Maternal and Child Health

Women helping women: Physicians for Peace volunteers with patients at Segou Hospital.

Laura Gwathmey and Laura Fine-Morrison are traveling with our VVF surgery team on the ground now in Segou, Mali. Here is their latest report, which shares their observations of both the patients and the staff they have encountered at Segou Hospital: 


Our work here in Mali makes us realize how lucky we are to live in a country that allows women equal status. Here, women have little control over their lives. Most of the patients we've encountered have scarring from female genital mutilation. One member of our team, the only female doctor on staff at the hospital, told us the story of her own experience with FGM. As a child, she was subjected to the practice, and decided very quickly that she would not want her own child to suffer as she did. Unfortunately, the Malian custom is that the husband's family gets to decide the fate of a female child, not the parents. Despite our team member's best efforts, her husband's mother decided that the practice would be contined with her grandchild, our teammate's daughter, at the age of 2. In reality, our teammate told us, she could accept it only knowing that uncircumcised girls, as they are known in Mali, never get the opportunity to marry or have a family. The choice is stark: genital mutiliation or a solitary life. 

 

We're here hoping to change that through our actions. Many of the patients we've seen require hysterectomies because of their extensive and prolongued conditions. Those for whom we recommended treatment all told us that they must ask their husbands before they can consent, and their husbands must sign the consent form, not the women themselves. As I write, one man is traveling to Segou to give consent for his brother's wife to receive a hysterectomy. As you can imagine, many husbands do not give consent, and their wives must live with an incomplete solution to their conditions. Through the actions of our all-women surgical team, working with local Malians, we hope to show that women can still be desirable and feminine while actively serving as role models.

- Laura Gwathmey
 

My experience of the hospital staff is that they care very much about their patients. The nurses and doctors joke around with them when appropriate, to put them at ease. A nurse or anesthesiologist will talk gently with a patient, and may touch her on the shoulder or arm if they see that she is nervous during surgery (in most cases the patients are not under general anesthesia.) And they work hard to educate patients about their treatment options as well as how to care for themselves post-operatively. 

 

How hard it must be for the staff, then, to have to work under conditions that often don’t allow them to provide their patients with very good care. The patients come in malnourished and often lack funds for food and medications post-operatively, including pain meds and antibiotics. The staff are tired, as they get very little time off  (doctors, for example, work 7 days a week; nurses work 5 days per week but are on call every 3rd night, which they must spend at the hospital). And the staff are well aware that what is available medically in other parts of the world is far greater than what doctors can offer here.

 

One doctor came over to me in the hospital break room while I was writing. He sat down next to me and asked what I was writing. When I told him, he said that what I wrote was very true. 

And he said things are going to get better. How did he know, I asked him. His response was that one has to be optimistic in life. Things will get better, he repeated, before walking out to attend to his next patient.

 

- Laura Fine-Morrison
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In May 2009, Physicians for Peace sent a team to Segou, Mali (Read about the first mission to Mali.) to help with efforts to address the widespread problem of VVF. (Read more about VVF and our surgery program.) Last week, Physicians for Peace volunteers returned to Segou to help more women get the surgery they need to heal this devastating condition. 

You can help mothers in poverty by supporting our volunteer medical missions in Africa. Donate now or visit www.physiciansforpeace.org to find out how to make a medical donation to our gifts in kind program.

Today was another successful surgery day in Mali.  We saw 6 patients, each of whom required extensive surgery and reconstruction. We also encountered a patient from our May mission who had returned to accompany her friend for fistula repair! She was completely cured and had encouraged her friends to travel to Segou for the same care. What a treat to see how our mission had changed her life! She was outgoing and talkative, unlike many of our current patients, who are shy and say little. Since the surgery, she seems to have come out of her shell.  

 

There is so much more work to be done.  I've included a photo of the welcome sign that the hospital and the Millennium Villages Initiative made for us.  We will be here through November 17 and seek to complete the daunting task of reconstructive surgeries for 50 patients.  Wish us luck and please keep checking back for more updates!

 

Laura

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In May 2009, Physicians for Peace sent a team to Segou, Mali (Read about the first mission to Mali.) to help with efforts to address the widespread problem of VVF. (Read more about VVF and our surgery program.) This week, Physicians for Peace volunteers returned to Segou to help more women get the surgery they need to heal this devastating condition. Laura Gwathmey, student of International Studies at Old Dominion University, is traveling with our medical volunteers to report on the progress of this mission. Check the blog for regular updates.

You can help mothers in poverty by supporting our volunteer medical missions in Africa. Donate now or visitwww.physiciansforpeace.org to find out how to make a medical donation to our gifts in kind program.

 

An important focus of Physicians for Peace Maternal and Child Health Programs is treatment and prevention of VVF and RVF (vesicovaginal fistula and rectovaginal fistula.) These serious complications of childbirth occur during prolonged labor, resulting in serious tissue damage to the mother. The condition occurs more often in developing countries where women become pregnant at a very young age. Read more about our VVF Surgery program.

In May 2009, Physicians for Peace sent a team to Segou, Mali to help with efforts to address this widespread problem. (Read about the first mission to Mali.) This week, Physicians for Peace volunteers returned to Segou to help more women get the surgery they need to heal this devastating condition. 

Laura Gwathmey, student of International Studies at Old Dominion University, is traveling with our medical volunteers to report on the progress of this mission. She sends her first update:

 

Greetings from Mali!  We've arrived in Segou and begun setting up at the hospital today. The staff and the Millennium Development office had arranged for a welcome banner for our group! I'll be sure to send pictures soon. We also began pre-screening fistula patients today. We expected approximately 30 patients, but when we arrived, we found 57 waiting for us and many more on the way. Apparently, the patients from Physicians for Peace's May 2009 mission were so pleased with their care that they passed along the word, and we have more patients than we can handle! We're also seeing a greater variety of patients than previously - we've had many fistulas, but also many children, one with complications from genital mutilation, and several male prostates.  Several of the women have been living with fistula for years; we met one woman today who has been living with fistula for 20 years! They have traveled for days to reach us and sleep on hospital grounds awaiting treatment. 

We also met with the governor of the Segou region and several local health officials today, pleading our case for greater support and assistance for the people of Mali. All of the officials agreed that there is much work to be done to help prevent and treat cases of fistula.  

 

We begin surgery tomorrow morning at 7 am and will continue until dark. Each day seems to bring a new challenge and a new heart wrenching story.  

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You can help mothers in poverty by supporting our volunteer medical missions in Africa. Donate now or visit www.physiciansforpeace.org to find out how to make a medical donation to our gifts in kind program.

Thursday, Nov 5, 2009

 

Greetings from Nigeria!

 

This week wasn’t nearly as exciting as last week - No births at the clinic. We did see a woman who said she had been leaking fluid for two days. She wasn’t in labor so we referred her to the hospital, after we found her husband who was off working in a neighboring field. She went to the hospital on Tuesday for induction of labor. Today she returned to the village with her beautiful, healthy baby!

 

A woman we referred for an ultrasound last week found me and gave me the report. When we examined her we could only feel the baby below her belly button and we heard the baby’s heart beat on the left and right side. Not sure if the baby was lying horizontally or there might be twins.  The report came back that the baby is transverse (horizontal).  She is about 8 months pregnant. We will watch her closely - if the baby doesn’t turn head down we will refer her for a Cesarean delivery.

