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On May 27th, Sarah Boseley reported on her Global Health Blog that the families of two women who died in childbirth have taken legal action against the Ugandan government, asserting that the women’s rights to life and health were violated.

Sarah Boseley’s Global Health Blog, The Guardian

“…The case is unprecedented in Uganda. Aid agencies and medical charities and donor governments can condemn the death toll in pregnancy and childbirth, but the most powerful argument is the devastating testimony of those who suffer.

Sylvia Nalubowa died in Mityana hospital on 10 August 2009 from the complications of obstructed labour. She was carrying twins, one of whom was delivered. The second died with her. Jennifer Anguko died in Arua regional referral hospital on 10 December 2010 when her uterus finally ruptured after 15 hours of obstructed labour. Her status as a district councillor brought her no favours – she was said to be the fourth woman to die in that hospital that day…”

Read the full story here.

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The Safe Motherhood Program at UCSF is accepting applications for an upcoming internship opportunity in the Copper-belt of Zambia. The intern will spend the majority of their time in the labor and gynecology wards at a district hospital and several peri-urban clinics, gaining an understanding of front-line maternal health service delivery and research.

Position Description:

This internship is based in the Copperbelt Region of Zambia.  The intern will work on a study that aims to reduce maternal mortality and morbidities in Zambia and Zimbabwe caused by obstetric hemorrhage.  This is a cluster randomized control study that compares outcomes based on evidence from intervention and control clinics.  The intervention clinics in this study are the clinics that are using the NASG (Non-pneumatic Anti-Shock Garment) as a first aid device for patients suffering from hypovolemic shock caused by bleeding during pregnancy.

Some of the duties of the intern include:

-Providing logistic support for the local Zambian team – distributing supplies, copies, etc.
-Reviewing data collection forms
-Encouraging protocol adherence
-Conducting trainings with local hospital and clinic staff
-Visiting the study clinics
-Following up on cases
-Liaising with the San Francisco office and the in-country staff

Desired qualifications: Experience in international settings, interest in maternal health, research experience, familiarity with clinical environments.  Must be highly detail-oriented, be well organized and have excellent follow-through skills.

Time requirements: Must be able to commit a minimum of 2 months in the Copperbelt, although 3 months is preferred.

Compensation/Funding:
Interns must secure their own funding for travel and lodging. There is no funding for these positions but it is valuable experience for someone who wants to make a huge difference in women’s lives.

To learn more about the NASG (Life Wrap), visit: www.lifewrap.org.

If interested, please send your CV and cover letter to Elizabeth Butrick at ebutrick@globalhealth.ucsf.edu, with a copy to Kathleen McDonald at kathleen.p.mcdonald@gmail.com

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The Global Health Corps is now accepting applications for their fellowship placements in Burundi, Rwanda, Uganda, and the USA.

I learned about this opportunity from Emily Bearse, a GHC fellowship alum, current GHC staff member, and grad school buddy of mine!  Here is what Emily had to say about it:

“Being a GHC alum from their inaugural class as well as working on their staff team now, I truly believe GHC has a great model and the power to build the movement for global health equity. We are built on a unique partnership model where we work with existing organizations addressing pressing issues in under-served communities. We partner one national with one international fellow at each site to promote knowledge sharing and synergies in order to create deeper impacts in the communities where fellows serve. We engage people from outside the traditional health space in order to bring valuable expertise to strengthen health systems.”

Emily also mentioned that GHC is offering several placements with Elizabeth Glaser Pediatric AIDS Foundation, Millennium Villages Project, and mothers2mothers–organizations with a strong focus on maternal and child health.

Excerpt from the press release:

“Global Health Corps is expanding this year to support 70 emerging leaders in their 2011-2012 fellowship class. Applications for placements in Burundi, Malawi, Rwanda, Uganda and the USA are now open at www.apply.ghcorps.org.  GHC is seeking applicants with diverse skill-sets from areas that are often viewed as outside of the traditional health workforce—managers, communicators, architects, computer scientists, supply chain analysts and other exceptional young people from disciplines important to building strong health systems.

‘The complexity and scope of today’s challenges requires people with diverse skills from a wide range of fields beyond medicine. To truly shift the tide of global health challenges, we need to engage young leaders from all backgrounds.’ Barbara Bush, cofounder and CEO said.

