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!

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 Blog: 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, [email protected], Kate Etue: (615) 481-8420 (m), [email protected]

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
| [email protected]

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.

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