The Tennessean

By Adam Tamburin
| atamburin@tennessean.com

The Bill & Melinda Gates Foundation is teaming with a local nonprofit founded by former Sen. Bill Frist to promote women’s health in developing countries.

Frist announced the partnership Monday. The Gates Foundation will focus on a new initiative spearheaded by Frist’s Hope Through Healing Hands organization.

That initiative, dubbed the Faith-Based Coalition for Healthy Mothers and Children Worldwide, will aim to encourage faith leaders to discuss health issues facing mothers, newborns and children, according to a media statement.

In particular, the coalition plans to emphasize the importance of spacing and planning births using contraception or natural family planning methods. Hope Through Healing Hands and the Faith-Based Coalition for Healthy Mothers and Children Worldwide will meet with evangelical and conservative leaders throughout the U.S. with an appeal to support these efforts, the statement said.

“Maternal and child health issues are at the core of global health and saving lives,” Frist said in the statement. “We know that family planning, including access to contraception, plays a critical role in combating maternal mortality and enhancing newborn and child survival rates.”

Dr. Jenny Eaton Dyer, the CEO and executive director of HTHH, says the coalition’s success could save lives.

“We are committed to leveraging our own networks in the United States to support maternal, newborn and child health by promoting awareness and education on the life-saving benefits of healthy timing and spacing of pregnancies for mothers and children worldwide,” Dyer said.

Haiti Nursing Graduate Faculty

Two years ago, the Clinton-Bush Haiti Fund granted $462,800 to Regis College to advance Haiti's future nursing leaders through a master's degree of nursing program in the country. The goal was to unite Haiti's government and higher education institutions to support nursing programs in their country. 

The grant enabled the country to elevate their nursing program to a higher level, which has resulted in sustaining nursing jobs, promoting healthcare standards, and transforming the health sector.

On February 18, 2014, the first twelve faculty graduates of the master's degree in nursing program from the University of Haiti. Twenty-four more faculty members will complete the program, who will in turn pass their education on to more than 4,000 students each year.

Read more at Regis College's website.

by Jenny Dyer, PhD

Over the last ten years, Ethiopia has implemented their Health Extension Worker (HEW) program building Health Posts with HEWs throughout the country. To date, there are some 38,000 HEWs; two at every post. This has amazing reach to communities whose individuals might otherwise have to walk for miles and miles just to have basic services for a sick child, contraception, or antenatal care. This being said, the Health Post does have limitations. The HEW cannot provide a high level of skilled care. For instance, women in Tigray are highly encouraged to take a “mobile ambulance” (i.e. stretcher) to the Health Center where they can have access to skilled health workers that are better prepared to manage complications during birth.

Agulae health center_ethiopia

We visited Agulae Health Center in Tigray which won the award for the best Health Center in the country a couple of years ago. The sign outside reads “Healthy Mom, Happy Child.” The Center focuses on maternal and child health , ART treatment, TB treatment, family planning, and youth friendly services, providing a holistic approach for development of identity for teens in the area. Ethiopia is serious about improving maternal health, or conversely, reducing maternal mortality. And, one step to do this is by encouraging moms to have their babies in the health center, not at home.

Healthy Mom happy child_ethiopia

Inside, patients waited for services including anti-retroviral treatment, immunizations, contraception, antenatal care, and pediatric care. The Health Center Director, Tirete Zeleke, shared with us the progress particularly in delivery services over the last five years. See the chart below. Note that Ethiopia’s calendar is eight years behind ours, so it is 2006 currently. In 2001 (Ethiopian calendar – so 2009), they record that only eight percent of mothers were coming to Agulae to have their newborns. But by 2005 (2013), they note 95 percent were choosing to come to the Center to take advantage of the services and resources for a safer delivery. This is an unbelievable change.

