TIME.com

by Bill Frist, MD and Jenny Eaton Dyer, PhD

When it comes to the health of children and mothers worldwide, there are immense challenges yet many signs of hope.

Over 6.9 million children die every year in the developing world from preventable, treatable causes. While the loss of these children is a tragedy of epic proportions, the good news is that over the last six years, this number has been lowered by 35%. We know we can combat newborn mortality and enhance child survival. Simple, low-cost measures are being taken to ensure better health for these children around the world. Measures like oral rehydration therapy, bed nets to prevent malaria, and access to immunizations have accelerated the rate of reducing child mortality in developing nations.

With an increased focus on maternal, newborn, and child health over the past few years, the global community has seen real progress against daunting challenges. An underappreciated part of that story is healthy birth spacing and timing, or family planning, which has a profound effect on the survival and quality of life of both mothers and children. As Michael Gerson, former speechwriter for President George W. Bush and Washington Post columnist, puts it, “family planning is a pro-life cause.”

When we talk about voluntary family planning in the international context, what do we mean? The definition I use is enabling women and couples to determine the number of pregnancies and their timing, and equipping women to use voluntary methods for preventing pregnancy, not including abortion, that are harmonious with their values and beliefs.

It shocks Americans to learn that one in every 39 child-bearing women in sub-Saharan Africa die in childbirth. However, when a woman delays her first pregnancy until she is at least 18, her chances of surviving childbirth increase dramatically. If she can space her pregnancies — through fertility-awareness methods (sometimes called natural family planning) or modern contraceptive tools — to at least three years between births, she is more likely to survive and her children are more than twice as likely to survive infancy.

The Center for Strategic and International Studies (CSIS) hosted a delegation in February for congressional staff, foundation, and nonprofit leaders, including Jenny Eaton Dyer, to see the emerging success of family planning in Ethiopia. With the infrastructure of their path-breaking Health Extension Worker (HEW) program, training 38,000 women as health workers in just a few years, women in the most rural communities now have access to antenatal care and family planning. With a Health Post designated for every 5,000 people, women have access to tools for healthy timing and spacing of pregnancies without having to walk for miles to a higher level health facility. In less than a decade, since 2005, Ethiopia’s contraceptive prevalence rate has nearly doubled, from 15% to 29%.

Healthy timing and spacing of pregnancies, alongside an increase in births taking place in Health Centers with skilled care during delivery and post-partum care, offers a strikingly successful model to reduce maternal mortality and improve child survival.

In addition to expanding access to voluntary family planning information and services, Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, has also focused on healthy timing and spacing of pregnancies as a critical factor for global health and development. Hope Through Healing Hands, with support from the Gates Foundation, is promoting awareness and advocacy among Americans to support maternal, newborn, and child health. We are highlighting the crucial role that voluntary family planning is playing in nations such as Ethiopia.

Healthy timing and spacing of pregnancies does more than save lives from health risks: it also allows girls to stay in school. In Ethiopia, where the average age of marriage is just 16 (with many girls married as young as age 11), girls are often forced to drop out of secondary school to begin families. If girls can delay their first pregnancy and stay in school, ideally until the university level, they will be better equipped to partner with their husbands to meet their children’s needs, in a more stable family economic environment.

And as First Lady Roman Tesfaye of Ethiopia stated, “When a mother can contribute to her own life and family, she contributes to the nation as a whole.” Moving beyond the national level, healthy timing and spacing of pregnancies is also a key to other global health goals, like combating hunger and improving the status of women and girls. Family planning is a key, often hidden, engine for additional global health achievements.

Family Planning 2020 is a global partnership of more than 20 governments working with civil society, multilateral organizations, the private sector and others. Created at a 2012 London summit, it represents a commitment to meet the needs of an additional 120 million women who want to delay or prevent pregnancy but lack access to information and tools.

With a focus on healthy timing and spacing of pregnancies, we can make major strides in just a few years. That’s great news for mothers, children, and our entire world.

Bill Frist is a former U.S. Senator from Tennessee. Jenny Eaton Dyer, Ph.D., is the executive director of Hope Through Healing Hands.

Whenever I’ve heard people reflect about their international medical experiences (especially among my colleagues who have worked here in Guyana), there tends to be a few common themes that emerge. There are statements about the gratitude of the local population, and their resilience in the face of adversity in nearly every aspect of their lives. They discuss the lack of resources available; how the hospitals/clinics can lack the most basic of amenities (gloves, bandages, water), or how few and far between medical practitioners are located. Universally, people say the experiences have changed them at their core; they now have a greater appreciation for the resources/opportunities available back in the US, and will continue to work to improve the plight of those less fortunate.