Global Health Corps aims to mobilize a global community of emerging leaders to build the movement for global health equity. GHC does this by providing young leaders year long paid fellowships with outstanding organizations working on the frontlines of the fight for global health equity…”

Read the full press release here.

For more info about the Global Health Corps, click here.

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On Monday, I traveled with my colleague, Anupam Sarkar, a nutrition and newborn health expert and Project Advisor for the Maternal and Newborn Survival Initiative (MANSI), to Hudu, a small, hard-to-reach village amidst forest, steel plants, and roaming wild elephants. It took us nearly 2 hours from Jamshedpur, weaving around and cutting through steel plants and villages along bumpy and muddy roads–the same roads that pregnant women must travel on if they opt for institutional delivery. We were heading to Hudu to observe a Seraikela Chhau peformance.

Seraikela Chhau is a traditional form of dance that originates in the Seraikela block of Jharkhand, part of the eastern steel belt of India. Over the past six months, I have been working as a Clinton Fellow with the Maternal and Newborn Survival Initiative in the Seraikela block. MANSI is a partnership between the American India Foundation, Tata Steel Rural Development Society, and the local government—with technical support from SEARCH. As part of our project activities, our team has recently coordinated a series of Seraikela Chhau performances that will combine the native dance form with key maternal and newborn health messages throughout the 174 villages of our project area.

When Anupam and I arrived in Hudu, we learned that a pair of twins had recently passed away in the village and we decided to visit the family before the performance began. We are conducting similar home visits for every maternal and newborn death that has been reported in our project area (spanning 174 villages) since the baseline survey was completed in 2009. The goal of the home visits is to gain a better understanding of the ground realities and knowledge gaps so that we can shape and inform the messages of the MANSI health communication campaigns in a way that meets the needs of the communities.

The local health worker guided us to the home where the twins had passed away. The parents were not at home–but we were able to meet with the paternal grandparents, Asha and Ganesh Sardar.

 

They shared their story…

The mother of the twins, Vilasi, is 28 years old. She and her husband, Ragdu, already had four children, all girls, and the family was  eager to have a boy. Soon they became pregnant with twins, one girl and one boy. All four of the previous children were delivered at home without complication–and the family assumed that this delivery would also be free of complications. They explained that they were unaware of the benefits of institutional delivery. When the twins were born, they seemed very small. Immediately following delivery, the mother put the babies to her breasts to feed them. They were weak and unable to suckle. Initially the family thought about giving them goat’s milk–but eventually decided to give sugar water (locally called Misri Pani). When it became clear that the babies were extremely weak and in critical condition, the family wanted to take the infants to the hospital but they had not anticipated the emergency. They were not prepared. They did not have a transportation plan or money set aside. One baby died the very same day–and the other died the following day.

We thanked the grandparents for sharing their story and asked them if it would be OK if we also shared their story with other communities. The grandparents agreed and the grandfather said, “After losing the twins, I have come to know about the importance of institutional delivery. Why not share our story and let others also come to know?”

It is tough to know precisely what led to the death of the twins—and if giving birth in a facility would have made a difference. But it is clear that many factors were stacked against them. The family was faced with poor roads, long distances to health centers, limited resources, combined with a lack of information at the community level about birth spacing and planning, care of low birth weight babies, danger signs, institutional delivery, and information on how to tap into government schemes that offer cash incentives for institutional delivery—all potential topics for future Chhau performances.

With the story of the twins on our minds, we returned to the center of the village to observe the performance.

With no electricity in the village, the performers rigged their loud speaker system to their vehicle battery. They began beating their drums and singing loudly, calling on community members to gather in the village center.

It did not take long for community members to gather, all curious to know what the commotion was about. They formed a crowd of boys and girls, and men and women of all ages. Soon the drumming and singing picked up pace, a performer dressed in a traditional colorful costume with a big mask jumped out from behind the vehicle, and the show began!

The performers acted out various situations, using dance and drama to cover several critical maternal and newborn health topics—with a focus on the importance of institutional delivery, birth planning/preparedness, and the five cleans of safe delivery. The audience watched with great enthusiasm.

