Maternal death – preventable, so when will it end?

I have a major assignment for one of my international public health subjects where I have to choose a public health issue that affects a “resource poor” country and basically write about it, and some programs that could help, etc. Anyways, I thought I might choose a country with a high rate of maternal deaths. A maternal death, you might be able to guess, is basically when a woman dies in childbirth, in the few weeks after childbirth relating to complications from the pregnancy, or whilst pregnant due to the pregnancy.

Today I was reading through the 2005 World Health Report, produced by the World Health Organisation entitled “Make every mother and child count”. In it I found some truly staggering information, which I have decided to share with you now.

Many of you will be aware of the Millennium Development Goals (MDGs) that were produced by the United Nations (i think…) as targets in many different areas, some of which pertain to health to be achieved by 2015. The fifth goal is as follows: “improve maternal health”.

This is broken down into two targets: Target 1: reduce by three quarters the maternal mortality ratio. Target 2: achieve universal access to reproductive health.

These are by no means easy targets, however sadly, not much progress has been made in the 20 years since the MDGs were set. According to the 2005 WHR, “Pregnancy and childbirth and their consequences are still the leading causes of death, disease and disability among women of reproductive age in developing countries – more than any other single health problem.” In 2005 an estimated 529 000 women were dying each year due to pregnancy and childbirth. In Australia, this figure is about 20 per year. In fact, maternal death is probably as close as we’ll come to eradicated from the western world.

The United Nations website suggests that the “high risk of dying in childbirth continues unabated in Sub-Saharan Africa and Southern Asia”, a suggestion which is backed up by WHO whose statistics show that in Africa the lifetime risk of maternal death is 1 in 16 (compared with 1 in 2800 in the West).

Another startling statistic is that of the 529 000 maternal deaths each year, 68 000 are due to unsafe abortions. That’s almost 13%. Women may be forced into having unsafe abortions when it is illegal in their country, and when they are unable to afford or access safe abortion clinics. I have a few thoughts on this. Personally, I do not support abortion as a practice, as I believe that new life begins at fertilisation. However, I certainly do not think that making abortion illegal is a good way to reduce abortions, and believe that unsafe abortions are one of the WORST outcomes possible. How is it that societies in our world can be so unsupportive of women with children that 68 000 women were willing to risk their own lives, and lose them, due to unsafe abortions? It’s just devastating.

Overall, I truly believe that if we can almost eradicate maternal death in the west, it should also be possible everywhere else in the world. The 529 000 women who die annually due to childbirth and pregnancy is a devastating and needless loss of life. In fact, if these women were able to access health care during and in the few weeks following childbirth, maybe they wouldn’t have died?

I would encourage you to read “Make every mother and child count” (WHR, 2005).

A public health ethics question

here’s an ethical question I’ve been pondering for the last two days. In public health, morbidity and mortality is often looked at in terms of “years of life lost” instead of “percent mortality”. (actually, gets more specific as is adjusted for disability, so you might hear about disability adjusted life years – DALY). The reason is because if you only look at percent mortality, you’ll find that heart disease is the number one killer. However, when you think about it, rarely does anyone under 60 die of heart disease. It’s referred to as a degenerative disease – as in, it occurs later in life as things start to break down.

So in public health, should you put resources into heart disease?? If you look at DALYs you find that things like HIV/AIDS and even depression are much higher up the list – mostly because these are diseases that affect young people.

My question is, is it okay to put different value judgements on people’s lives based on their age? Does it matter if a 4 year old dies of diarrhea, a 28 year old dies of HIV or an 84 year old dies of heart disease? In one sense I want to say that it’s right to focus on diseases that kill younger people, as the elderly are going to die anyway… but it doesn’t really sit right with me. And I wonder whether I’ll still be saying this when I’m 70??

First day in International Public Health

So, I’m home again, and having neglected this blog for the second half of my trip (sorry) I have decided to start it up again. With a different twist.

Today was my first day of my new degree – a graduate diploma of International Public Health. What is this?? apart from a really long title… well, the international bit means that we study low to middle income countries, which can be anywhere really from Africa, South America, Eastern Europe, Asia (except South Korea, Japan, etc), Sub-continental Asia (ie India, Sri Lanka, Bangladesh, etc). And “public health” is mostly about health on a population level. For example, you might be looking at a particular disease (HIV/AIDS, tuberculosis, malaria) and implementing programs to combat that disease in a country or community.