Looking back upon my experiences here in Guyana, my colleagues could not have been more right. Despite significant influence from first world nations, life in Guyana is hard and often unforgiving. Conditions that seem routine back home can often prove fatal down here, and both the medical providers and patients are well aware of this fact. This doesn’t stop either of them, however, from fighting as hard as they can, and utilizing their resources as fully as possible. I feel blessed to have had many opportunities to help care for patients here, and the experience has without question pushed me to higher places as both a physician and a person.

Above all else, my time here in Guyana has left me motivated to come back and do more. The potential that exists amongst the medical community, especially in Emergency Medicine, is quite palpable, and there seems to be a feeling that the tipping point can soon be reached. Once that happens, it could ripple through the rest of Guyanese society and hopefully produce successes and advancements that might have once seemed impossible. Of course, it’s not a guarantee, and many obstacles need to be dealt with. However, there is genuine hope, and that’s often the most important first step. 

Our mission at the Faith-Based Coalition for Healthy Mothers and Children Worldwide is to create advocates for maternal health, infant and children’s health, and for the healthy timing and spacing of pregnancies for women in developing world. This includes mothers in Africa, India, Mongolia, Guatemala, and everywhere where moms and children are living in extreme poverty. Where 222 million women (mostly married) want access to contraception, but it’s simply not available where they live.

It’s hard for us in the United States to get outside of our own experience when we look at these issues. The debate about domestic healthcare rages on, and it’s difficult for us to separate this from international maternal health. But once we’re able to imagine a daily experience outside our own, the need for advocacy becomes crystal clear.

Unicef photo childPhoto (c) Unicef

In the country of Niger, for example, 75 percent of girls become child brides. Of course, this is the country that has the highest prevalence of child marriage, but the truth is that young girls—often around eleven years old—are regularly given in marriage across Africa and southeast Asia. When these girls marry, they’re often forced to leave school, stunting their intellectual development and their social growth. They've also frequently not been educated about reproduction, and their young bodies simply are not ready to become mothers, evidenced by the fact that a girl is 10-14 times more likely to die in childbirth if she has her children before the age of 18.

Or consider Beatrice Namulondo. She was 13 when first became a mother, and she had dreams of raising a small family of children. But at age 36 she’s now mother to 17, because she had no access to any kind of contraception. This is compounded by the fact that the women in her village told her timing and spacing her pregnancies to suit the life she dreamed of and to match what she was economically and emotionally prepared to care for would make her weak and unable to work her garden, when the exact opposite is the truth.

But good work is being done to turn the tide, and in countries like Ethiopia the maternal mortality rate is dropping, the country’s GDP is rising, and political leaders believe these things are intimately connected. With Ethiopia’s Health Extension Worker (HEW) program, women and children receive visits from the 38,000 HEWs like Miheret, who travel to hard-to-reach places (like Ethiopia’s border with South Sudan) to administer vaccines, test for diseases like diarrhea or pneumonia, and monitor the hygiene in the home. Women are given access to contraception and maternal care when they do choose to have children. The results are staggering—child mortality has been slashed in half, poverty rates are down, and twice as many children are in school.

If you want to learn what you can do to help more women get access to this kind of life-saving assistance, visit our Faith-Based Coalition for Health Mothers and Children Worldwide page and see what advocacy activities we’re involved in at the moment. Follow us on Twitter @HTHHglobal and on Facebook. We need you!

Prior to my arrival in Guyana, I had the opportunity to spend a considerable amount of time with one of the Guyanese EM residents when they visited Vanderbilt. In one of our discussions, he brought up a fact that surprised me: the majority of Guyanese in the world do not reside in Guyana. Instead, they are scattered throughout North America, namely New York and Toronto. Only 10-20 percent of his family, for instance, remained in the nation, with the rest living in one of New York’s five boroughs. When I asked him if he would eventual join them in the US, he said no. His colleagues, however, had a much different approach.

After being here, I can understand why that sentiment exists. Guyana is a nation in flux. On one hand, it is quite modern; many people have cell phones, the Internet is widely available (I had WiFi in the middle of a rainforest), and the dissemination of information can occur rapidly and quickly (via Facebook, or other methods). Many of the excesses of our time are at the fingertips of a large portion of the population, especially in Georgetown. Unfortunately, it seems luxury has outpaced necessity, with the end-result being a palpable level of frustration.