 

Our babies from last week came back for weight checks and vaccines. The little girl who weighed 2.3 kg at birth was down to 2 kg so we reviewed breastfeeding with Mom. This is her first baby. She came back the next day and the baby had gained. No signs of dehydration. Mom brought me a bag of ground nuts (peanuts) as thanks. My “grandson”  gained .25 kg. I gave his mom a bag with powdered milk (for her, not the baby), another protein based beverage powder and 4 cans of sardines. After all her blood loss, we want to build her back up. We are encouraging greens and liver also. Maryam #2 gave me another bag of ground nuts and 6 bars of soap. I was overwhelmed - they have so very little. 70% of the people in the village are living on less than $1/day, and they are giving me gifts!

 

I have been walking every day and said I wanted to walk from Pampaida to Saulawa. Everyone kept telling me it is too far, too hot, etc. Yesterday, Dr. Ojo left to go to another clinic to get vaccines for our new babies (we don’t have a refrigerator). I got bored waiting for him - and decided to trek to Saulawa to help with the prenatal clinic. Several people stopped on motorcycles and offered me a ride. Thank you, no! I did it. I walked 9 kilometers. I think I probably sweat 3 liters, but I did it! Dr. Ojo started teasing Banke (she is 25) that the elderly woman is more fit than she is! I could be their mother, but elderly? Though 48 is the typical life span here, and  I am 52.

 

This weekend, I am taking Dr. Ojo and Banke to dinner. There is a Chinese buffet, but they want to go to Chicken Republic. I will let you know if it is like our KFC! They also want to go to a photographer and get a formal picture of the three of us. “The Pampaida Birth Team." Also, Banke and I plan to go to the market this weekend to see if I can find something for Matt’s (my son-in-law) wall. He is a history/geography teacher. Also my “sister” Joy wants some Nigerian fabric for a quilt.  So we will go exploring. 

 

I am counting down the days until I go home - in 8 days I will be on the plane. It will be a bittersweet farewell. I have made some lifelong friends here. Mary, from Physicians for Peace, is already starting to talk about my next trip. Right now, I just want to spend some quality time with my family.

 

Not sure if I will write again before I return. I promise to post lots of pictures when I get back.

 

Blessings!

Robin

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria, Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

Greetings from Nigeria!

 

We couldn’t go to Saulawa for clinic today because the ambulance driver was no where to be found and no one knew where the keys to the vehicle were. I was resting from our first delivery, when Banke woke me around noon and said we had another woman in labor.

 

Her name was also Maryam.  She is 20 years old and this is her 5^th pregnancy. It seems she only has one living child, and we never did find out what the circumstances were of the deaths of the other 3.  She has a 4 year old daughter.

 

She was dilated 5 cm and Dr. Ojo said her bag of waters had ruptured 2 hours earlier. We started monitoring her contractions and the baby’s heartbeat every 30 minutes. We are committed to being more diligent with the partograph. It was decided that we will have Banke “catch” this baby. Maryam was on the bed. The contractions were only 2 in 10 minutes, so we decided to walk a bit. These women make very little noise during the labor. I would occasionally see a grimace, or more likely I would see her just bend over when she got a contraction. Around 4 we checked her progress - only 8 cm. She is going slower than we expected. Dr Ojo decided to go play some soccer.  We told him to be sure to be back before dark to start up the generator so we could have some light.

 

We just hung out walking with Maryam, setting up our equipment and patiently waiting. At around 8, we checked her again - only 9 cm. Hmm, time to consider a plan. Baby’s heartbeat was beautiful. We felt Mom might be anxious, so we would be patient. (And still no driver or vehicle keys) Around 10, I noticed Maryam had some vaginal bleeding - a little more than we normally see. Baby looked great, but she really wasn’t pushing effectively. As the head moved down, Banke assumed the  “Catcher’s” position. She did a beautiful job! At 10:35 pm, a beautiful baby boy was born. No lacerations, either. He was a nice 3.5 Kg (7 ½ pounds). I took him and did the ‘baby stuff’ while Dr. Ojo and Banke took care of Mom. The placenta delivered intact 10 minutes later. 

 

Around 11, Banke was cleaning instruments, Dr. Ojo was in the hall chatting with family, and I went to check the Mom. She was lying in a pool of blood. She was starting to go unconscious. We put in an IV, gave her 10 Units of Pitocin in 500 cc of IV fluid rapidly to contract the uterus and drained her bladder with a catheter. So glad the class this week was on Post Partum Hemorrhage. We responded quickly without wasting any time. Mom’s pulse and blood pressure stayed normal. We put the baby to breast, elevated Mom’s legs and continued to monitor closely. The uterus firmed up for a short time, but the bleeding continued. We decided to give another drug - Misoprostel to firm up the uterus. This worked very nicely.  We reexamined the cervix and birth canal for any tears that might have been missed. None.

 

By around 2:30 things had calmed down. Maryam’s pulse and blood pressure remained stable and the bleeding had become normal. In all, we estimated she lost a little over a liter of blood.  Everyone was exhausted. I told the others to go to bed for a couple of hours and I would stay up. The generator ran out of fuel at 4:17 am. So my checks were done by lantern light.  The baby nursed again.  Maryam was resting comfortably.

 

Dr. Ojo relieved me at 6. When I went back to check on them at 8, Maryam had gotten up to go to relieve herself and had eaten some food.  She is pale and will be on iron supplements for a while.  God was definitely with us. We have no doubt if she would have stayed home to deliver, she would not be alive today.  We are hoping that this will encourage more women to come to the clinic to deliver.

 

That is the story of Pampaida ‘s second delivery! The training prepared us for this emergency. We are reminded to always be alert and ready to respond in a systematic, calm manner.

 

I have claimed this little boy as my African grandson. I will post pictures when I get back home. 

 

That’s all for now.  I need sleep!

 

Blessings!

Robin

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

I am finally able to write of the first ever birth at Pampaida Health Clinic, New Millenium Village, Nigeria!

Maryam is a 17 year old mother with her first pregnancy. The team tonight consisted of Dr. Ojo, Banke, the nurse, a CHEW-community health worker, and me. Maryam had her mother-in-law, aunt, husband, a niece and nephew and about 5 other men in her entourage. The men and children quickly found a bench or position on the floor and went to sleep.

We timed her contractions. This was something I hadn’t done in about 8 years. I had really become dependent on the fetal monitors for telling me when contractions we occurring and how long they were lasting. She was having 2 contractions in 10 minutes. They were only lasting about 30 seconds. We started a partograph to frequently record information on the labor. The baby’s heart rate was wonderful and the head was well down in the pelvis. Maryam’s blood pressure was a little high at 142/90 and she had a little protein in her urine. We would have to watch her closely.

Around 1 am, we saw much more restlessness and quiet moaning. Maryam would grab her back during a contraction. I started apply pressure on her lower back or squeezing her hips to help relieve her discomfort. The two men were busy playing video games on their cell phones. I guess some things are just universal!!!

We let Maryam push as she felt the need. No coaching, yelling or bright lights! So nice. The baby’s head slowly came out. The rest of the baby followed quickly. Time of birth 2:12 am Oct 27, 2009! We dried off the baby girl. She had a  nice strong cry. Banke and I tended to the baby. Her Apgars were 8 and 9. This is a scale to determine how well the baby is adapting to life outside the womb. She was doing great! We  tied off the cord with a fine string that had been soaked in alcohol (Spirits). Dr Ojo checked to make sure there were no more babies and gave Maryam 3 tablets of Misoprostel. This is a drug to help contract the uterus, deliver the placenta and prevent excessive bleeding. 