The point, is that I think there are some really interesting facts and discussions that come up in international public health that are important for Christians to know and be thinking about. So, if you’re not interested in our brothers and sisters in poorer countries, then still read, cos this might help you become interested!! and if you are read and comment – it’s important to discuss these things!!

Today I learnt that in Malawi there is one doctor for every 91,000 people who live there. In Australia there is 1 doctor per 400 residents. The WHO’s position is:

“Every woman, man, youth and child has the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. Enjoyment of the human right to health is vital to all aspects of a person’s life and well-being, and is crucial to the realization of many other fundamental human rights and freedoms.”

It’s really easy to agree with this position – yes, attaining health is a human right, no there shouldn’t be any discrimination. But there is.

It’s much less easy to do something about it. What can we do? All train as doctors and move to Malawi? It might be a start. However, truthfully there are aready some NGOs that are doing awesome work in international public health. Medicins sans frontiers, world vision and oxfam are the big three. Supporting their work (prayerfully/ financially) would also help!

In class today, we were discussing a book that suggested that a person who earns $100K should be donating $5K to the poor. This caused a great stir, “but $5000 is so much! too much!”

I suggested they should give away $50K, but it was taken as a joke. What do you think?

A typical conversatsation from two days ago…

Bronwyn: well do you want to just get the clothes you have to wash
Merran: ahhh… you know how I only have one set of clothes at the moment?
Bronwyn: right. well…. ah.
Merran: How about I take a shower, and bring my clothes out in a towel. ah… can I borrow a t shirt?? for later…?
Bronwyn: okay.

But the era of that conversation is over finally! Thanks to the amazing delivery man who delivered my suitcase. after five days. clean clothes. my manicure set. just awesome!!

Tomorrow we are checking out some rolling green hills in the towns of Glendalough, Wicklow and Kilkenny. I have high expectations of this, I must admit, but I think it should be great. Will let you know! Loving the Irish accent too! so beautiful…

Travelling adventures…

The last few days have been a little bit unexpected. Yesterday, Bron, Sally and I were meant to travel to Ireland, the elusive place of all happiness that was drawing us in with its rolling hills and the promise of friendly english speakers. but alas. as much as we tried to get there yesterday… well… hmmm.

We arrived at the airport at like 1pm for our 4pm flight… something even Bronwyn’s dad would be proud of!! The lady as we checked in was like… there has been no delays announced. hurumph. after waiting another 7 hours they told us the plane to dublin was cancelled and we would have to go down stairs to rearrange flights and accomodation for the night. We lined up for about 20 minutes, and were then told that actually they were only helping families with kids. so we then had to wait in another line for those with no children. fair enough i suppose. so we waited another hour… and then (and this is the most outraging part) they called for french speakers!!!!!! honestly. The man next to me was like “they should be calling Irish speakers first” which made me laugh for some time. Eventually, we found out that they weren’t adding any flights the next day… so people had to fight for seats on the planes already departing… so they recommended us to change our seats online. which basically meant they didn’t want to speak to us. So we did change our seats to the first flight to Dublin the next morning. They didn’t offer us accomodation. we had to do it ourselves. thank goodness for travel insurance.

so we rocked up to the airport the next day and a man came over to us with a list and was like “if you’re on this list that means you’re on the 10.20” – i was like (????) we better be!!! But we were so it was all good. Anyways this plane was 40 minutes delayed… but eventually we got to Dublin!!! hooray.

only to find that my luggage is still in Paris. blast it all. oh and i broke my glass ring today… it shattered so i had to throw it out. such a shame… so i hope the luggage arrives soon…. cos i have no spare underwear!! or a toothbrush. eww…

Concurrently, Mike was due to meet us in Ireland today at 11. but he got stuck at Gatwick, which is possibly the worst place he could have been!!! if youve seen the news about London weather at all… so all day at our accomodation we were waiting to hear or for him to turn up. which he eventually did!! right after we called his mum. and his suitcase was lost too….

so all’s well in ireland, except mike and i have no suitcases, and we are somewhat sliding around the streets. our driving plans are possibly being revised as well… icy icy roads here.