This is quite evident in the sphere of healthcare. The physicians here harbor much of the same knowledge and skills that we possess and they know what interventions are needed to treat the most complicated of medical or trauma patients. However, they have very limited resources in terms of pharmaceuticals, imaging, and surgical support to adequately treat the conditions they see. I’ve only been here a few days and I have often felt handcuffed. I can’t imagine how hard it is on the local staff to feel constrained to that degree all the time. When faced with the options of either staying home and going through the growing pains (which may take decades and is by no means guaranteed), or moving to a place (the US or Canada) that has already arrived and that boasts a seemingly thriving ‘local’ Guyanese community, the decision to stay can seem illogical. This is probably why many young, educated folks, especially doctors, leave, which in turn only serves to delay progression further. It’s a detrimental dynamic.

The doctor who visited me at Vanderbilt says he’ll stay in Guyana. Being a part of the construction of not just the specialty of Emergency Medicine but of his nation is something he cannot leave. It’s a brave stance to take, and I genuinely think the new residency program in Emergency Medicine will help him avoid succumbing to the temptation to leave. For me, I am honored to be able to help support this institution, even though it’s in a very minor way.

In the end, while it’s a baby step, it’s still a step, and they will eventually add up. 

Andrew Pfeffer headshot

The next two weeks I found myself much better able to engage in the hospital system. Now I had learned the names of Benson, Mugo, Humphries all clinical officer or medical officer interns. It became my pleasure on night and weekend call to lead them through surgical triage or procedures. On subsequent calls I was able to help one of the medical officer interns through two chest tube placements. These patients had spontaneous pneumothoraces, but were not in extremis, thus I could take my time and coach the intern through the procedure. By the second placement, Mugo was able to anesthetize the patient appropriately, make the incision, and perform this life saving procedure. He remained a bit tentative, but I had seen vast improvement by this second time. These guys and gals are the front line of the Kenyan medical system, and are seeing patients in isolated places with no surgeons, or even residency trained physicians available. Teaching Mugo to place a chest tube well could benefit multiple Kenyan patients in the future.

We also had opportunity to entertain these learners in our home. We got to learn of some of the struggles they had to overcome. One resident commutes nearly an hour each morning and evening for the benefit of her family. Other interns come from extremely poor or difficult circumstances. The Kenyan health care system relies on these young men and women.

Jason Axt with staff

Another sad and challenging case that I encountered was that of D. He is 45 year old man who had been diagnosed with appendicitis over a month prior to my meeting him. He had been taken to theater for an appendectomy at an outlying hospital. When I met him he was post op day 2 and 3 from a second laparotomy for peritonitis and periappendiceal abscess. He had succus pouring from the lateral portion of a “hocky stick” incision. It seems he had been diagnosed with a post appendectomy abscess, and the medical officer (almost certainly not a surgeon) had encountered dense adhesions as he or she had attempted to drain this abscess. The operation had resulted in multiple enterotomies and now enterocutaneous (EC) fistulas. He likely had generalized peritonitis after his first operation or maybe at the time of his first operation. EC fistulas are difficult problems in the United States; here an EC fistula is devastating and likely fatal. We took him to theatre and did a diverting ostomy while closing or resecting the 5 enterotomies or anastomoses that had been left. We placed him on TPN – a rare and expensive resource here. We were unable to close his abdominal fascia, and settled for closing the skin.

He remains alive now 1 ½ weeks later. He remains on TPN after an episode of central line related sepsis and partial opening of his abdominal wound for infection. D. is an example of advanced surgical care done amidst quite austere and resource limited setting. He also is an example of a patient who would have fared much better with initial treatment by a well-trained surgeon. Simple ultrasound guided abscess drainage could have avoided this morbid procedure in this patient, but is available here in a limited fashion. D. remains very grateful for his care and is asking the hospital clergy and medical staff to pray with him and for him. Surgery in Kenya is far different from that at home. Learning to work and teach amidst the resource constraints here has been a stretching and eye opening experience. 

FGHL Jason Axt: Extreme Medical Issues in the Field

Warning: This post contains graphic medical images.

Feb 28 2014

Warning: This post contains graphic medical images.