For the next two hours we continued to monitor Maryam and the baby.  They were doing well, so after cleaning up we went to bed at 4 am. I woke up at 6, checked Mom and baby were doing well. 

We had breakfast, saw 28 women in prenatal clinic and then went to discharge the new family. We did a discharge physical on both mother and baby and taught Maryam, her husband and the mother-in-law what to expect, when to return if certain signs developed, how to monitor the baby for dehydration and how to take care of the umbilical cord. We will see the baby back in 1 week. We will check her weight. Her birth weight was 2.3 kg - just a smidge over 5 pounds. She will get her BCG vaccine (to prevent TB), a Hepatitis B vaccine and her oral polio vaccine. Ideally, she would have received these right after birth but we have no refrigerator to store the vaccines so we have to get them from the clinic in Ikara and carry them in a cooler. Maryam will return for a check in 2 weeks.

We were all exhausted. So after pictures with the family, we sent them home in the ambulance (Maryam wasn’t quite ready to travel on the back of a motor bike), we all went to take a much deserved nap.

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

Here is the lastest news from Robin Jones, a Registered Nurse and Women's Health Care Nurse Practioner, who is currently leading a team of Physicians for Peace volunteers on a mission to Zaria, Nigeria, to assist with work being done there as part of the United Nations Millennium Village Project. The core mission of the project is to help underserved regions of sub-Saharan Africa reach the Millennium Development Goals for ending poverty and improving maternal and child health by 2015. Physicians for Peace volunteers are working with local clinics to assist in midwifery education. This is an exciting look at the work being done daily to improve health care for women and children in this region...

Thursday, Oct 15, 2009

Greetings from Pampaida!

Wow! What a week! Monday, a woman came to the office in Zairia. She was introduced to me as a Midwife/Lecturer at the local Training Hospital. Dr. Woje asked that we meet and have open discussions and perhaps I could lecture with the students one day. We traveled over to the teaching hospital, where I was introduced to the Director of Midwifery and the Principal (Dean of Nursing Education). A meeting with the Faculty has been arranged for Friday (tomorrow) morning. I have also requested to spend a day following a midwife. I have drafted a list of questions for discussion. Also, I will ask their help in developing a Safe Childbirth Checklist.

Monday afternoon, in the middle of a rain storm, we headed out to Pampaida Village. There were 17 of us crammed in a small van, plus supplies. I did wear my seatbelt (ALWAYS!) The driving is a bit crazy. They use the horn all the time.

I settled in my room. I have a bed net here. No mosquito buzz attacks in the middle of the night. Banke, one of the nurses, has the other room on the women’s side of the quarters. She also does the cooking. She is an excellent cook. I have had French fries, fried yams, fried plantain, beef stew, spaghetti, rice, beans, greens, and melon and custard. My stomach hasn’t adjusted to the greens just yet. A sauce is made from sun-dried tomatoes and red peppers. It is put on rice, meat, vegetables and spaghetti. I am really enjoying the food. This morning for breakfast I have spaghetti with sardines and hash brown plantain. I was finally able to convince Banke to let me wash dishes. I told her the cook should rest after the meal and allow the ones she served, to serve her.

In clinic at MV1, Maru-a village Health Worker, has learned to do tummy checks. She measures the uterine height and also assesses how the baby is positioned so we know where to listen for the heart beat. She learned very quickly. Next week, I will work with Banke.  The Doppler is a hit with Dr. Oje. He works with the Doppler and I follow with the fetoscope to perfect my newly learned skill.  We have discussed the need to maintain the fetoscope skill as it is not dependant on batteries, nor does it have components that can break. The problems with technology...

In the late afternoons, Banke and I have been strolling through the village. The small children- toddlers are still frightened of the white skinned woman! The rest of the children flock around as they love having pictures snapped. I have to be careful - sometimes there is shoving to get attention and the littler one are pushed to the ground. I took pictures of the settlement-cooking, bedrooms, shops,etc. I have finally learned what millet is. It is a grain that grows on a stalk that looks similar to bamboo.  The grain grows on the top, similar to the tops of the corn stalk. When it is harvested, they beat the stalk to remove and collect the grain.

Today, we had our first training session. We discussed the reproductive system, fertilization and fetal development and prenatal care before the computer died. I have 4 students, one of which is a male. Lots of great questions were asked. We will continue on Monday.

I have enjoyed sleeping with a mosquito net. When I arrived back in Zairia, I was told they are going to put one up here also.  Not sure if it was the open spaces of the village or the net,but I certainly slept well there.

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Monday

Oct. 19, 2009

As another week begins, we will be heading out to Pampaida in the next hour. I will do another lecture today.  We will wrap up prenantal care-maybe even a quiz. Then we will go over the components of labor. Tomorrow, I will be working with Banke in the clinical setting-doing ‘tummy checks’.

This weekend was much better than last weekend. I spoke with Jeff on Friday via Skype, so the feelings of homesickness weren’t so bad.  Saturday, I did some laundry. Boy, did I take my washer and dryer for granted!  I used a bucket and a large bowl to wash the clothes.  I ran out of bottled water so I boiled the municipal water (when it was on). Even after 20 minutes of boiling there was still a dirty looking sediment. I only used it for cooking. I couldn’t bring myself to drink it.

I read 2 books this weekend and did some knitting.  My exercise routine is up to 20 laps around the compound, 30 toe touches, 50 sit-ups and 50 leg lifts a day.

Yesterday, Dr Woje and his family came by to take me to church.  The message was on willingly doing God’s work. Another timely message. The Sunday school lesson was on daily Bible reading and study.  Mrs. Woje (Hannah) was very disturbed that I only brought my little New Testament. She has lent me a Parallel Bible and also given me a Study Booklet.  She has invited me to go to a Revival Convocation in Kaduna the last weekend of the month. She is going to be the boost I need to become more disciplined in reading/studying the Bible!  After church, I was invited to have lunch with the family at their home.  I helped cut up cabbage for cole slaw.  The meal was wonderful-rice with the spicy red sauce, curry, fried plantain, cole slaw (not quite like ours) and paw-paw. It was my first time trying paw-paw.  It is almost like a cross between the mango fruit, papya and cantaloupe. Very good!  Dr Woje extended an invitation that I stay in their guest wing on the weekends. I thanked him, but declined.

His wife has a water filtering business next door to the house.  They take the municipal water and filter it through sand and ultraviolet filtration, then bag it in small bags. People bite a hole in the corner of the bag and can enjoy clean water. Quite impressive!  He dropped off about 50 bags last evening.  I will take about half out to the village with me.

I transferred another 180 pictures from my camera. Maybe Friday, the IT guys can show me how to attach/send them. Or I can figure out Flickr. 

Signing off until Thursday afternoon when I return to the city.

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Friday, Oct 23,2009

Greetings from Nigeria!