D/S_ethiopia

There has been much resistance from Ethiopian women to give birth outside her home. First, the “stretcher” that some communities in Tigray have developed to  carry the pregnant women from their community to the Center, or at least to a paved road to get transportation, has been stigmatized. It was said if you left on the stretcher, you never would return. To destigmatize the stretcher, they now call it a “traditional ambulance.” Secondly, there are rituals to be performed immediately after birth to drive away the evil spirits that might take your life or the life of your newborn. This involves a coffee ceremony and the partaking of porridge. Family and friends in the community join in these rituals, partaking together. The Center has recognized this void for the community, and it has created a space for performing the coffee ritual.

coffee ritual_ethiopia

Also, it has required all farmers in the region to donate 1 kilo of teff (an ancient grain) from their harvest to the Center to make the porridge. This attention to community beliefs and ritual has helped break down the cultural barriers that were impeding the women to leave her home during labor.

Lastly, as a final incentive, they have started to create beautiful, laminated birth certificates after one year of postnatal care and infant care. These special documents serve as birth registries and include a photo of the child and all the necessary health care information. Birth registration is so important for establishing name, nationality, and providing the dignity of identity for citizens.

brith certificates

Finally, they have pursued religious leaders to join them in encouraging couples to seek out both family planning options as well as to encourage women to deliver in the Health Centers. The synergy of religious, social, cultural, and governmental forces working together in Tigray has made Agulae Health Center a model for progress in Ethiopia, particularly for maternal health.

by Jenny Dyer, PhD

Upon the conclusion of the seventeen-year Ethiopian civil war, the region of Tigray, the northernmost province in Ethiopia, is the home to the Ethiopian People’s Revolutionary Democratic Front. Their late Prime Minister Meles Zenawi who led the revolution and won is celebrated still across the country. Today marked the annual Tigray People’s Liberation Front Celebration and the town of Mekele took a holiday to celebrate in a public event.

Tigray

Our delegation, however, was there for another reason. We wanted to learn more about the Health Extension Worker program, and how it worked. To do so, we first visited a Health Post. This post serves a population of about 5,000, and they are placed throughout Ethiopia. A HEW who has achieved an education to the tenth grade and then one year of HEW training is placed with one other HEW colleague at a Health Post and lives in the village she works. Almost all of the HEWs are women.

The drive from Mekele to Gemed Kebele took us over a landscape not unlike that of New Mexico. We wound around paved roads that showcased a vast expanse of an arid landscape with a background of rocky mountains. We traveled up a dirt road the last part of the trip into a small, quiet village where some children were seen carrying yellow water jugs and others were racing through the valley. We finally arrived at the health post to meet Miheret Gebrehiwot.

This health post is a simple concrete structure lacking running water and electricity. But it has a patient bed, sparse pharmaceuticals, and a space to keep data on the health of the community.

Health Post_ethiopia

Miheret is a trained HEW who is one of two who manages the health post. She presented herself in a white coat and welcomed us inside her office and patient’s room. There, she described the kinds of services she provides, largely for mothers and children. She has detailed charts covering the walls, meticulously keeping data on diagnoses and disease in the area. She must then report this data monthly to the Health Centre, which we will visit tomorrow.

Minheret

Miheret herself was a child-bride. She was married at the age of 11 while she was just in the third grade. Upon marriage, she left school to take care of her new home. She bravely retold her journey to becoming a HEW and her passion for educating women about healthy timing and spacing of pregnancies. Miheret had her first child at the age of 16. She knew then that she had to return to school for a better life for herself and her children. With help from her mother with her child, Miheret pursued graduation from the 10th grade. She then sought training to become a HEW. Miheret has been able to space her pregnancies, have a second child, and pursue a happier, healthier life for herself and her family. She wants to become a nurse someday.

The Health Posts, just like the one in Gemed Kebele , provide critical family planning services to women in rural communities who might otherwise lack access to contraception. Moreover, they have HEWs who keep track of their choice of contraception and when they are due for their next appointment. At the Health Post, they offer Depo Provera, an injectable, which is the favored contraception of choice in the area, and it lasts three months. Other options include Implanon (an implant which can be performed by the HEW), birth control pills, and condoms.

Eth_birth control  health post_bed

If these women can access consistent contraception, they can better plan their families according to the best timing for their own health and the health of their children. Again this leads to better opportunities for the mother to return to school or return to work and provide a more substantial income for her family.

HEWs also provide Antenatal care. They carefully track pregnancies in the communities. For every pregnant woman, they recommend four medical visits including one to the Health Centre. They also advocate for the mother to travel to the Health Centre to deliver her baby. There they can have access to skilled attendants, running water, and electricity.  Alongside the rising contraception prevalence rate of expansion of family planning, these combination may be the key to combatting maternal mortality.