As we traveled the bumpy roads away from Hudu, a jagged rock punctured our tire–delaying our return to Jamshedpur and reminding me of the numerous barriers that women face in accessing care. While we waited for the tire to get repaired, I thought of the twins and the grandparents who we interviewed. I also thought of the Chhau dance and all of the community members in attendance. That day, I witnessed the consequences of the various factors that were stacked against the twins. I also witnessed one strategy for building community awareness of critical maternal and newborn health information. I left feeling confident that the Chhau performance that we observed will help to equip the community of Hudu with key information about maternal and newborn health—and will serve as one of many important steps toward the overall goal of protecting the health of women and infants in the Seraikela block.

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On November 15th, Maternova, an organization that conducts continuous research into the latest innovations impacting maternal and newborn health, featured the “paperless partogram” on their blog. The blog post explains that for the past thirty years, the partogram has been the recommended practice for preventing prolonged labor in low-resource settings–but it seems that not all health workers find it to be an appropriate tool for the contexts in which they work.

Maternova

“…The partograph is a low-cost tool for saving the lives of mothers and babies. But does that mean it is an appropriate tool? Dr. A. K. Debdas of India would say no. Even after the WHO simplified the partograph model to make it more user-friendly in 2000, the partograph is still rarely used in low-resource areas, and, when actually used, it is rarely interpreted correctly (2). Debdas argues that the WHO’s partograph fails to meet the organization’s own requirements for appropriate technology: the partograph has not been adapted to local needs, is not acceptable to those who use it, and cannot be used given the available resources. Debdas believes the partograph is simply too time-consuming for overburdened clinicians and too complicated for many skilled birth attendants—many of whom have not received higher education.

Dr. Debdas proposes a new, low-skill method for preventing prolonged labor—the paperless partogram. It takes 20 seconds, requires only basic addition and the reading of a clock or watch, and holds potential for more effectively mobilizing clinicians to prevent prolonged labor. Appropriate on all counts…”

Click here to read the full post on the Maternova blog and learn how the “paperless partogram” works!

And while you are on the Maternova site, be sure to check out the Health Innovations page. I found the “Baby Bubbles” and the “Salad Spinner Centrifuge for Anemia” particularly interesting…

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The International Reporting Project at Johns Hopkins University is offering two groups of fellowships this spring: International Journalism and Global Health Reporting.

Up to five fellows will be selected for the Global Health Reporting Fellowship with the International Reporting Project. They will be given five weeks to report on a specific topic in global health such as malaria, HIV/AIDS, tuberculosis, or maternal and child health.

“Fellows will spend two weeks in Washington at the IRP offices preparing for their overseas trips and then five weeks reporting on their chosen health topics in the country of their choice. Fellows will return to Washington for a final two weeks of reporting and presentations of their findings.”

Eligible candidates are journalists based in the United States with five years of professional experience in journalism.

The dates of the fellowship are March 3, 2011 to May 7, 2011.

Deadline to apply is December 20, 2010.

For more info, click here.

Click  here to apply!

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The Center for Reproductive Rights has released, Dignity Denied: Violations of the Rights of HIV-positive Women in Chilean Health Facilities, an in-depth investigation into the issue of discrimination against HIV positive women in Chile—specifically when seeking reproductive health services. 

In an email I received from colleagues at the Center for Reproductive Rights, they wrote:

“Over a period of six months, we spoke with 27 women in five different regions of Chile, gathering their stories. The research confirmed what we already knew from a previous study carried out by VIVO POSITIVO—women living with HIV/AIDS were frequently pressured not to become pregnant, were often scolded by healthcare workers for wanting to do so, and were sometimes pressured, coerced or forced to undergo surgical sterilization. The Center wanted to make clear that the abuse and mistreatment suffered by HIV-positive women are violations of their human rights…”

Excerpt from the report:

“In 2004, Julia received the good news that her viral load was undetectable. With this improvement in her health and after witnessing other HIV-positive women give birth to healthy, HIV-negative children, Julia and her partner decided to try for a child in consultation with a private physician. however, despite the low risk of mother-to-child transmission (mTCT), healthcare professionals repeatedly chided Julia after she became pregnant, telling her, ‘What were you thinking? Don’t you see that you are going to have a sick child?’

During the first trimester of her pregnancy, Julia began experiencing an orange-colored vaginal discharge. Concerned, she went to the hospital to have it checked out. Instead of treating her, however, hospital workers turned her away and told her to return for her regularly scheduled check-up. She was admitted to the hospital three days later, hemorrhaging and with severe abdominal pain, but she still sat untreated…”

Download the full report here

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