 

This was a very busy week. I taught Monday and Thursday. We covered labor and delivery and complications. They have grasped previous concepts well. I continually quiz them on things we have already covered. Prenatal clinic days  are Tuesday and Wednesday. The male student, Tajudeen, did  "tummy checks" with me on Tuesday. He did a very good job.  He also taught the  pregnant women about condom use. I know...too late to prevent pregnancy, but they are encouraging condom use to cut down on the HIV incidence. He always asks the most questions during class.

 

We had a little girl that the doctor thinks might have sickle cell disease. She was dehydrated, febrile and didn't make a sound when they put the IV in. By late afternoon, she had perked up and was eating without vomiting. They will send blood for Hgb electrophoresis.

  

On Wed, at the other clinic, we saw 52 pregnant women! The nurse was gone to a conference so the doctor and I were busy. We took Maru, another nurse, with us. One woman said she was 4 months pregnant, but we couldn't feel anything on palpation. Did a pregnancy test which was a very faint positive. So we will see her back in 4 weeks. Either she is newly pregnant or had a blighted ovum. Another thought she was 6 to 7 months but had no uterine enlargement above the umbilicus. There was a lot below-either twins- I heard heart tones in the right and left quadrants or the baby was transverse. We referred her for an ultrasound.

  

After clinic, I showed Maru and Tajudeen how to clean up - wash the exam table, doppler, tape measure and scale with alcohol. They are using hand sanitizer between each patient. I have enough to last a couple of months. We had an assistant clean cobwebs, wasp nests and mouse and lizard droppings from the exam room in Saulawa. I wanted to do it, but the doctor vetoed the idea. The clinic is scheduled for a renovation, but we need to have it as clean as we can for the sake of the patients.

   

I have been doing a lot of walking - through the village or just down the road. It feels good to move. I have watched the men play football a few times. (soccer) They sure are good at heading the ball and also lots of fancy footwork - even barefoot or in flip-flops. There is certainly that sense of competitiveness. I guess that is a universal trait among males!!!

  

Banke, my housemate in the village, is coming by to take me to the market today. I want to get some material and have an outfit or two made. It will be my first trip out. I need that. The weekends are the worst as far as homesickness goes. Today is the halfway mark. Part of me wants to leave today and the other part knows there is still much to do. 

    

We have 9 women at term at Saulawa clinic so I am hoping we are around for a couple so the nurses who haven't done deliveries get some experience before I leave. The goal is to have the women come to the clinics to deliver. I warned the doctor that change takes time. If the nurses can train the TBAs (Traditional birth attendants) in warning signs and when transfer to the clinic or hospital is appropriate, they may be more successful with their goals.

  

I showed my Breech delivery/Shoulder dystocia video yesterday. Dr Woje informed the staff that I would leave the video so they can review it whenever they want. Guess I will get another when I get home! I have been able to utilize my teaching powerpoints from school. Most of the time my computer battery lets me get through the lecture.

  

Banke has asked me to let her take notes from the powerpoints in the evening when we have generator power.  I will probably download my powerpoints on Dr Woje's computer or a flash drive if he has one. Also, he has asked me to download the soft copy of "A Book for Midwives." I told them we believe in See one, Do one, Teach one - so I expect everyone to pass on the knowledge they are obtaining.

  

I will talk with Bala today to see if he can arrange a visit with Biya Dogon before I leave. Dr Woje doesn't know the name.

 

That's about it for now. Have a great weekend!

 

Robin

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We thank Robin for her excellent reports from the field, internet access permitting! If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site atwww.physiciansforpeace.org.

Day 5 -

Greetings from Nigeria!
 

   The internet was down when I came to the office so I thought I would write as soon as it was available..

The little girl I saw yesterday after having a febrile seizure from malaria is improved today. Praise God!

 

I have been able to cook the soup mixes I brought.  I cook on top of a gas canister that has a stove grate on top.  It is sufficient. I will take my soups and oatmeal packs to the village, just in case the local food doesn't agree with me. The one local meal this week didn't!

 

One of the secretaries went shopping for me yesterday. She was able to get me a sheet- I had been using my shawl from my shalwar kamiz (Afghani outfit) to cover up. There was more to be covered than the shawl could accomodate! When the electricity goes out, I have been using a little pen light to get around. Now I can even read! She also got me a case of water.  I drink one bottle during the day, then really load up in the evening. That way I have the western toilet  vs. the squat toilet.  I look forward to my daily splash bath. The cold water feels wonderful.

 

Today, Dr. Woje and I will choose teaching topics.  He has also asked me to come up with a Safe Childbirth Checklist to post in both delivery rooms. So any of my fellow midwives, please feel free to send me ideas, anything you have used . You,too, can impact birth in Nigeria!

 

Barbara, another secretary, will take my laundry back to her home in Kaduna and wash things this weekend for me. She has invited me to spend next weekend at her home. We will shop for cloth and have her neighbor, a tailor, make me some clothes. Yeah!  You know how much I love wearing ethnic clothing.

 

I have been invited to worship with the doctor at his church on Sunday. I am sure it will be very upbeat and exciting. Many of the people here in the office listen to Contemporary music. It is great and makes me feel  like I have a family here.

 

I am starting to acclimate. I think it is in the high 90s to low 100s each day. Evenings cool off nicely-so the sheet is great to have. I am getting to sleep between 1 and 2 am.  The internal clock has been hard to readjust.

 

The people have been friendly. The babies are starting to warm up to me a little. They aren't screaming as long when they see "the ghost."

 

Peace on Earth Begins with Birth,

Robin

Day 6-7

The weekend was rough. I had a major case of homesickness. Everyone cleared out of the office by 3. The office was locked so no internet access. I was alone in the Guest House and there are bars on the window . And everything is inside a guarded, locked compound. Great for safety, but talk about feeling like I was in prison.  I had plenty of opportunity to review the book and outline my lecture for the week. I will actually start on Thursday.

  

Plenty of time for reading. I read 3 books over the weekend and started knitting a prayer shawl.  I finall broke down Saturday and called my husband, Jeff.  It was so good to hear his voice. Sunday, Dr. Woje and his daughters arrived to take me to church with them.  It was a wonderful time of study, singing and worship. 

 

This morning, one of the Midwives from the Training Center came by at Dr. Woje's request.  We then went to the University Training Center where I was introduced to the Principal and the Director of  Midwifery Education.  We have arranged a meeting on Friday with all the Midwifery Instructors and myself for some Cultural Collaboration.  I am  hoping to "follow" a midwife for a day or two and actually witness a few births with them.  I have already mentioned that I would love their input on developing a Safe Childbirth Checklist for the delivery rooms at Pampaida.  We talked about all the midwives who are retiring. I suggested, perhaps they would be interested in apprenticing some of the CHEWS and TBA s in the village.  I think involvement of the Nigerian midwives would be a great way to go rather than me coming in and explaining the way I learned.  I am so excited to see what natural birth looks like - wasn't able to do much when working with the physicians!! They like to manage labor and childbirth.

 

Everyone has been very welcoming. I did give a copy of "The book for Midwives" to the Director and principal with an inscription. "Looking forward to collaboration with you for the health of mothers and babies" signed Physicians for Peace.  We will be tight on books. I have 7 left. I will make sure the nurses who will attend deliveries get one. I have asked Dr Woje to disperse the rest to the CHEWs as he sees fit.

Peace on Earth Begins with Birth,

Robin

 

Many thanks to Robin for taking the time to send such great field reports from our volunteer medical missions! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, please visit our web site at www.physiciansforpeace.org.