Welcome to Addis!

Meeting First Lady Roman Tesfaye

Feb 19 2014

The Center for Strategic and International Studies (CSIS) has pulled together a congressional delegation trip to Ethopia, and they invited me to join them. In leading HTHH’s Faith-Based Coalition for Healthy Mothers and Children Worldwide, I was invited to meet the faith leaders here to learn their stories and the position on the progress of healthy timing and spacing of pregnancies here in Ethiopia.

Ethiopia has achieved the reduction of 2/3 of child mortality for 2015. However, they lag behind, as do many other countries, in addressing maternal mortality. Here, they have rolled out in the last ten years a robust Health Extension Worker (HEW) program of over 35,000 HEWs across the nation. The government manages the HEW program, placing 2 HEWs at a health post to which ideally every person can reach for primary health care services. If there is a health issue that requires a higher level of expertise, the patient is referred to a Health Center, a more substantial facility that has more resources and higher level of trained health workers. This HEW program is taking the lead in educating women about contraception so that they can better time and space their pregnancies. If these young women can delay their first pregnancy and space out their births at least 3 years apart, they have a better chance for their own and their children's survival.

First Lady Roman Tesfaye

Upon arriving, we quickly got ready and drove across town to the Prime Minister’s residence for a private meeting with the First Lady Roman Tesfaye. Ms. Tesfaye knew we were here to learn more about maternal, newborn, and child health and family planning here in Ethiopia, and she clearly had much enthusiasm discussing her country’s progress in these areas. She spoke at length about her passion for women’s health, particularly around family planning. She explained how family planning was the key to gender equality. With contraception prevalence doubling over the last five years from 15% to 29%, young women are emerging as leaders in their communities. Girls are able to stay in school through high school and then even attend one of their new 32 universities, and women are contributing to the rise of the economy.

Ms. Tesfaye noted, “Family planning is liberating our women. Not only can women now contribute to their own lives, but they are contributing to our country as a whole.” 

The goal for 2015 is to provide 66% women access to contraception or education about healthy timing and spacing of pregnancies. Right now, they expect the 2013 statistics to show that 40% of women have access some form of contraception. Their goal is ambitious, but they believe it is within reach.

Ethiopia has a good story to tell, and Ms. Tesfaye tells that story with elegance and quiet excitement. They have success in decreasing AIDS, decreasing poverty, decreasing infant mortality, and they are increasing their economy. They have also set a focus on decreasing maternal mortality; they are optimistic that the indicators will soon reveal success there due to spacing of pregnancies. It is an exciting moment to be here in the midst of this progress.

Frist Global Health Leader Beth O'Connell, Part 3

Report from the Field

Feb 14 2014

We visited a malnourished and abused child, named Cesar, who is doing much better. My hosts and I visited him in the hospital yesterday and he looked like a different child. He had been given a much needed hair cut and had gained about five pounds. He was watching cars and motorcycles out of his window and jabbering away in Q’eqchi’ about them. We did understand “beep, beep!” He is expected to be transferred to a rehabilitation center next week.

I have spent time this week continuing data analysis on a malnutrition study. The results are staggering. Of 954 children, 63 percent were chronically malnourished, with stunting as a result. Eighteen children were acutely malnourished, but improved to normal weight for their height by subsequent visits after receiving nutritional supplements based on the United Nations protocol. Another fourteen were acutely malnourished at their last or only visit. We will be following up with these children to retake height and weight measurements and provide the supplements according to the UN protocol. We hope not to find more situations like the abused boy, but are prepared to help children in whatever way is necessary.

I have also assisted with two dental health fairs. The first had 266 participants including children, parents, and teachers, and the second included 231 participants. There were four stations through which participants rotated. The first station taught participants to brush teeth and learn a little song about how to brush them. They practiced by brushing the teeth of a stuffed monkey. The second station educated participants about what causes cavities and allowed them to do a fluoride rinse. The third station was on healthy eating for healthy teeth. And the last station was a demonstration of dental sealants available through CAFNIMA, my host organization. All instruction was done in the local indigenous language. Toothbrushes, toothpaste, and fluoride are made available for purchase at a very small amount. There was a positive reaction and many purchased toothbrushes and toothpaste.