This week started with an orientation to the hospital. I learned where the theatres were, where the clinic patients were and the location of the wards. Patients were housed in common sleeping rooms with 4 – 20 patients per ward, with men and women housed separately.  I was introduced to Dr. Irungu, the Kenyan consultant whose service I would join. 

I quickly realized here that the practice of general surgery is far broader than what I am used to. One of the first cases I scrubbed into was a transcystic suprapubic prostatectomy. This is a case that is seldom performed in the US but is frequently done here. This man had disabling enlargement of his prostate that had resulted in urinary retention and renal failure with a creatinine of nearly 4. His renal failure resolved after the placement of a foley catheter and monitoring for several weeks. After confirming by biopsy that the prostate was not enlarged due to cancer we removed his prostate by this transabdominal procedure. He was extremely thankful when we discharged him four days later sans catheter and urinating on his own. This basic surgery had transformed his life and reversed the process that had resulted in his renal failure.

I encountered a disturbing patient early in my second week. During clinic we see about 80 to 100 patients between two consultants and two residents. I met and admitted a young man from a large refugee camp. He had initially had a “leg blister” two weeks prior. When I met him he had at least 15% body surface area total skin loss to his left leg. It was a lesson in muscular anatomy, as all the muscles were completely in view. The joint capsule was open, seeping a mixture of pus and synovial fluid. He had had a debridement procedure elsewhere, but it had been wholly inadequate. Although not in critical condition or septic shock, he would need extensive debridement and at least an above knee amputation if not a disarticulation of the entire leg. Regardless, he would require weeks to months of rehab even given an expeditious amputation with skin closure. We took him to the theater the next day, and our fears were confirmed. There was extensive soft tissue loss with residual deep infection. He would require leg disarticulation. 

Jason Axt Patient Leg

The man refused to consider amputation, stating that he was young, needed to work, and could not do without his leg. He and his friends demanded discharge so that they could go to look for another surgeon who would be able to save his leg. Reluctantly we released them, telling them we were more than willing to help them if they wanted to return. The needs are large, the presentation was late, and the die was cast. I hoped that this was not the last that we would see from him, because I am sure he would progress to generalized sepsis and death without amputation.  

The Ethiopian Orthodox Church (EOC) comprises 43.5% of the population, or almost half.  After that, Muslim communities make up 33.9% of the population. In the minority, Protestant denominations comprise 18.6%. And finally, there are a few other traditional religions at 2.6%, and Catholics at less than 1%. The EOC has a long, rich cultural history in Ethiopia. It was a part of the Coptic Orthodox Church until 1959 when it was granted its own patriarch. It is a hierarchical religion with archbishops and bishops worldwide.

rock church_ethiopia

In the Tigray region, there exist a host of monolithic churches, or churches hewn out of one single rock. There is a community of churches in Lalibela that are famous rock churches, but there are a few in Mekele as well. We visited one on the outskirts of town while there.

Perhaps most famously, in the town of Axum, The Chapel of the Tablet at the Church of Our Lady Mary of Zion claims to house the original Ark of the Covenant with the Ten Commandments as held by Moses.

In Mekele, we were able to visit with both an Eastern Orthodox Priest, Keshi Gebre Tsadkan, as well as staff from the St. Frumentius Abba Selama Kessate, Berhan Theological College Mekelle including Mr. Tesfaye Hadera, Dean; Mr. Mekonnen Tesfay, Vice Dean; and Mr. Assefa Reda’e, Bible for Development Coordinator.

priest_ethiopia

Knowing that there are over 500,000 Ethiopian Orthodox Priests throughout the nation of Ethiopia, there is an embedded potential arm of the culture to support and educate citizens about access to health care. Before he died in 2012, the former Patriarch Abune Paulos urged Ethiopians to seek not only “holy water” to heal HIV/AIDS, but he also encouraged his followers to adhere to their regimen of anti-retroviral medications. This was a crucial message for people living with HIV/AIDS to seek proper care and treatment.

In the same way, priests serving as “godfathers” to families throughout the country have the opportunity to educate families about the importance of women’s health, antenatal care, and family planning. This being said, the situation is made complex by the current stigma that still surround issues of sexuality.  The statistics show little participation in pre-marital sex in Ethiopia, probably due to the average age of 16 for marriage for girls. Yet, girls typically marry older men who want children immediately. The gatekeepers of the community including ethnic leaders, mothers-in-law, and religious leaders tend to support the husband in the wish for families. Thus, the highest unmet need for contraception in the country is for young married girls between the ages of 15-19 at 30% as of 2011.