More news from Robin Jones on of our Maternal and Child Health medical mission trips on the ground now in the Millennium Village of Pampaidas in Zaria, Nigeria...

Day 3 - 

 

No water or electricity when I got up at 7 am.  Breakfast of bread and butter with tea.

I arrived at the clinic. Dr. Woje loves the “Book for Midwives.”  I will check e-mail and then we will leave for Pampaida. 

 

It was about an hour ride to MV1.  I was with Dr. Oje doing ANC (antenatal care) The woman gets her record, goes to the lab for urine dip and anything else required. Then she sees the doctor. She is asked how far along she is, and if there are any concerns.  She then goes to the exam table.  We did raise the head to prevent vena caval syndrome.  Fundal height is assessed. All moms today were close to the “month" they said they were in. If > 28 weeks the fetal heart tones are assessed with the fetoscope. I even heard them. I took the Doppler but forgot the gel .  They assess the conjunctiva for pallor and assess the ankles for edema. The weight is obtained in Kg.  Today the women ranged from 40-60 kg. They are told when to make their next appointments.

 

On the initial visit the mother is screened for Blood type and Rh, VDRL HIV and now they are starting to screen for Hep B.  After the 1^st trimester, they are treated for malaria and dewormed. Some mothers told us how many pregnancies/babies they have had but don’t know how long ago. Age isn’t that important.

 

Girls marry around 13 or 14 years old. They have problems with CPD so I will be teaching the Partograph to identify when labor is lasting too long, without progression. VVF is a big problem.  Early identification of problems will prevent these.
 

I will be teaching the nurses prenatal care and the importance of early identification of preeclampsia- hopefully preventing eclampsia.   If the urine dipstick is + for glucose, a random glucose or fasting is used as the screening tool for GDM.  This isn’t too common of a problem here.

 

I was given a tour of the staff quarters where I will be staying from Monday- Thursday every week.  Nice sleeping area, small kitchen and a squatty potty!  There is running water and a shower.  My room has a lot of bees right on the window screen. I have been told they will spray.  No internet and very limited electricity so I doubt I will be e-mailing throughout the week.

 

After finishing clinic we went to the other clinic – MV2.  They had a delivery about an hour before we arrived.  The placenta hadn’t separated yet.  We had the baby nurse and promised to return after going to a community health survey of a village outside Pampaidas Millennium Village.  Ht/wt, Hgb, blood smear and urine and stool cultures are being done.  These people are the control group to see if the MV has shown improvement over the outlying communities.  They will gather the data and do teaching with these people.

 

When we returned to MV2, the placenta was out and intact! We rode back to the Zaria office.  Barbara, the secretary , is spending the night here with me.  Dr. Woje stopped at a restaurant so I could get a meal.  I got greens (spicy), pounded yams (bland), beef and liver.  I also  got two  bottles of water and some fruit juice. Going all day in the heat without water is tough. I downed them in no time.  I shared my meal with Barbara. Then she suggested we walk down to the Chinese restaurant to get bread for the morning.  I bought a loaf of bread and 2 more bottles of water.  It was good to go for a walk, but I won’t venture out on my own.

 

The electricity just went out so I will bathe by penlight.  This consists of splashing water, soaping up and rinsing off with a small bowl dipped into a bucket of water.  It will get rid of the dirt and sweat and cool me off.  I feel privileged to have these amenities.  My computer is  on battery and getting low so I will close for tonight. 

 

Great Day!

 

Day 4 - 

 

Today I was in Pampaida village to meet with the village chief.  He welcomed me as his guest and assured me of my safety. He asked what Nigerian food I will eat. Food is spicy here, so I am preparing for that. I told him I am willing to try anything. I met with the nurses (females) and the CHEWS (Community Health Extension Workers) (males) that I will be teaching. It looks like teaching days will be Mon and Thur, Prenatal clinic days are Tues, Wed and births will be OJT.  I will actually stay in the village Mon-Thur, then back to the guest house at the office in Zaria (1  hr drive) Fri-Sun.  There I will have electricity and Internet access (though sporadic).  So after this Sunday, Communication will only happen on the weekends.  Dr. Woje has invited me to worship at his church this Sunday.

 

From my work e-mail, I can attach pictures.Yeah!  Here are just a few.

 

Thanks!

Many thanks to Robin for taking the time to send such great field reports from our volunteer medical missions! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, please visit our web site at www.physiciansforpeace.org.

Robin Jones, a Registered Nurse and Women's Health Care Nurse Practioner, is currently on a mission to Zaria, Nigeria, to assist with work being done there as part of the United Nations Millennium Village Project. The core mission of the project is to help underserved regions of sub-Saharan Africa reach the Millennium Development Goals for ending poverty and improving maternal and child health by 2015. 

Robin will be working with local clinics to provide education so that those who are assisting during labor will have the knowledge they need to help prevent trauma to the mother and protect the health of the baby. She will also lay the groundwork for future missions in midwifery training to increase the number of qualified midwives available to expectant mothers. 

Robin sends us her first impressions of Pampaidas and the progress being made there: 

Day 1 -

Hi!

  I finally arrived in Nigeria yesterday at 11 am. We had a 3 1/2 hr drive to Zaria, where the Pampaidas Millenium Project offices are located. I checked into a hotel for 2 nights.  The accomodations are meager but sufficient. Water was off until this morning and electricity is sporadic. The 24 hr internet cafe was locked up. But the office has wireless, so I will be able to keep in touch with those in the States!

I was given an overview of the Millenium Village project this morning, watched a documentary of the project and met with the various directors.

 

There are roughly 5,000 people in Pampaidas village. Seventy percent of the village are below the poverty level (live on < $1 US/day) The areas being addressed over this 5 year project are
 

    1. Education- the children are educated from grades 1-6. They are working at ensuring the girls, as well as boys, attend school. Each child is given a backpack with books, paper and pencils. School furniture was obtained and they are completing the building of a school kitchen. Each child is guaranteed one meal a day at school.

      Goal: to sensitize parents on the need of school enrollments

 

    2.  Health- they now have 2 operating clinics.  Last week the clinics saw 221/158 patients.  Total antenatal care was 15/24 with 4/8 new OB patients.   .

       a. Outpatient consultations- provide basic PHC (Public Health Care ) services to all villagers; treatment of common diseases; provide short-term in-patient care.

       b.  Antenatal care - to provide routine prenatal monitoring including interventions such as deworming, IPT  Iron/folate and vitamin A supplementations.

        c.  Child welfare clinic where basic immunizations, growth monitoring, Vit. A supplements are provided. Deworming and treatment of  common nutrition/infection related illnesses are treated. 

       d.  Outreach activities- provision of proximity interventions that target families in their homes, build trust and ownership throughout the communities, and address cultural beliefs and socio-economic and behavioral barriers to care.

     I will tour the village and clinics tomorrow and meet with the clinic staff to formulate the needs/teaching plan.  I am excited to get started.

 

    3..  Gender and Community Mobilization- to mobilize the community (men and women) for farmer field day and to mobilize community clusters for training in agriculture and business development.

 

    4.  Water and Sanitation- 23 wells have been dug and capped to provide clean water with easy access, Latrines are being built.

   

    5.  Agricultural Business development and environment- on-going improvement and training on agriculture and business; develop receipts for repayments of loans; Improve on grains banking; increase fish farming activity and business; encourage home gardening to improve nutrition; start stocking agro input supply centerwithin cluster.

