Salud Reproductiva

I was attending the meeting organized by officemate which aimed at enabling girls and women access fistula repair, where the consensus was to establish a National Referral System (NRS). The system links lower and higher levels health facilities e.g. health centers, hospitals to each other so referrals are managed efficiently. The system also connects NGOs, CBOs and FBOs and other partners to the hospitals providing repairs, so a wider network of actors are involved in helping girls and women with fistula access treatment. In that meeting what I felt needed to be done is to try to bring the service users as one way of fistula prevention by which our organization if focusing. Normally in this meeting fistula survivors are invited to dialogue with hospitals providing the repairs and other partners to make sure that strategies are put in place so that women and girls are prevented from ending up with fistulas as well making sure the fistula patients easily access repairs. It is when the idea was brought up as it seemed very critical for fistula prevention to include the community, health providers and the policy makers for effective strategies of improving maternal health services.

While studying anthropology as an undergraduate, I volunteered for a professor's research study. She was doing some basic physiological tests on me while telling me about an idea for my senior thesis. She told me about the problem of obstetric fistulas, and about the Fistula hospital she had come across while working in Ethiopia. She told me that we had to stop talking about it for that moment, because my heart rate had spiked and I was skewing her data.
After educating myself about the problem of obstetric fistulas and the areas that needed more research, I found partnership in the Tanzania-based organization, Women's Dignity. I worked with them to conduct my field research on the social reintegration process of women with fistulas and met dozens of women whose lives have been severely affected by the lack of obstetric care. Fortunately, many have accessed surgical repair and are doing well.
After completing the research, I began medical school at a unique school to train physicians to work in developing countries. Since the school is in Israel, I've been able to stay connected to the work on fistulas in Africa. I spent part of my summer after first year with surgeons at the Hamlin Fistula Hospital in Ethiopia and then returned to Tanzania to follow up on the research we had conducted there and disseminate the findings to the community. During a community meeting, I was urged by a community leader to continue working on the issue of maternal health and to "not forget the people of Ukerewe."
I also had the chance to meet with the Member of Parliament representing Ukerewe who confirmed her desire to work on a major project to prevent fistulas on the island and to reduce maternal mortality and morbidity.
This past year, although very busy with school, I have had the privilege of attending two international conferences that addressed the issue of obstetric fistulas. I presented our research at the conference for International Society of Fistula Surgeons and learned even more about the medical and social issues of women with fistulas in communities around the world. I met many experts who convinced me that what I most needed to direct my energy on was actually preventing the fistulas from happening in the first place. It is clear that with improved maternal health care and access to that care, the problem of obstetric fistulas will also disappear.

Several studies were being conducted on maternal death, with the aim to reduce this event. However, what showed up was a lack of knowledge in between the healthy pregnancy and the death itself. Efforts were made to define the conditions of severity in wich health actions could avoid the progress to death. The recent World Health Organization's definition of severe maternal morbidity and near miss led us to conduct a surveillance in Brasil, applying those new criteria. This is a way to validate those criteria and to know the feature of maternal morbidity in our country.

In 2001, a publication about Cartagena identified the city’s child mortality rate as 48.4 infant deaths out of one thousand births, (compared to less than 5 occurrences in developed countries). Most of the cases, related to diseases caused by malnutrition, could likely have been prevented with adequate nutritional services. JFGE found it unacceptable that any children should die due to lack of resources and therefore made it a priority to address the reduction of child mortality due to malnutrition.

In 1991, the Sternins faced what seemed like an insurmountable challenge in Vietnam. As new Director of Save the Children in Vietnam, Jerry was asked by government officials to create an effective, large-scale program to combat child malnutrition and to show results within six months. More than 65 percent of all children living in Vietnamese villages were malnourished at the time. The Vietnamese government realized that the results achieved by traditional supplemental feeding programs were rarely maintained after the programs ended. The Sternins were mandated by the government to come up with an approach that would enable the community to improve AND sustain their young children’s health status…and quickly!

Building on Marian Zeitlin’s ideas of positive deviance, working with four communities and a population of 2,000 children under the age of three, the Sternins invited the community to identify poor families who had managed to avoid malnutrition despite all odds, facing the same challenges and obstacles as their neighbors and without access to any special resources. These families were the positive deviants. They were “positive” because they were doing things right, and “deviants” because they engaged in behaviors that most others did not. The Sternins and the community discovered together that caregivers in the PD families collected tiny shrimps and crabs from paddy fields, and added those, along with sweet potato greens, to their children’s meals. These foods were accessible to everyone, but most community members believed they were inappropriate for young children.v The PD families were also feeding their children three to four times a day, rather than twice a day, which was customary.

The communities developed an activity which enabled all of the families with malnourished children to rehabilitate their children and to learn how to sustain their children at home on their own, by inviting them to practice the demonstrably successful but uncommon behaviors which they had discovered in their communities. The pilot project resulted in the sustained rehabilitation of several hundred malnourished children and the promotion of social change in their communities.