Nude Art Revisited

There is a lot of nudity in Europe. Not like public nudity. Mostly. But just about every painting and sculpture has a woman with no clothes on her upper half… Or men wearing no pants. It’s interesting. Especially because some of them are where people do or used to live. For example at Versailles, there are paintings on the ceilings of naked people or cherubs… It would be a bit strange to live in s room decorated in this way. Can you imagine painting your ceilings with that? Actually it’s hard to imaging living in a room so ornately decorated at all. Even sans cherubs.

Don’t get me wrong Versailles is one of the most beautiful places i’ve been so far in Europe. It’s just weird how our society can be so shocked by life drawing and yet just go back to the 17th and 18th centuries and every painting has a naked breast in it! Or Greek sculptures of earlier periods.

The Vatican is also full of nude art. Our old friend michaelangelo was quite the fan of it (eg sistene chapel).

This reflection has mostly been due to the reactions people have had when I told them about going to life drawing… How what’s acceptible as art changes so much over time…

Highlights and lowlights of the last week

So it’s been a while since I blogged… Internet has been a bit patchy lately… Anyways I’m hoping to race through some of the best and worst times of last week.

Last time I blogged we were in greece! From there we planned to catch the ferry to Italy. This took us 31 hours. Longer even than it took us to get to Berlin from Sydney. First we had to go to patra which was a five hour trip cos the trains were down and we had to catch a bus. On the bus this guy was trying really hard to get bron’s number. Quite hilarious for me. Supremely awkward for her. He was like “these things happen for a reason, so I can get to know you… It’s fate” hahahahaha. And bron kept turning to me to like get support or something and he was like “why do you need permission from your friend?” haha pretty funny. Then we took the overnight ferry to Bari. We met some crazy italians on the boat. One woman who kept saying prego to me and I was like ahh… These oldmen spoke to us for an hour but they did’t know much English and we knew less italian. They kept saying the Eiffel tower had fallen over and we should take them back to Sydney instead! Haha.

From Bari we caught the train to tarranto, which was okay but then no one dpoke English and we needed to get to Napoli but the train didn’t leave for 4 hours! We ended up on a bus and I still don’t know whether we had a valid ticket. Our final destination was Pompeii (which has two i’s in English but one in Italian).

Pompeii was very cool. Lots of stray dogs though. Bron befriended one and called it Plautus after one in the “adopt a dog from Pompeii brochure” but in the end he abandoned us. I also spent a lot of time hiding and scaring bron amongst the ruins. She won’t admit she got scared.

From pompeii we went to Rome where we visited the Vatican which wad totally amazing. Serious respect for michaelangelo and Raphael now. Very catholic though. I guess that’s only natural. But lot’s of Mary. In fact in the last judgement apparently Mary is the intercessor for humankind. In Rome we also went to the colosseum, forum, pantheon, trevi fountain and Spanish steps. All very cool but it rained our entire time in Rome!

We then went to Venice. It is a nice change from Rome. No traffic! Only boats. So beautiful too. All the canals. We stayed right near San Marco. We went to the top of the tower and saw Venice from on high but it was in the morning so it was all misty. It also flooded at night! Due to the tides. We went to murano which is where the glass is made and there were these awesome glass art statues around. On Christmas day we did a gondale ride down the grand canal under the rialto bridge. And got attacked by pigeons. Seriously.

The next day we took a very expensive plane to Paris. The train we planned to book was full. In fact it was impossible to get to Paris for the next few days even by the most round a bout routes. Very frustrating! But now we are in Paris! Yesterday we went to montemartre and the sacre coeur. We then climbed the Eiffel tower. It was so cold cuing up! In fact it was 6pm by then. (we had walked down the champs élysées earlier). Amazing views from the top though! And the light show was pretty amazing.

Today we went to the Bastille monument to the revolutionaries. We tried to book ballet tickets at the opera Bastille but sadly it was completely booked out. It broke my heart. The nutcracker is on too! I’m so devo. We also went to pere lachaise cemetry and kissed Oscar wilde’s grave which was a weird experience. But apparently it’s the thing to do. Afterwards we went to the Latin quarter to Shakespeare and co which was pretty cool. It’s famous for publishing Ulysses and being a bookshop where authors went to be inspired. I bought a Dumas which I thought was appropriate… Being in France and all. We saw angus and ali for dinner too which was very nice.

