neutral
Melvin Kranzberg, The Six Laws of Technology

In Austin, Texas today law student Cody Wilson is printing guns. Well, technically, he prints parts of guns. And these are not just any guns; Cody Wilson prints semiautomatic weapons. In seven hours, Mr. Wilson’s Defense Distributed Company prints a key component of firearms (the AR-15 lower receivers), the exact component that (not coincidentally) happens to be tracked by the U.S. government.

What’s the significance of Mr. Wilson’s actions, actions that are seemingly so far outside of our interest in improving maternal and child health here at Maternova? Why discuss such fear-inducing actions, actions of a dubious ethical and legal nature? The answer is the technology. To quote Michael Weinberg’s white paper on the revolutionary nature of 3-D Printing, “It will be awesome, if they don’t screw it up.”


Bits to Atoms to Saving Lives

3-D Printing, also known as “additive manufacturing” has been all over the news lately. By 2017, it’s expected to be a $6 billion industry, and has been called the “next Industrial Revolution.” MIT has a class solely devoted to “digital fabrication.” Retail stores for MakerBot, one of the largest 3-D printer manufacturers, have opened on Newbury Street in Boston crowded with wonder-struck crowds. But what exactly is this exalted technique and burgeoning industry?

While Michelangelo sculpted David...

June 25, 2014

Meet Aisha Khadar, Executive Director of Khadarlis Global and nurse by trade. Khadarlis Global works to provide healthcare and sustainable development in Sierra Leone, a country that is known globally as stricken by war and poverty. But Aisha represents a different face of Sierra Leone—a member of the diaspora connected to an ancestral village and with the well-being of her compatriots at the heart of everything she does We at Maternova were blown away by Aisha’s passion and drive when we met with her last week. Having immigrated to the United States, Aisha returned to Sierra Leone after the civil war and used a Médecins Sans Frontières building in Jimmi (Bo district) to enhance a clinic. The clinic is an example of how a health system is built, or rebuilt from scratch. Aisha and her team started shipping goods for the clinic in containers, mostly compromised of donations, from basic medical supplies to the materials used to build the clinic itself. They even sent raw, reclaimed lumber, to be made into furniture for the clinic. Though aid agencies come and go and can make a huge difference while they are present, our bets are on the commitment of people like Aisha to rebuild health systems in Sierra Leone.

In a country where it is difficult to access sterilized medical equipment, non-expired drugs such as Tylenol and Aspirin let alone more advanced life-saving drugs such as oxytocin, vaccines, and condoms, an increase in medical services is critical. Some...

"State of the World's Midwives"
June 06, 2014

A few weeks ago we said that the State of the World's Mothers was in our view the most important global report around. Well, we didn't lie, but a tie for 'most important' would have to include the State of the World' Midwives. This report was launched for the first time in 2011, and this second edition, the 2014 report, saw considerable publicity associated with the Triennial International Conference of Midwives in Prague.

Since 2011, the report does take note of tangible positive changes that have occurred, including the following:

-33 of the 73 countries (45%) report vigorous attempts to improve workforce retention
in remote areas;
-20 countries (28%) have started to increase recruitment and deployment of midwives;
13 countries (18%) have prepared plans to establish regulatory bodies;
-and 14 (20%) have a new code of practice and/or regulatory framework.

What is really starting to emerge is strong quantitative data and evidence on the impact of midwives. If you remember nothing else from this report, remember that the training of a midwife who then is deployed in community health care yields a 16-fold return. How do you measure that return? In c-sections avoided and lives saved. Kudos to the WHO, UNFPA and ICM for quantifying the impact of midwives and getting the messages so clear in this report.

Let's return to the tangible results. So while noting that there is progress, and that is preferable to...