I am sitting on the terrace of my hotel in Kathmandu, sipping spicy masala tea and looking out at the cityscape for the last time. Below me, the pudgy, fresh-faced toddlers of affluent Nepalis learn to swim in the crystal-clear swimming pool, a far cry from the muddy, leech-infested floodwaters of the nation’s rivers and lakes. The all-seeing eyes of the Boudhanath stupa, the holiest Tibetan Buddhist temple outside of those in Tibet, gaze placidly down at me from their towering perch above Kathmandu, watching over the nation. In the distance, somewhat obscured by the dust and smog of the capital city, I can see the Himalayan foothills, their dark, untamed beauty seductive in its wildness. I think of my ten SBA students, scattered now throughout isolated villages in those very mountains, providing contraception services and prenatal care and delivering babies in remote clinics. I offer up a silent prayer for them, and for the women, children, and families they are serving.
This is now my third trip to Guyana to work at Georgetown Public hospital, fondly referred to as GPHC, in the Accident and Emergency Department (A&E). Each trip has been eye-opening, motivating, inspirational, at times frustrating and heart wrenching, and always immensely rewarding. I am fortunate to be the current Global Health Emergency Medicine Fellow at Vanderbilt, meaning I will spend much of my time this year working in Guyana.
There is no period more critical in a child’s development than its first few months of life, which is why so much attention is paid to what the mother, and the child, eats during that time. Nutritionists like to call it the “golden window” — the slim period of time where a child, if he gets the right nutrients, can set out on a healthy path, or, if he doesn’t, risks irreversible stunting and developmental delays. “Eighty percent of the brain development happens in the first 1,000 days of a child’s life, starting from conception,” says nutritionist Sanjay Kumar Das.
Over 13 million adolescent girls between 10 and 19 years–equivalent to the population of South Sudan–were married in India in 2011, according to census data, but fewer literate women were married as children or had children early compared to those who were illiterate, according to an analysis by Child Rights and You (CRY), a Mumbai-based child rights nonprofit.
The Senate confirmation last week of our colleague Ambassador Mark Green to be USAID Administrator comes amid the struggle between the president and Congress over the administration’s proposed 30 percent cuts to foreign assistance. In this convergence of events, we see a real opportunity for Congress and the administration to do much more than debate where the burden of potential cuts might fall, and instead make lasting reforms to make our foreign assistance better able to enjoy long-term success and provide savings far beyond next year’s budget. Success will not be easy and will require significant changes to our approach to development.

Barbara Kühlen: Midwifery is Part of the Culture

By Barbara Kühlen

Aug 03 2017

Despite the enormous progress that has been made in reducing rates of maternal and infant mortality, over 300,000 women still die every year of complications from pregnancy and childbirth. Six million children under the age of five die each year as well. Millennium Development Goals (MDGs) 4 and 5 fell shortest of their targets. Traditional midwives play a central role in preventing mortality, attending births and caring for mothers and their newborns. But their possibilities vary greatly.
Yesterday, the ten SBA participants, their nursing instructors, two representatives from One Heart Worldwide, and I all celebrated the final day of the program, during which the students received official certificates testifying to their new status as skilled birth attendants.

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