 

    6.  Infrastructure- receive materials for completion of work on poultry houses and agro processing centers.

 

   As you can see, a lot is happening here in the Millenium Village Project. I am excited to be a part of helping this village to become healthier, more educated and sustainable. I will try to send frequent updates

 

 

Peace on Earth Begins with Birth!

Blessings!

Robin

Day 2 - 
 

My body is still on US time so sleep is quite elusive.  When the electricity is up, I read. Currently I am reading Three Cups of Tea by Greg Mortenson.  It is about an American who decided to build a school in the mountains of Pakistan.  It is amazing what people can do when they put others before their own comfort. When the electricity is down, I have been listening to my IPod- music or audiobooks.

 

Last night I had my first full “splash bath”. You fill a bucket with water (cold), use a bowl to splash water on yourself, soap up, and then splash to rinse. It felt good to cool off. Much better than the Baby wipe bath the day before!  When finished, you mop the bathroom floor of all the water you splashed!

 

For breakfast, I had bread with peanut butter. I remembered to take my weekly Malaria Prophylaxis today. Several mosquitoes have already dined on me, so I don’t want to take any chances!

 

Last night I plugged my phone in at the office to recharge. When I walked in this morning, they turned the generator on. I heard a POP! And saw flames shooting out of my adapter/converter. That is now fried. The phone is OK but didn’t charge. I brought 2 adapters so I was able to get the phone charged. Glad I brought two.  I may have to get another locally!

 

Today we were at MV2 doing prenatal care. I worked with Hadassah, the midwife. Unfortunately, she said the BP cuff didn’t work. Dr. Oje had the Doppler at the other clinic, so while we waited for him, I did the weights, tummy checks, and improved my skills with the fetoscope.  Dating is difficult as women do not use calendars as we know them and most today had no idea how far along they were. Babies come when they come.  So the pregnancy wheels I made will be of little use.  We just measure the belly and see if there are appropriate changes in size and weight between visits.

 

I taught Dr. Oje how to use the Doppler. It is just an $80 model off E-Bay but it works well.  He was amazed when we found heart tones on a 14 week fetus.. Yesterday he wore and changed gloves between each woman. I have just used hand sanitizer between patients as we only do external exams.  I will bring extra for the clinics next time. Gloves seem to be a bit much just for measurements!

 

We had one girl, about 15 or 16 years old here with her first pregnancy.  They explained that she is of Low IQ, as is her husband.  She was very anxious, but we were able to get her calmed down and check the baby.

 

There is a lot of anemia due to the poor nutritious quality of the diets.  The primary stable is maize (corn) They grind it up and make a cereal or paste.  All the women are given iron supplements and also folate (B vitamin).  I saw several women with Vit B deficiency.  They develop cracks in the corners of their lips.
 

They admitted a young child to the ward who was having a seizure.  They gave her IV medications to stop the seizure.  The doctor felt it was a febrile seizure as a result of malaria. I said a short prayer for her.  

 

The staff are teaching me short phrases “senu de zwa” means Welcome; “Na Gode” is Thank you,” "Ina quana” is good morning and “Sa hanjuma” means See you later.  I hope to add a phrase or two each day. At my age, I can only retain small amounts with lots of repetition.  I am learning so much from them. I hope when we formally start classes, they will learn from me.

 

We will have a meeting with the health workers tomorrow to set up a class schedule that won’t interfere with the clinic work. Today, the doctor, midwife and I were a very efficient team. Between 11 and 1:30, we saw around 30 women. The midwife documented while the doctor and I did the exam.  Team work is great.  I will also poll them to see how they want to proceed with the classes. I think we will start with prenatal and move on from there. If a delivery comes in, we will immediately do “on-the-job training.”

 

Time to go to my room and relax a bit. I hope all is well back in the States.

 

From Nigeria,

Robin

We look forward to hearing more from Robin as we receive her reports from the field! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, visit our web site at www.physiciansforpeace.org.

 

Above: Kissairis Rodriguez (left) proudly wears her "Madre Tutelar" vest as she pays a visit to

one of the young girls she mentors as a Resource Mother.

In light of today's New York Times article, "Saving the World's Women" I thought I would share with you a first hand account of how Physicians for Peace maternal and child health programs are healing and empowering women around the world. It is the story of Kissairis Rodriguez, a young woman in the Dominican Republic who evolved from a scared teenage mother, trying to make a life for herself and her child in the barrios of Santo Domingo, into a mentor for other young mothers living in poverty...

 

"When I was 15 years old I got pregnant and had my baby at the age of 16. When I find out I was pregnant, I felt that the world was coming apart. I experienced all the difficulties and dilemmas of being a pregnant teenager. Four years ago, when leaders of my community talked to me about a program for pregnant adolescents, and invited me to attend a meeting, I went to the maternity hospital and received all the information about the Resources Mothers Program. I got very excited thinking about the possibility of being a part of it, because I knew there were other pregnant teens out there, and I wanted to be sure they could receive the help they needed. I was selected and trained by the Physicians for Peace staff, who offered me employment as a "Resource Mother."

 

As Resources Mothers, we are part of our barrios - we live there and  share our clients’ needs. Thanks to our training we can help young women keep away from drugs, alcohol, and tobacco - things so common in our community. We help them take care of themselves during their pregnancy, accompany them to prenatal check ups, and visit their homes, advising them and their families on how to have a healthy pregnancy.  We also advise them how to eat well, even when there is so little to eat.  We teach them how to nourish not just their bodies, but also their souls, so they can deal with all their worries and fears. 

 

My experience as a Resource Mother has inspired me to go to the School of Medicine, and in a few years I will become a doctor. I am grateful to God and to Physicians for Peace for the opportunity to believe that there is light at the end of the tunnel, but most of all for the opportunity to become a better human being."

Kissairis' story shows how women around the world are making a difference in their own communities. Global health organizations are realizing that supporting maternal and child health programs is the most effective use of their resources. Physicians for Peace is part of this movement. Please help us to empower mothers in poverty with our Resource Mothers Program, Midwifery Training Program, VVF Surgery Program, and Prenatal Lifesaving Program. 

Donate Here or visit our web site to learn more. 

Thank you for your support! 

This blog entry was contributed by Dr. Nabeel Qureshi, a recent medical school graduate who served as an intern for Physicians for Peace in his last year at Eastern Virginia Medical School. Nabeel's contribution to the Resource Mothers Program was significant. As a student of psychiatry, he was able to provide training on two very important and difficult aspects of women's health - depression and domestic abuse. He had this to say about his experience: 

"I made my decision to work with Physicians for Peace last year when I was being introduced to the fourth year MD curriculum. In the catalog was a section on "International Medicine". I talked with Dr. Paul Aravich and Jaya Tiwari, and I decided that a medical mission trip in international health education would be a great fit for my future medical endeavours. No matter what I end up doing in the medical field, I hope to take that knowledge and help people around the world. 

Before starting work this March, I talked with Jaya Tiwari and Mary Kwasniewski, Directors of Global Health Programs at Physicians for Peace, and we decided that working with the Resource Mothers program in Santo Domingo would be a great idea. It had come to their attention that the women in Santo Domingo were having difficulty dealing with domestic abuse issues with their clients, and that they needed training with how to respond. I gathered information in English and in Spanish and put together a two hour workshop on domestic abuse training.