A large part of my job has been crowd control with hundreds of children to manage. A double language barrier has prevented me from direct educational involvement. We will be doing two more dental health fairs during my stay.

I have attended two community meetings while I've been here. The culture of this population is very communal and all decisions and important events are discussed in community meetings. Therefore, my host organization participates in them to get permission for projects and to promote participation in events. I have found this experience important to my understanding of community health and working with communities to improve health.

It is worth noting that this population is spread out over a mountainous terrain and that putting on events and attending meetings often requires intense hiking. To get to one community meeting, I and my hosts hiked an hour and a half down a mountain and half way up another. There was a bridge in the middle to cross a river. It rained, so the hike back was a two hour slip-and-slide climb on hands and knees at times. In other words, a two hour event actually takes most of a day to accomplish. This is fairly typical and another interesting part of community health when working with a rural population. 

What is the MDG5?

And how can you be involved in improving maternal health worldwide?

Feb 12 2014

MDG5

Of all the Millennium Development Goals (MDGs), MDG5, or Improving maternal health, is critical for addressing other global health issues like child survival, extreme poverty and hunger. If Mom dies in childbirth or suffers severe complications, the entire family is in jeopardy. Kids may not be able to finish primary education in order to raise siblings. Mom may suffer from poor health and cannot maintain her job. Newborns lack a mother to nurture them in their first years of life.

Every year about 350,000 women die from pregnancy-related complications. 99 percent of these deaths occur in developing regions, and 80 percent of them are preventable.

Maternal mortality has fallen by 50 percent since 1990, but still only half or women in developing regions receive the recommended health care during pregnancy. The goal is to reduce the maternal mortality ratio by 75 percent by next year. We have far to go.

You can help improve maternal health and combat maternal mortality through learning more about these issues, working alongside groups focusing on maternal health such as Every Mother Counts, and advocating for these women. We encourage you to make a phone call or email your Congressional Leader today to let him/her know that you care about maternal/child health and you want them to fully fund programs which would improve the lives of mothers around the world. 

Resources:

UN: Millennium Development Goals 

Action for Global Health  

The Bill & Melinda Gates Foundation

Image by Action for Global Health

Frist Global Health Leader: Beth O'Connell

Descriptive Statistics

Feb 10 2014

            The comprehensive report that I have been creating of a baseline study has proven to be a challenge and a great learning experience. I have learned how to use SPSS software more fully and gained a better understanding of application of biostatistics and epidemiologic concepts I learned in the classroom. Having to actually use information always brings a new level of understanding. I have called upon colleagues within my network at the ETSU College of Public Health to help me along the way. After finishing up some literature review for recommendations, my report will be ready to submit to the organization by February 14.

            Findings of my data-crunching include demographic, water and sanitation, maternal and infant health, economic development, communication infrastructure, education, community organization and advocacy, women’s empowerment, and nutrition data. Some of the more interesting findings include the number-one cause of death of children being diarrhea, as well as a high prevalence of diarrheal illness at the time of the survey. Figures from these questions are shown below. 

Beth O'Connell Child Cause of Death

Beth O'Connell Current Illness of Children

Other highly interesting data is found in education levels and literacy rates. Please see the graphs and table below. 

Beth O'Connell Literacy

Beth O'Connell Languages Spoken

Beth O'Connell Highest Grade Completed

These are just two examples of data standing out from this now forty-page report. I expect my work to be of significant value to my host organization, and it is certainly adding to my knowledge and understanding of baseline needs assessment and data analysis. 

Beth O'Connell dental fair
Day 1, Guatemala

I spent my first night in Guatemala City with Christian Aponte, director of CAFNIMA, my host organization. He helped me review the report I have been working on of the household survey data. We have been fine tuning it to be the most helpful to the organization and people. From there, I took a five-hour bus ride to Cobán and a two-hour truck ride to the Ulpán Valley. 

