Mr. B is a middle-aged man who was following up with us after an acute visit about three weeks ago for chest pain, which, at the time, was thought to most likely be due to acid-reflux. It was clear as I spoke with him that afternoon that while his reflux-related pain had subsided some with the addition of a medication, he still wasn’t feeling like himself.
I guess you might say that everything is unexpected for me on this trip. This is my first time on the continent of Africa and so many things have been a surprise. For example, here in Kenya, almost everyone speaks English and there are zebras by the side of the road grazing on grass just like there are horses in the US.
As a surgical resident in a tertiary care center, I have seen a lot of patients in consultation for surgical evaluation. A typical consultation request includes age, gender and diagnosis of the patient. When I decided to pursue surgical training, I specifically acknowledged that I would forego much of the diagnostic process as typical referrals come to us diagnosis already known.

Nov. 23, 2015 | Christian Post

My involvement with issues surrounding maternal and child health began in 1997 when our oldest daughter, Emily, and I traveled to Haiti. It was my first time to visit a developing nation; I was heartbroken and challenged by what I saw and experienced. I will never forget walking the streets of Port-au-Prince, hand-in-hand with my daughter, and being approached by a Haitian mother with a young child on her hip. "Please, please, oh please," she begged me, "Please, take my child with you."

I believe her plea was one of loving desperation. Reflecting on the sacrifice his son's birthmother made in choosing to place her child for adoption, theologian Miroslav Volf writes, "She loved [my son] for his own sake, and therefore would rather suffer his absence if he flourished than enjoy his presence if he languished."

Mothers and their children should be able to remain together. It is a bond and relationship that is not easily broken. A mother wants to provide the very best for her child, and she will go to great lengths to do so. But, often due to circumstances beyond a woman's control, mothers around the world feel forced to make a decision between her child's wellbeing and her familial integrity. I can't imagine the anguish and heartbreak these women experience feeling incapable of fulfilling their desire to nurture and protect their own. I think of the women who birthed our three youngest daughters; I can't imagine feeling coerced, whether it be because of extreme poverty, oppressive sexism, or government regulations, to forever separate myself from my child.

Read the full post on the Christian Post.

Nov. 16, 2015 | Patheos

November is Orphan Awareness Month. It is a time to raise awareness and funding for the millions of children around the world displaced by HIV/AIDS and extreme poverty.  According to UNICEF, there are over 153 million children worldwide who have lost one or both parents. Of these orphans, HIV/AIDS has orphaned 17.9 million of these children, most of them in Sub-Saharan Africa and Southeast Asia.

There is good news.  The peak deaths has been reached, in 2005, and since then AIDS related deaths have declined by 30% worldwide. Moreover, while in 2002, less than 50,000 people in Africa had access to anti-retro viral (ARV) medications, today, over 10 million people across Sub-Saharan Africa have access to ARVs thanks to U.S. global leadership and American tax dollars.

With this decline should also come the decline in orphans, as well. More parents will live robust lives. More families will stay together. And more children can stay children, without becoming adults too early in life shepherding younger brothers and sisters.

This being said, there are miles to go and many children who still need our support.

As we pause to reflect on the orphanhood crisis this month, perhaps beyond awareness  and fundraising, albeit necessary, we could also reconsider the role of prevention.

There are over 220 million women around the world who say that they want to avoid their next pregnancy but they lack the education or resources to do so. Many of these women are child brides, married by the time they are sixteen wishing to delay the debut of their first pregnancy so that they can stay in school and finish their education. Some of these women have had several children, and they simply cannot afford to feed or educate each child each day and wonder how they will ever support yet another.

And, very sadly, many of these women – that is, more than 287,000 – will die due to complications in pregnancy and childbirth. These younger women, if in their late teens, are three times more likely to die than if they could wait until after twenty years of age to have their first child. Yet, over 80 percent of these deaths are preventable and treatable.

When a mother dies during childbirth, the newborn is ten times more likely to die within two years of their mother’s death.

We can address these issues. We can contribute to ending the orphanhood crisis.

One critical intervention is healthy timing and spacing of pregnancies (HTSP) for women in developing nations.  If we can address these millions of women with the knowledge and access to contraceptives to better time and space their children, we can save lives, close the gap on maternal mortality, and contribute to the prevention of orphanhood among children.

One great example of a faith-based program deploying HTSP is World Visions’ MOMENT projects in Kenya and India. The goal of these projects is to increase women’s access to high-quality, voluntary family planning services using community-led meetings and local networks so that communities have ownership of the program. World Vision seeks to work with gatekeepers in communities to educate leaders on the importance of HTSP to reduce maternal mortality and infant mortality rates. Because newborns without a mother are ten times more likely to die than those whose mother’s survive.

We advocate for stronger dialogue, particularly among faith-based communities, and support for healthy timing and spacing of pregnancies for healthier mothers and children worldwide. Let’s move beyond just awareness and rethink the critical role of planning families for women to stop the orphanhood crisis this Orphan Awareness Month.

This piece originally appeared on the Patheos blog.

Nov. 13, 2015 | Mail & Guardian Africa

THREE years ago, at the 2012 London Summit on Family Planning, the global community committed to increasing access to contraceptives for 120 million more women and girls by 2020. The findings have been encouraging. Today, according to a new report released by Family Planning 2020 (FP2020), more women than ever before have access to contraceptives and in the past three years alone there were an additional 24.4 million women. 

This means that in the past year alone these women have averted, 80 million unintended pregnancies, 26.8 million unsafe abortions and 111,000 maternal deaths.

In an exclusive interview with Mail & Guardian Africa, almost five years from the 120 million goal post, we take stock of the progress that Africa has made with Melinda Gates,  of the Bill & Melinda Gates Foundation a key figure in this movement. She  holds family planning and women and girls health as one of her top priorities. 

“Family planning is vital,” said Melinda, “if women can space their births, they can then afford to feed and educate their children and to also participate in the economy. The woman will be able to lift her family out of situations of poverty because we know that they will plough their money back into the household.” 

She was encouraged by the progress made across the continent, with the most rapid acceleration in modern contraceptive prevalence rate seen in Burundi, Kenya, Lesotho, Malawi, and Senegal. She explained that one of the areas of most concern though had been West Africa. A region which had, with an average of 5.5 children per woman, one of the highest fertility rates which results in many unplanned pregnancies that posed serious health risks for mothers and children.

Read the full article on Mail & Guardian.

This week, former Senate Majority Leader Tom Daschle and I released a report recommending a policy of strategic health diplomacy, inspired and informed by the success of the President’s Emergency Plan for AIDS Relief (PEPFAR). The report’s publication was announced at a conference in Washington, DC, where many of the architects of PEPFAR came together to advocate for a foreign policy approach that incorporates health care and humanitarian aid. The PEPFAR program has provided access to anti-retroviral treatments to more than 7.7 million men, women, and children worldwide. It has prevented transmission of the virus to 95% of infants with infected mothers, offered care and support to millions of orphans, and trained over 140,000 new health care workers. It is by all accounts a major success. Yet it took many years for us to get to this point.

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