Before arriving in Santo Domingo, I did one week of medical mission work in Honduras. While there, I noticed that people suffering from depression received very little help, despite the pervasive effect this disease has on one's life. I began brainstorming on how this problem could be addressed, and decided the best place to start would be with diagnosing the condition and educating the people whom it affects. So when I arrived in the Dominican Republic, my focus became not only to identify domestic abuse and discuss it with the Resource Mothers, but also to determine the extent of depression amongst these women and their clients.

In Santo Domingo, I visited each client's home one at a time, documenting the location of the homes via GPS and taking pictures of the women standing outside of their residences. This was to help locate all the clients on a map to better serve them and to be able to show the work that Physicians for Peace is doing in a more tangible manner. I also wanted to get to know the clients and have a better understanding of their living situation. During this time, I also translated the World Health Organization's Major Depression Inventory into Spanish and administered it to the Resource Mothers. This inventory does two things: definitively diagnoses depression, and also determines the severity of the depression. Of course, the translation was not sanctioned by the WHO, but it was as good as we could do. In addition to the administration of the MDI, we also trained the Resource Mothers on depression and post-partum depression, as well as domestic violence. 

Traveling to the Dominican Republic and working with Ramon Lopez, Director of the Americas for Physicians for Peace, was a great experience. My eyes were opened to the conditions of people who truly are in need, and also to my condition of luxury in the States. After spending a week visiting all the clients, I had no doubt in my mind that Physicians for Peace was doing an amazing service in their lives and the lives of their new children, a service that would continue to benefit these families for their entire lifetimes. I will not soon forget the stories, the emotions, and the relationships that I experienced in this vibrant and life-loving culture."

We thank Nabeel for his work in this area of need in and helping women understand and diagnose the disease of depression in an area of the world where this problem is often overlooked. Addressing the problems of depression and domestic violence is crucial to our mission of improving third world health care and helping mothers in poverty. 

To learn more about our Resource Mothers Program, visit www.physiciansforpeace.org/wch.html

You can contribute to our Maternal and Child Health Programs. Make a donation today!

Our volunteers returned safely this weekend from Segou, after a successful surgery mission to help dozens of women in Mali heal from severe complications of childbirth.  Jaya Tiwari, Director of Global Health Programs for Physicians for Peace, who traveled with the mission team, sends out her heart-felt appreciation for all the hard work and dedication of everyone involved:

 

Hello Ladies,

Just wanted to drop a little note to say a big thank you to all of you for your time, energy, skills, and resources in making this mission a success!!! I have traveled with many other PFP teams before and can tell you that without a doubt this was my best experience of a PFP team working so well together on their first mission. Even with all the bureaucratic and language barrier issues, the whole mission ran so smoothly!!

Laura, I couldn't thank you enough for agreeing to not only join the team at a short notice but staying the extra 11 days to help us do the post-op follow up and information gathering. I am humbled by your compassion, commitment, and willingness to invest your time, skills, and resources to help women suffering with VVF!! You know that I will always have a soft spot in my heart for my “PSR Docs” but seeing you jump in and make the kind of personal and financial commitment and sacrifice you did in your first PFP mission left me speechless!!!  Even before this mission, I knew you were a fantastic surgeon but seeing you blend so easily and work so efficiently with the Malian team and your amazing ability to put people at ease, whomever you interacted with and wherever you went, made me realize what a wonderful and special human being you are!!!

I am really excited about you working with Dr. Samaki in Segou on additional cases this week and especially getting the opportunity to work with Professor Oauttara at Hospital Point G for 4 extra days before you leave for U.S. With this and your previous VVF mission experience, you are unquestionably the most experienced VVF surgeon of the U.S. team that PFP has worked with so far, and I truly hope that you will become one of the core members/U.S. team leaders for our future VVF missions. After this surgery mission, I am more and more convinced that regardless for where in Africa we do VVF missions, we must find an in-country team leader like Professor Ouattara for Mali or Dr. Saad for Nigeria to take the overall lead of the mission, at least for the first three or four missions, in every country we go into, so I will need to work with my bosses at PFP to see if we can adopt this as an organizational policy. However, even with a strong African team leader, we need an equally strong, experienced, and skilled (but also humble and culturally and politically sensitive) U.S. team leader and I see you taking on this role in future PFP missions in Mali and other countries in West Africa!! As you heard, Mavis and Dr. Coulibaly were requesting additional PPF VVF missions not only in Segou, but in Markala and Timbuktu, so we are really going to need to expand the team and have you and Ellie start to take on the lead in helping recruit and train more surgeons and OBGYNS to join the U.S. team!! 

Ellie, I know this was your first VVF mission and at times you were unsure and nervous but I want you to know that I have seen veteran U.S. OBGYN (people twice your age and twice the years of service in U.S.) on their third or fourth VVF mission be completely at a loss about what to do (and that is in a English speaking country!!). As I mentioned to you in Segou, most U.S. OBGYN are so intimidated by their lack of exposure to VVF as a condition that they cannot even muster up the courage to join a mission let alone travel to Africa and do half as well as you did in Segou on your first day in the OR. The fact that Professor Ouattara asked you to take the lead on a number of cases on your very first mission should tell you the level of trust and confidence in your skills and ability by one of the most prominent Malian surgeons. Also, the fact that you were so prepared and came so loaded with meds and supplies for your very first PFP mission warmed my heart and left me forever grateful to you!!  Your energy, drive and motivation, attention to details and the willingness to jump into a completely unfamiliar situation and master it all so quickly is exemplary!!! I know you run your own very busy practice and have two young kids of your own so taking 10 days off to be on a PFP mission is a HUGE financial and personal sacrifice, but I hope that the joy of being able to help some of the most vulnerable women in Africa and the opportunity to step out of your comfort zone and expand your surgical, professional and cultural experience in life made up for some of it. The fact that I have repeatedly asked you to plan on joining the next mission in Segou and remain a core team member of the Mali VVF team, and even think about taking the lead of the U.S. team of one of the future VVF missions in Mali or other countries in West Africa should tell you of my trust and confidence in you. As I said earlier, this was our first surgical mission (and of course first VVF mission) to Mali so it was a learning experience for all of us (including our hosts at MV/MCI project and at the hospital) and I assure you that things will continually get easier and more efficient as we work together. I hope that you and Laura will continue to be our lead doctors of VVF team in Mali and help us figure out how to expand our volunteer medical missions to cover even more people and places!!

Pam and Lisa, thanks a million for bringing so much more than your superior medical skills to this team. Your patience, warmth, charm, and sense of humor kept all of us grounded and sane whenever things started to get crazy and stressful. Pam, as we discussed earlier, as we expand the scope of the mission and start to work in other hospitals and cover additional surgical specialty areas in Mali, we will be able to utilize more and more of your fine trauma and triage skills but I am indebted to you for your flexibility and willingness to roll with the punches and adopt to the new and ever changing roles and responsibilities we threw your way everyday to keep the mission running smoothly. I am so glad I called on you to be a part of the Mali VVF mission, you really completed the team. And you lucky bum, I am so envious (happy for you but still envious) of you that you got to spend a few hours in my favorite city in the whole world, Paris, while Frances and I were moping around at the CDG airport!!)

