I've Got Clamps! (and a Call to Action)

It has been a while since I've given a Mama Maisha update, but it has been steadily, quietly plugging along, even while I was traveling.  This month we started working with two students, Kathryn and Becky, from the Clinton Global School of Leadership.  They came to us through our partner, Village Life Outreach Project.   Kathryn is working on a study of Barriers to Obstetric Care in Rural Tanzania and Becky is working on a map of contraceptive services in our area, including supply chains and costs.

Meanwhile, our partnership with Mennonite Central Committee is starting to bear fruit!  While I was traveling we received a transfer of funds, and Fred spent last weekend going from pharmaceutical supply shop to shop tracking down all the supplies needed for our first round of birth kits.  These kits are targeted at Traditional Birth Attendants (TBAs), who are not supposed to deliver babies, but in many situations (both emergency and non-emergency), they are still very necessary assistance for women at the time of birth.

We designed the kits with the advice of local TBAs and global health NGOs, and they're designed to bridge many of the gaps that the TBAs identify as keeping them from providing the best possible care when it is too late for a woman to reach a health facility (which may be 30-90 minutes away or more).

Here's a quick tutorial.  The World Health Organization recommends "Six Cleans":

• Clean Hands of Birth Attendant
• Clean Delivery Surface
• Clean Cord Cutting Tool
• Clean Cord Tie
• Clean Cloth for Wrapping the Baby
• Clean Cloth for Warming the Mother

Those last two are already part of the birth culture in East Africa, but we're trying to do what we can to teach TBAs about hygienic practices in the first four areas.  Common practice is that the TBA does not wash her hands, even if she needs to reach into the mother to assess the baby's position.  We've been in numerous TBA homes to see where women deliver, usually on a mat on the dirt floor.  In many rural environments, the umbilical cord is cut with a kitchen knife or a machete, which may still hold trace amounts of animal blood or other contaminants, and the cord is usually tied off with a strip torn off of a khanga, the multipurpose cloth every Tanzanian woman wears as an apron, a jacket, a blanket, a skirt, a head scarf, etc.

Most TBAs, especially those who are retired nurse-midwives or who have received training from some non-profit sometime somewhere, know that gloves and a sterile razor blade are essential.  Even those two tools, which cost about fifteen cents, are sometimes difficult to come by, especially since gloves are usually sold by the box ($3.50-$4 for 50 pairs), putting them outside the financial range of women who usually make about $10-20 a month.  Only the TBA with unusual foresight stocks up on these items in advance on a visit to a larger town.  Most hygienic delivery kits use a bit of twine to tie off the umbilical cord, but the umbilical cord clamp is so simple, so sanitary, so easy to keep clean while on the baby, and so affordable (a nickel a piece) that we determined to try teaching women here to use them instead.  

In addition to
          - latex gloves (clean hands)
          - a hospital grade reusable rubber sheet (clean surface)
          - sterile razor blades (clean cutting tool) and
          - umbilical clamps (clean cord tie)

we also added (on the suggestion of the local TBAs)

                                       - a thick plastic apron for the TBA to wear
                                       - a solar lamp to replace her kerosene lamp

                                       - two plastic basins--one for catching the placenta and one for washing up

                                       - antiseptic liquid to be diluted in water for cleaning up afterward
                                       - and a custom-made metal box to keep it all safe and secure.
All told we're looking at about $93 for each kit to provide 6-12 months worth of clean births.  To refill the kits with the essentials (gloves, razors and clamps) will be about $20 for another 6-12 months worth of services!

Although we are super excited to do the training and deliver these kits, and although we anticipate these kits, along with the basic ones we're putting together for individual mothers, will have a great impact, sepsis from an unsanitary birth environment is not the only cause of death for delivering women. 

Postpartum hemorrhage is a major problem, even in health facilities, where blood reserves are minimal.  According to MamaYe, Tanzania is collecting less than a third of the blood it really needs to have on hand.  Some of you may read my posts about Mama Maisha and think "That's terrible, but there's nothing I can do."  Well, Sunday is World Blood Donor Day, so, even though you may be halfway around the world, go give blood this week in honor of the mothers who need it, including those in rural Tanzania who are dying for lack of it.  Go to the American Red Cross if you're in America, or find your local Red Cross or health facility and GO GIVE BLOOD!  Especially if you live in East Africa and you're reading this, it is so important.  Your local health facility may not even know what to do with someone volunteering to give blood, but make them figure it out!  

Your sacrifice, though small, could save the life of a mother and her baby
-- that's real Mama Maisha!