Finally!! Some photos…

Bron in a sleigh!!

This is Bron in a sleigh at the airport in Helsinki. Teehee. Finland. The place of all glee 😀

Memorial for the murdered Jews

This is me at the Memorial for the Murdered Jews…\

The Berlin Wall

Me outside a section of the Berlin Wall

Prague Castle

Prague Castle 😀

Athens!! Hadrian's Arch

And this is Athens – Hadrian’s Arch and blue blue skies!

Okay that’s all I have time for for now.

Acropolis… now

Athens is a beautiful city. Everyone tells us there are more beautiful places in Greece. It’s almost hard to believe. Greece is a place I definitely want to come back to. In summer. To the Islands. Maybe on a boat. mmmmm…

Yesterday we went to the Acropolis – we got tickets to go into all the archeological sites in Athens. We saw the Parthenon, the temple of Athena Nike, the Theatre of Dionysos (where we sat for a while, pretending like there was some theatrics going on… I can imagine being an ancient Greek and watching a show there)… lots and lots of places. We went into the Acropolis museum where there is a lot of the statues that have broken of the sides of the Parthenon. We also watched a video of what all the statues represented which was quite helpful. I learnt about the battle between the centaurs and the Lapiths because the centaurs were making off with the Lapith women. It was really difficult to know who was winning the battle… “centaur overcoming Lapith” “Lapith overcoming centaur” “battle between centaur and Lapith”

We also went to the Ancient Agora where there was the church of the twelve apostles and a couple of other largish buildings (i forget what they’re all called). At lunch we got more free alcohol. Shots this time. Of some kind of alcohol that tasted like honey. The waiter said it was “poison”, so i said it was good tasting poison… he then brought us a second round. Well, i figure we’re only in Greece once (actually i hope not!!) so why not?? but all this free alcohol is meaning we are stumbling around Athens instead of walking. haha only joking.

Today we went to the temple of Olympian Zeus and Hadrian’s Arch. We also went up to Hadrian’s library and then to Kerameikos – an ancient Greek cemetery. We also did a bit… or a lot.. of shopping!! But mostly things are shut here by 3pm, so we are usually coming back for a bit of a rest (and internet) before we go out for dinner.

We have picked our restaurant for dinner already, but we might act as if we’re not sure in the hope that they offer us free wine. haha i’ll let you know of any success on that front!!

Athens.

Tonight Bronwyn and I diligently looked up lonely planet to see which restaurant we would go to for dinner. We are in Greece today. And Greek dinner seemed very appealing to us.

So we found one. It looked nice and authentic and was maybe three longish streets away. Seemed worth the travel anyways for the “home-cooked style” food.

In Athens we are staying at the Students and Traveller’s inn, which is very close to the centre of Athens (ie like 200m from the Acropolis). So we took literally 3 steps from our door way and happened upon another restaurant. I don’t even know what it’s called. Anyways there was a man out the front who immediately spotted us (easy targets) and tried to convince us to go there. He picked we were Australian (suggesting that Bron looks like Nicole Kidman (!!))… and then he offered us free wine.

sold. hook, line and sinker. But it was very good food. I had lamb that was so tender it literally fell apart. It was cooked in a lemon sauce with artichokes. Delicious! And we had a greek salad. Bron got a veal dish with potatoes and egg plant that was also very nice.

The free wine was also very good. After the first glass we decided to get a second (a very modest two) – but then they gave us a third for free again (argh!!)… so now we have had three glasses of wine and are very full of Greek food.

I’m not going to lie. It has been an amazing night so far. We’ve been in Athens maybe 4 and a half hours now and it has not disappointed. I’m absolutely loving it.

Also it’s a very mild 13 degrees celcius. Beats chilly Prague’s -2 degrees of yesterday. Although I did enjoy Prague a lot too!

Anyways, I’ll keep you updated on the food situation. (after all, that is what I was most looking forward to in Greece and it has not disappointed)