Lisa, in addition to being an excellent medical assistant, you are a sweetheart!! I can see now why Ellie is so fond of you and insisted on bringing you as part of the team. I have to tell you that I am always hesitant to let someone with no previous overseas travel experience join a PFP mission to Africa (because of the obvious physical, professional and emotional challenges we have to face on these trips), and had my reservations about how you were going to handle the trip. You, my friend, exceeded my expectations! The fact that even after Ellie making you walk all over town in 106-108 degree temperature you could still jump in and do a full day of OR assisting left me speechless.  You have such a big heart, and so much empathy for those less fortunate than you, that I wasn’t surprised a bit when you broke down at the sight of the boy with leg injuries. I was humbled by your willingness to take on the responsibility of paying for his care!! You single handedly saved that kid from so much pain and suffering in life, and you know that even without knowing your name and knowing a whole lot about you, that boy and his family will always remember you as someone who reached out and helped in time of their need!! Don’t forget to show your kids (and their young friends) pictures of this boy and his family and remind them just how lucky they are compared to the majority of kids their age in other parts of the world.   

Frances, my traveling companion in Nigeria, travel buddy and roommate in Mali, and surgical tech extraordinaire, you don’t need me to tell you how lucky PFP is to have you as a volunteer. You were the glue that held the PFP’s Nigeria VVF team together, and you are now the core part of the Mali VVF team. Your ability to anticipate what’s needed in the OR room and step up the supply room and make things run smoothly under the most stressful situations, and relate to our host hospital staff so beautifully despite the language barrier is an amazing gift and something PFP will continue to depend on for future VVF surgery missions in many years to come. My hats off to you our “Africa Princess” (we do have to switch you to a different anti-malarial pill for the future missions though!)

With every obstacle that came our way in planning and implementation of this very first surgical/VVF mission to Mali, I couldn’t have asked for a better team!!  I will always treasure the time spent in Mali with my “sisterhood of traveling medical mission team”. It was my personal honor and privilege to accompany this team, and PFP is indebted to each one of you for your contribution. We look forward to working with you for many years to come!

With lots of love and hugs to you all,

Jaya

Help mothers in poverty suffering from VVF by supporting our international medical missions to improve maternal and child health - Make a donation




 

 

Last Thursday night, Physicians for Peace, along with partner organizations Eastern Virginia Medical School, Children’s Hospital of the Kings Daughters, and Los Minas Maternity Hospital in Santo Domingo, Dominican Republic were jointly recognized by Old Dominion University College of Health Sciences with their “Great Science for Better Health” award.  This award was in recognition of a joint pilot/demonstration project in Norfolk some years back that was then replicated by us in the Dominican Republic, now known as Resource Mothers. The program has been greatly successful helping mothers in poverty by providing them with a mentor to assist with prenatal care and nutrition, giving them a better chance at having a healthy pregnancy and healthy baby. 

 

Congratulations to Dr. Ed. Karotkin, Laverne Morris, Mary Kwasniewski, Dr. Ramon Lopez, Dr. Diana Forno Batres, EVMS, CHKD, Los Minas, and most importantly, all of our Resource Mothers for a job well done. 

To read about our other programs that support the Millennium Development Goals for
improving maternal and child health, visit our web site: www.physiciansforpeace.org

The first report is in from Jaya Tiwari, Director of Global Health Programs, who is traveling to Bamako and Segou with our team of volunteer surgeons who are on this very important medical mission trip to treat women suffering from VVF: 

After a long journey, a few flight connections and airport delays, the Physicians for Peace team safely arrived at Bamako International Airport on Sat, May 9th night. The team consisted of Dr. Laura Hart, an urologist from Seattle, Washington, Dr. Ellie Hogenson, an OBGYN from Fairbanks, Alaska, Mrs. Pamela Allen, a Physician’s Assistant from Boston, MA, Mrs. Lisa Byman, a Surgical Assistant from Fairbanks, Alaska, Mrs. France Dargan, Surgical Assistant from Norfolk, VA.

Going thought immigration in Mali seemed surprisingly and pleasantly  unbureaucratic and fast so we happily proceeded to the baggage claim area. Well, we more than made up for our fast clearance through the immigration process in the baggage claims area, where a small conveyer belt SLOWLY and with frequent stops proceeded to spit out the checked bags from our flight. Given that we had checked in 8 huge suitcases of medicine, medical donations, and
instruments essential for this mission, we all stood around nervously awaiting the appearance of each bags of supplies, all of which finally arrived at safe and sound. We proceeded to the customs area in one big and semi-confused mass of people where another slow baggage screening machine was used to screen every single bag and passenger item with many passenger bags being pulled off the screening belt for hand searches and inspection. Unfortunately, two of our huge bags of medical supplies were also pulled aside for additional inspection, and after some more delays, explaining and negotiations, we finally got all our bags with all items intact and could leave the airport more than three hours after our flight landed!! 

We were met at the airport with Mavis Ama Frimpong, Sub-Regional Sexual and Reproductive Health Advisor of the Millennium Development Goals (MDG) Center, West and Central Africa. After an overnight stay in Bamako, the capital of Mali (West Africa), we started another three hour jeep ride to Segou, the site of this Vesicovaginal fistula (VVF) repair mission, accompanied by Mavis and our esteemed team leader, Professor Kalilou Ouattara. Professor Ouattara is one of Mali’s most renowned surgeons and VVF repair experts and is also the Head of the National Fistula Policy. This is Physicians for Peace’s first VVF mission in Mali, conducted in partnership with the MDG Center, West and Central Africa, and the Ministry of Health to assist the women suffering with VVF in the Millennium City of Segou.

The ride between Bamako and Segou was pleasant as we passed the roads lined with mango groves and small street side market areas. Both Bamako and Segou are famous cities rich in history and architecture, which given our busy schedule, we have not had the chance to explore but hope to do so by the end of the mission. Monday and Tuesday were full, long days for the volunteer mediteam in visiting the hospital: meeting various stakeholders and health officials key to VVF repair and prevention campaign in Mali, getting to know the local doctors and health professionals that will work alongside the U.S. team for the duration of the week, familiarizing themselves with the VVF work in the OR at the Segou Hospital, setting up supplies, screening patients, and starting to perform operations. Stay tuned for more...

Find out more about the problem of VVF on our web site: www.physiciansforpeace.org/vvf.html

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Physicians for Peace was recently granted membership status in the Core Group, a coalition of global health organizations working to improve maternal and child health.

 "CORE Group members and their local partners are committed to reaching the Millennium Development Goals of reducing child mortality worldwide by two-thirds by 2015 and reducing maternal mortality by three-quarters by 2015"

We look forward to working with CORE and its members to better the lives of women and children around the world. 

Learn more about the CORE Group

Recently, the New York Times reported on the devastating problem of vesicovaginal fistula (VVF) that affects over 2 million women and girls in sub-Saharan Africa and Asia. This condition, which often results from prolonged labor in young girls, is a tragic problem for mothers in poverty who have no access to medical care. 

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Physicians for Peace has had several successful medical missions to Kaduna, Nigeria. Kaduna is part of the Millennium Cities Initiative created by the Earth Institute at Columbia University to help sub-Saharan cities achieve the Millennium Development Goals defined by the United Nations. Physicians for Peace has been able to heal the lives of dozens of women. Thousands more are waiting for help. Find out what you can do: 

Learn more about VVF on the Physicians for Peace web site