However, some priests are aiding in the destigmatization of family planning in their communities, such as Gebretsadkan. He shared that he goes with his wife to the Health Post to demonstrate his support for her choice of contraception. As a “godfather,” he advises many husbands and families on how to better time and space pregnancies, encouraging contraception, as a life saving mechanism in some cases.

When I asked about his theological position supporting family planning, he asked, is it not a sin to not be able to provide food, clean water, and clothing for your own children? To allow your children to suffer from hunger, malnutrition, and potential disease because you cannot support them? Isn’t it better to take advantage of the knowledge that family planning allows for healthier deliveries, births, newborns and children properly timed and spaced as well as a more stable family economically?

Similarly, in speaking with the Dean and Professors of the Seminary, they too argued that in fact Ethiopia had accomplished the request to “Be fruitful and multiply the earth,” as noted in Genesis. Now, it was time to rethink the health of mothers, children, and families with access to family planning.

The St. Frumentius Abba Selama Kessate, Berhan Theological College Mekelle partnered with UNFPA and Population Council to create a “Developmental Bible.” This book, printed in Amharic, held 365 different devotions with Scripture related to development and health issues. The Scripture correlated with issues such as HIV/AIDS, maternal and child health, infectious disease, hunger, malnutrition, and family planning.

These books are the basis of a “Developmental Bible” course at the Seminary for formal training of priests as well as an informal training for current priests through workshops. At the end of the training, they receive the books to use in their communities in devotion and worship. These Developmental Bibles have been disseminated throughout the nation.

Some argue that the religious leaders pose a barrier to family planning. Others contend that the support of religious leaders has been helpful from HIV/AIDS awareness and education to family planning. We conclude that due to the pastoral, rural nature of the country, that likely there is much work to be done to educate and encourage priests to urge their followers to seek information and services to improve maternal and child health, including family planning.

In every village, there is a priest or an imam or a pastor. If these religious leaders were incentivized to promote awareness and education of health care opportunities, like family planning, the religious communities could also be a powerful arm mobilizing the nation to achieve MDG5, improving maternal health.

FBC for HMACW logo

FOR IMMEDIATE RELEASE

Contact: Melany Ethridge: (972) 267-1111, melany@alarryross.com, Kate Etue: (615) 481-8420 (m), kate@hopethroughhealinghands.org

NASHVILLE, Tenn. – Senator Bill Frist, M.D., announced today that Hope Through Healing Hands (HTHH), a Nashville-based global health organization, will partner with the Bill & Melinda Gates Foundation to create the Faith-Based Coalition for Healthy Mothers and Children Worldwide. The organization will be based in Nashville, Tenn., and led by Executive Director Jenny Dyer, Ph.D., who has been with HTHH since 2008.

HTHH was founded by Frist in 2004 to promote improved quality of life for citizens and communities around the world using health as a currency for peace. Now, through its new Coalition, it will focus on galvanizing faith leaders across the U.S. on the issues of maternal, newborn and child health in developing countries, with an emphasis on the benefits of healthy timing and spacing of pregnancies, including the voluntary use of methods for preventing pregnancy, not including abortion, that are harmonious with their values and religious beliefs.

“Maternal and Child Health issues are at the core of global health and saving lives,” says Doctor-Senator Frist. “We know that family planning, including access to contraception, plays a critical role in combating maternal mortality and enhancing newborn and child survival rates, addressing directly Millennium Development Goals #4 and #5.”

More than 220 million women worldwide who want to avoid pregnancy do not currently have access to effective contraceptives, information or services.

Support for healthy timing and spacing of pregnancies is one of the most cost-effective and powerful strategies to empower women to get more education, obtain better jobs, and contribute to the economic health of their families and communities.

“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,” says Jenny Eaton Dyer, PhD. “We call on others to join this movement to save lives.”

HTHH 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 initiatives, which will save the lives of mothers and children by greatly reducing the number of high-risk and unintended pregnancies that occur each year.

Hope Through Healing Hands is a Nashville-based nonprofit 501(c)(3) whose mission is to promote improved quality of life for citizens and communities around the world using health as a currency for peace. Senator Bill Frist, M.D., is the founder and chair of the organization, and Jenny Eaton Dyer, Ph.D., is the CEO/Executive Director.

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.

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