(Website: www.TCWmag.com)
In a hospital in the Northern Nigerian city of Kano, a woman has given birth to twins behind a flimsy sheet curtain. The second birth was severely delayed; with only four doctors employed by the entire hospital, no ob-gyn saw her during the delivery.
She hemorrhages blood onto the floor, a red pool slowly spreading beneath the metal frame of her hospital bed and creeping toward the toes of her caregivers, exposed in their flip-flops. The nurse midwife, Aisha Bukar, paces, while the woman lies expressionless on the bed. Despite the massive blood loss, there's nothing the Aisha can do for the patient, Sakina. In Murtala Mohammad Specialist Hospital, which sees 30 delivers every 24 hours, there is no blood for this mother, and so her husband, Muhammed, has left on his moped to procure her rare blood type from another hospital or a private blood supplier at the price of $68 per pint--or about three-quarters of his monthly salary. Precious minutes tick by as the stain of blood spreads with no source to replenish it.
Thus opens "The Edge of Joy: Confronting Maternal Death in Nigeria," a documentary by journalist and Chicago native Dawn Sinclair Shapiro. The film, which was screened on January 13 in Chicago as part of The Chicago Council on Global Affair's Women and Global Development Forum, tells the story of the most populous country in Africa, whose 140 million citizens watch 36,000 women die in childbirth every year.
Nigeria's maternal death rate is the second highest in the world; in West Africa, about one in every 12 women will die in delivery. In the U.S., that number is one in 4,800. As Daniel Pellegrom, president of Pathfinder International, said in a post-screening discussion, "No issue divides the haves and have nots more than the simple act of a woman attempting to have a baby."
Dawn's film compellingly demonstrates the causes and potential solutions for this health crisis. Sakina, sadly, is the rule more than the exception: the leading cause of maternal death is blood loss, unsurprising in a country where half of all women deliver outside of a hospital, as Sakina did with her previous two children. The problem, as the Murtala Mohammad Specialist Hospital Head Nurse Midwife Farida Babelle says succinctly, is "how to get blood."
Often compounding these challenges are cultural issues in Nigeria (a nation of about 50 percent Christians and 50 percent Muslims), a topic addressed honestly but respectfully by "The Edge of Joy." For example, for those who follow Sharia, or Islamic law, travel by women without a male relative (or male relative-approached) escort is forbidden, a particular problem when hospitals are often many hours away from the villages where mothers reside; women must continue having children as long as they are able; and a male relative's verbal permission is needed in order to perform a potentially life-saving hysterectomy.
The second point is especially pertinent: in causes leading to maternal death, the ability of mothers to time and space their pregnancies falls not far behind hemorrhage. As pregnancies number more than five, the risk of life-threatening complications increase; same goes if pregnancies are less than two years apart. Family planning is key to solving this crisis. Thirty years ago, about 10 percent of people worldwide used some form of contraception; today, that rate is 60 percent. In Nigeria, that number grew from only 12 to 18 percent in the same time span. As Farida observes after a patient has stated that her husband would not allow her to stop having children, "The reason most of our people don't believe in this family planning is because sometimes they misquote religion."
While women in Africa are slowly becoming more proactive in their own healthcare, the involvement of men in this process is invaluable, explains Professor Oladosu Ojengbede, director of the Center for Population and Reproductive Health. We see him in the Southern Nigerian village of Mele, opening a forthright discussion about sexual needs to a room of men to whom "family planning" means "celibacy," a concept worthy of laughter and derision. He explains birth control pills. He explains condoms. And he explains the financial, health and familial benefits of a wife being able to space her pregnancies. After all, the death of a mother exponentially increases the likelihood that children under 5 will not survive; spacing pregnancies also allows more time for a family to save precious nairas (the Nigerian currency) should a medical emergency, such as a last minute scavenger hunt for blood, arise. "Spacing" opens up the conversation in a non-threatening, and less culturally encroaching, way. Slowly, the men nod. A maternal death is a family death; family planning allows for healthier and more robust families.
As for hemorrhage and access to blood, "The Edge of Joy" presents varied solutions, often low-tech and inexpensive, explains Prof. Ojengbede. One is the "anti-shock garment," originally developed by NASA in the 1970s, which can be used in hospitals as easily as rural villages. Swaddling a hemorrhaging mother's torso and limbs, it shunts blood away from extremities and back toward to vital organs, buying time until blood can be obtained. The garment, Dawn explained after the screening, costs a mere $160-$180 and can be reused up to 50 times.
But it only buys time. In the Murtala Mohammad Specialist Hospital (where Sakina eventually recovered after her husband's three-hour search for blood* but lost the second of her twins), establishing a blood bank devoted solely to the maternal wing of the hospital has reduced waiting times by 75 percent, explains Farida Babelle, who implemented a rigorous evaluation of the hospital's maternal death rates and established the blood bank.
And therein lies a crux of the problem: a gorge between the knowledge of what needs to change and the tools to do so. Throughout the film, I was repeatedly struck by the caregiving provided for those able to travel to a hospital. The nurses were experienced, caring, passionate and eager for change; but intention is an ill substitute for resources. The advocates are progressive and well-versed in the area's culture; but the relationship between religion and modern science is tenuous, a statement that rings true even in the United States. As Prof. Ojengbede explains softly, "You can say women's rights should be well-protected. But for now, we have not put in place all the structures that protect women's rights completely in developing countries. And that's what we must put into context when we're fashioning out programs and projects that would serve women. To find the appropriate way and culturally acceptable way of circumventing the obstructions...The frustration is everywhere. But the resolve is stronger than the frustrations."
*Underscoring the role of economics in maternal health, the filmmakers note that they provided money to purchase the blood after Muhammed was unable to secure funding.
http://www.chicagonow.com/blogs/todays-chicago-woman-jobs-money-opinion/2011/01/edge-of-joy-tells-harsh-truth-of-maternal-death-in-nigeria.html
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