Fragile States

Fragile States (including Afghanistan, Democratic Republic of Congo, Haiti, Liberia and South Sudan)

Immaculée, seated, holding her twin boys. Thanks to the intervention of the center’s midwife, at left, both of these babies are now in good health. {Photo credit: IRC.}Photo credit: IRC.

Thirteen newborns die every hour in Democratic Republic of the Congo (DRC). So on July 23, when 25-year old Immaculée went into labor with twins at the Monvu Reference Health Center in the Idjwi Health Zone, and her first twin was born without signs of life, the chances of survival were not in his favor.

The odds are stacked against newborns in the DRC: neonatal mortality hovers around 97 deaths for every 1,000 live births, and has done so for years, explaining the acute need for intervention in this area.

Recognizing this need, the USAID-funded DRC-Integrated Health Project (DRC-IHP), in conjunction with the Church of Latter Day Saints and the Ministry of Public Health, organized a “Helping Babies Breathe” training in Kinshasa in April 2012, to build the capacity of health providers who oversee labor and delivery.

Helping Babies Breathe is an evidence-based neonatal resuscitation approach designed for resource-limited areas, which teaches health workers how to handle newborns’ breathing in their first minute of life, a critical period known as the “Golden Minute.”

MSH: Saving lives and improving health in 2013.{Image credit: MSH.}Image credit: MSH.

We have seen some remarkable gains in global health in 2012. Yet millions of women, children, and men still die from preventable causes. As we pause and reflect on 2012 and look ahead to the new year, I invite you to read and share some of our favorite blog posts from the year.

A community-based distribution agent discusses family planning options with a family in the DRC health zone of Ndekesha. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted from Frontline Health Workers Coalition.

Evidence of the need to scale up the number of frontline health workers in developing countries abounds throughout sub-Saharan Africa, as described in a recent post on the Frontline Health Workers Coalition blog by Avril Ogrodnick of Abt Associates. Yet training new health workers is not sufficient, in itself, to sustainably address the crisis: governments must also invest in providing management support to harvest the full value of these trainings.

2012 World AIDS Day event in Port au Prince, Haiti. From left to right: Pamela White, Ambassador of the United States to Haiti; Michel Sidibe, Executive Director of UNAIDS; Sophia Martelly, First Lady of Haiti; Florence Duperval Guillaume, Minister of Public Health and Population; and Guirlaine Raymond, Director General of the Ministry of Public Health and Population. {Photo credit: C.Gilmartin/MSH.}Photo credit: C.Gilmartin/MSH.

In recent years, Haiti has endured some of the greatest misfortunes in its history, including hurricanes, floods, the devastating 2010 earthquake, and the cholera epidemic that followed. These natural disasters and public health crises have added to the harm already caused by the country’s widespread poverty, social and political unrest, and under-resourced health system. Haiti’s fragile population is further plagued by the highest HIV prevalence in the Western Hemisphere at 1.9 percent, which translates to roughly 120,000 HIV-positive individuals and 93,000 children who have lost their parents to AIDS (UNAIDS, 2011).

Malawi mother and children {Photo credit: MSH.}Photo credit: MSH.

I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.

It was 1993 during my residency in pediatrics in Cleveland, Ohio. We were at one of the best children’s hospitals in the world; it didn’t matter. The young girl died a few months later.

With the advent of antiretroviral therapy (ART) a few years later, the whole world changed. The world of HIV medicine blossomed; new drugs and drug combinations literally exploded with amazing effect. HIV-positive mothers could give birth to HIV-negative babies, and HIV-positive children and their moms could get treatment.

Dr. Stephen Macharia of MSH TB CARE I South Sudan speaking at Union World Conference symposium. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted from the MSH at the Union World Conference on Lung Health 2012 blogManagement Sciences for Health (MSH) presented at several symposia and workshops throughout the 43rd Union World Conference on Lung Health (read more).

Friday’s symposium on November 16 dealt with: Saving lives in areas of conflict or disaster: partnering for results (PDF). Dr. Eliud Wandwalo of MSH Tanzania coordinated the session along with Morgan Richardson.

Trying to cross through a flooded section of road in South Sudan. {Photo credit: E. Polich/MSH.}Photo credit: E. Polich/MSH.

“We’re going to try to drive through that?”

After spending nearly two years working in South Sudan, I was on my way with two colleagues to one final meeting. The USAID-funded second phase of the Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH), ended activities on July 31, 2012, and three of us needed to travel 360 kilometers (220 miles) to a results dissemination meeting. A flight booking mishap meant we had no choice but to drive --- during rainy season.

With a key bridge washed out.

And it rained --- down poured --- for over an hour the morning we left.

After passing several toppled trucks, overtaking pickups irrevocably mired in mud, and crossing through a river, we came across the point where I uttered the above quote (“We’re going to try to drive through that?”).

Health for All.Health for All.

The October edition of MSH's Global Health Impact newsletter (subscribe), features stories of people, communities, and countries on the road toward universal health coverage (UHC).

The vital role of the essential package for health impact

On the Road to Universal Health Coverage: The Vital Role of the Essential Package for Health Impact

The convoy faced many challenges, including the rainy climate en route to Mulungu. The vehicles often got stuck in the mud, requiring the help of many people to get them moving again. {Photo credit: MSH.}Photo credit: MSH.

The Democratic Republic of the Congo’s Sud Kivu province has been an area of armed conflict for many years, with various rebel factions fighting for control over the resource-rich region.

The continued fighting has disrupted health services --- which were weak to begin with --- due to geographic isolation and poorly supported health workers.

In the health zone of Mulungu, there had been no delivery of medicines or supplies for more than six months. More than 105,000 people live in the remote area, where health issues include malaria, malnutrition and anemia. In April 2012, the USAID-funded Democratic Republic of Congo-Integrated Health Project (DRC-IHP) deployed a team of health workers from Bukavu to Mulungu, to transport more than 2,640 pounds of medicines and supplies; 2,700 insecticide-treated mosquito nets; and 50 containers of petrol to supply cold chain storage units for vaccines.

A woman receiving antenatal care in South Sudan. {Photo credit: J. Warren/Save the Children.}Photo credit: J. Warren/Save the Children.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

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