The major project I have been working on since my arrival is a malnutrition study. We are using the WHO program Anthro to determine which children are chronically and acutely malnourished and require intervention. This determination is based on the height, weight, and age of each child. So far, I have identified fourteen children who were moderately to severely acutely malnourished at the last visit. We will be visiting as many of these children as possible to remeasure them and provide nutritional supplements as well as education to the family on their care. The supplements given with the supervision of a physician based on the United Nations recommendations for in-home recuperation of malnourished children. These interventions have been shown to work—an additional eighteen children were previously acutely malnourished and improved in subsequent measurements following intervention.

Beth O'Connell Chained

The first child we visited as a part of this study had not been previously seen, but a CAFNIMA employee, Ricardo, had been told about him. At our first visit to the home, it appeared that no one was home. We heard noise behind the house and found a six year old boy chained to a post. It was immediately apparent that this was a case of abuse rather than simply lack of food in the home. Because this organization works with the community, this situation needed to be handled delicately. We returned to the home when the adults were present including a mother, aunt, and grandfather. The other four children in the home appeared healthy. We got permission to weigh and measure each child with the intention of focusing on the six-year-old’s situation. After discussion, we found out that this one child was mistreated because of a superstitious belief of the Maya that if the mother experiences trauma during pregnancy, the child is cursed. This belief was further encouraged when he was born early at four pounds. He is currently only 21.8 lbs. We provided the family with supplemental food and vitamins and watched the child eat as fast as he could. Ricardo was communicating with the community authorities to see what could been done to change the situation from an authority standpoint.

The following day, we returned to the home with clothing for all of the children and more food. We gave the boy food again while we were there, and he vomited immediately. We then found out that he had been vomiting and had diarrhea with the food provided the previous day. He also had a cough. We told the family the protocol we were using and the organization physician both advised that with such complications the child be taken to a hospital. They agreed to allow us to take the mother, the sick boy, and a younger sibling who was still breastfeeding to the hospital. It was a long night of trying to get help because it took about three hours to get to the first clinic (with several stops when he would vomit or have diarrhea again) and then we had to take him to another facility. There was a long delay before he was actually registered and began receiving care. We stayed the night in the city to get a few hours of sleep and returned to the hospital the next morning to check on him. They would not allow the younger sibling to stay in the hospital, so we took the mother and baby back to the community and convinced her to leave the baby with the aunt and return to the hospital to stay with the sick boy. All of this was in an effort to reconnect her to her child and learn to care for him again. Additionally, an organization employee filed an official abuse report to the government. The church the family attends has also been involved, and we hope that there will be encouragement from them as well for the family to change their treatment of him as “special.” For now, the child is receiving care and food and the proper actions have been taken to get him legal help as well as to encouraging the family to change their views of him.

All this happened in my first three days in the community. It has been a rude introduction to the needs of the people and the complexity of cultural situations. We have fourteen more children to find and follow up with. I am also providing the organization with further data on all of the children involved in the study. Chronic malnutrition is rampant, with 63% of those measured fitting guidelines for moderate to severe stunting. I pray that we are able to make a difference for these children and families.

Tomorrow my hosts and I will attend a community meeting to promote upcoming dental health fairs. 

MDG4 Gates Foundation

Five years ago, Save the Children asked me to chair their Newborn and Child Survival Campaign. In 1990, over 12 million kids were dying every year; that is, over 33,000 children were dying every single day from preventable, treatable disease.

Today, the statistics have changed. We have almost cut that number in half. The goal for Millennium Development Goal #4 to reduce child mortality by 2/3 is within our grasp. The numbers show that almost 6.6 million children die per year, or about 18,000 children per day. The good news is that we are making progress.

What are the keys to this progress? With over 40% of the deaths under 5 being attributed to newborn or infant mortality, addressing the need for a skilled birth attendant, keeping the baby warm and dry at birth, and encouraging breastfeeding goes a long way. After the first year, simple interventions such as vaccines and ORT (oral rehydration therapy) combat the number #1 and #2 killers of children in developing nations: pneumonia and diarrhea. Bed nets, nutrition, clean water, and sanitation access have also been key interventions to combat child mortality.

We aren’t there yet. But we are on the way. Join Hope Through Healing Hands and follow us on Twitter to stay up to date on MDG4 and other global health news and why it matters. 

Photo from the Bill and Melinda Gates Foundation website.

Subscribe to our newsletter to recieve the latest updates.