Sharing knowhow and joining forces towards Health for All
Contribution by DWA Cuamm to the MMI Annual Report 2011

Mothers and children first

Mothers and children first

Once upon a time there was Ayen, a 22-year-old woman who had been married for
about two years. She had already had three pregnancies: the first had ended in miscarriage; the second was carried to full term, but she lived too far from the hospital and, after 24 hours of labour, her daughter was born but had stopped breathing. Now it is her third time to give birth. Ayen is at home when her waters break and the contractions start, getting stronger and stronger. The pain from the contractions is coupled with her fear of not succeeding this time either.

It is a critical moment. Ayen looks for help, she reaches out for her husband’s hand, knowing full well that it won’t be enough. The time has come to seek help. She struggles to start walking. There is a health centre not too far from her home. She has heard about other women who have been there. She can trust the place and can still count on her own two feet. She starts the journey towards young motherhood, afraid but brave.

She reaches the health centre tired out and just in time to yield to the care of a nurse. The situation is critical. She needs a caesarean section and the health centre is not equipped to perform one. She will have to be taken to the main hospital in Aber. The rush begins and things start moving quickly due to the urgency of the emergency. Aber hospital is called, the ambulance leaves, covering kilometres of dirt road enveloped by a profound, mysterious African sky that gives no clues to the outcome.

Ayen, silent and undaunted, with the typical composure of African women when they look pain in the face, puts her trust in the female doctor she has already heard about. “If I must die, I would like it to be in the hands of that white doctor.” The white doctor, the “muzungu”, welcomes her, prepares her and takes her into the operating room for the caesarean section.

Fear gives way to hope.
The miracle of life takes place.
Sarah arrives, almost three kilos of joy.

This is not a fairytale. And unfortunately not all the stories have such a happy end. This is what Doctors with Africa Cuamm faces every day, even now. Mothers and children, most notably the newborn, are the most vulnerable of the vulnerable.

It is an out-and-out health emergency afflicting many African countries.

Country

Angola

Ethiopia

Tanzania

Uganda

Italy

Maternal mortality

14
every 1000

7
every 1000

9
every 1000

5
every 1000

0.04
every 1000

Child mortality

130
every 1,000 live births

69
every 1,000 live births

67
every 1,000 live births

85
every 1,000 live births

3.38
every 1,000 live births

As the data show, the number of pregnancies with a negative outcome is still very high in African countries. The overall probability of dying during childbirth is, for mothers in poor countries, one in every 16 pregnancies. In developed countries it is instead 1 every 2,800. Combined maternal and neonatal mortality account for more victims every year than any other illness. Every year, approximately half of maternal deaths throughout the world (265,000 deaths, i.e. 49% of the total of 536,000) occur in Sub-Saharan Africa.

There is a multitude of causes for the dramatic maternity conditions in Africa: inefficient health systems, inadequately trained human resources – doctors, nurses, midwives –, high cost of gaining access to healthcare, long distances from health centres, lack of information on reproductive health. In sum, economic, spatial and cognitive barriers play a decisive role.

That is where Doctors with Africa CUAMM has opted to intervene, maintaining the need to put “Mothers and children first”. This is a route the organization has been taking for over 60 years, in response to its pledge to uphold the right to health in the countries of Sub-Saharan Africa. Specifically, the NGO focuses the greater part of its work on safeguarding mother and child health, which is an indirect but essential indicator of how an entire health system works.

And this route has also been improved in 2011. The association undertook to develop an ambitious project, launched last 5th November and casting real hope for the countries involved: to double the number of safe deliveries from 16,000 to 32,000 per year, within five years. Four hospitals in four countries – Angola, Ethiopia, Uganda and Tanzania – will be involved, covering a catchment area of approximately 1,300,000 population. Overall the project will provide free assistance for 125,000 deliveries, of which 11,500 will require a caesarean section.

These impressive numbers highlight the staunch commitment of Doctors with Africa CUAMM to achieving Millennium Development Goals 4 and 5: to reduce child mortality and improve maternal health. The journey has begun, which Doctors with Africa CUAMM intends to pursue with determination, to ensure that many stories have a happy ending like that of Ayen and Sarah.

Contribution by DWA Cuamm to the MMI Annual Report 2011. Author: Chiara Di Benedetto

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