SAM Blogger: Sara Gorman

Most public health crises facing India need no introduction: communicable diseases, lack of healthy drinking water, HIV/AIDS, poor hygiene practices, and poor quality healthcare and healthcare facilities top the list of problems studied by professionals and covered in the international press. But what about health-seeking behavior among Indian populations?  Are people aware of existing healthcare options and how best to access them? Can those living in impoverished and rural areas identify symptoms requiring immediate medical attention? What are some of the social reasons that diseases, especially among women and children, go untreated? Can increasing health literacy really make a difference?

A 2007 Pew poll surveyed global populations on what they perceived to be the greatest problems facing their countries. The priorities listed for Asia as a whole were, in order of decreasing urgency: crime, corrupt political leaders, pollution, illegal drugs, spread of HIV/other diseases, and terrorism. The spread of diseases, which was not even listed in the same category as “healthcare,” ranked relatively low in comparison to concerns about crime and corruption, and in comparison to where these same problems ranked in other parts of the world, notably Africa, where health concerns consistently topped the list. If, however, healthcare ranked lower on the scale of national concerns for populations in Asia, health on a family or individual basis consistently emerged as a primary concern across all regions, continents and socioeconomic groups. When asked to name the issues of highest personal concern, health ranked second only to financial concerns among people polled in 33 countries around the globe.

This disjunction between personal and national concerns suggests a fundamental disconnect between individual versus national healthcare priorities.  It also raises questions about whether people understand how the health challenges they face as individuals can affect their country’s overall healthcare profile. According to the Pew study, in Asia as a whole, the list of the most pressing healthcare priorities was, in order of descending urgency: HIV/AIDS; building and improving better healthcare facilities and better prenatal care; clean water; hunger and malnutrition; chronic diseases and immunizations; access to care; tuberculosis, malaria and other infectious diseases. In areas with the highest rates of low birth weights and unattended births, including Bangladesh, Mali and India, prenatal care consistently ranked among the top three health concerns. Yet concern over immunization and infectious diseases was staggeringly low in Asia, where epidemics are a constant threat. Similarly, access to care ranked eighth in a list of nine healthcare issues, surprisingly low given the actual existence of serious barriers to care in places like India. What accounts these mismatches between perception and reality, and how do these misperceptions affect the attainment of quality care?

A brief look at the way India handles maternal mortality can help shed light on why perceptions of health issues are sometimes divorced from reality.  A recent report by Human Rights Watch reveals a disturbing mismatch between the number of reported and actual maternal deaths in the developing world.  The high number of maternal deaths is caused by a lack of tools and personnel needed in an obstetric emergency. This issue falls squarely under the category of building and improving healthcare facilities identified by the Pew poll as the second-ranking concern among healthcare issues in Asia as a whole. However, several of the other major barriers to prenatal care are not issues listed as of prime importance to those surveyed in the Pew poll. A lack of awareness among healthcare workers of what constitutes a maternal death contributes to the mismatch between actual and reported numbers of maternal deaths in places like Uttar Pradesh. For example, if a woman develops a fever and dies 72 hours after giving birth, her death is not recorded as a maternal death, even though it is well-known in the medical community that women can develop complications from childbirth 72 hours after giving birth and that fever is often the first sign of such complications. Without accurate statistics on maternal mortality women in these nations cannot appreciate the true scope of the problem.

Other barriers to access may have such deep roots in societal custom that they failed to be perceived as barriers.  Gender discrimination in neonatal care has been acknowledged in India for years, but quantitative data to confirm this accepted assumption have emerged only very recently. A 2009 study of the Uttar Pradesh region published in the Journal of Health Population and Nutrition found that the average expenditure for neonatal care in houses with newborn males was nearly four times higher than the expenditure in houses with newborn females.  Furthermore, in 55% of households, decisions to seek healthcare from a provider were made by family members other than the mother, usually by the husband (31%) or the mother-in-law (18%).

These data confirm gender-specific patterns of health-seeking behaviors recorded in a 2006 study of Uttar Pradesh published in the Indian Journal of Community Medicine. Through interviews and focus groups researchers discovered that most women did not seek care because their husbands refused to accompany them to the doctor. The women were generally not permitted to seek treatment for themselves or for their children without being accompanied a male member of their household.  Most men refused to discuss their own health problems with their wives, especially if they were suffering from reproductive health problems or sexually transmitted diseases.  In many cases, men approached doctors in nearby villages in secret or discussed health problems with their mothers. Aside from confirming the fact that women are most often neglected in family healthcare decision-making, this suggests that women’s exposure to sexually transmitted diseases could be reduced in part if their husbands discussed their health problems with them more openly.

Can health literacy, increased awareness and general education help healthcare access in these cases? Several recent studies suggest that the answer to this question is “yes.” One study on knowledge of hygiene and its health consequences in Eastern India found that basic socio-economic factors, especially education, “play a pivotal role in conditioning the perception and practice of hygiene.” More than 90% of people with some kind of formal education indicated knowledge of proper hygiene practices, and women with better knowledge of good hygiene reported less disease in their households. This finding is important because some of the most potentially serious infectious diseases in India are associated with poor hygiene, including typhoid fever, cholera, hepatitis, malaria, dengue and worms. The 2006 Uttar Pradesh study reported that literacy status and perceived quality of healthcare services play essential roles in the selection of a healthcare provider. Not only are general education and health literacy pivotal in increasing access to care, but perception of the state of local healthcare services also determines the process of seeking proper aid. Educating people in India about the major health crises facing entire communities and making them aware of healthcare options may go a long way to increasing individual access to care.

Researchers have found abortions of girl children in India are far more common in families with at least one female child. In a culture that values male children for carrying on the family line and generating revenue, female children, who live with their husband’s family after marriage, are often perceived as costly to raise and marry off.  Although  prenatal gender testing has been illegal in India since 1996, the ban has proven largely ineffective in the face of inexpensive technology, as evidenced by the skewed ratios of female to male children in India: 893 females per every 1,000 males.

In 2005, the ratio of girls to boys under age 6 had declined from 906 per 1,000 to 836 per 1,000. The decrease has been even more pronounced in families where mothers were wealthier and better educated, suggesting that abortion is more accesible to wealthier mothers.  One proposal for tackling this issue is to closely and reliably monitor sex ratios at birth in each district of India, as current numbers address ratios at age six.

Click here to read “India Abortion of Girls on the Rise: Study.”

Photo via Creative Commons / Christian Haugen

In the essay she recalls her  feelings about the conditions in these wards and the availability of care for women in labor.  Pregnant herself during the assignment, she takes a more personal approach when portraying the stories of the women:

There were dozens of women in labor. Most of them weren’t making much noise, but the conditions were pretty rudimentary. But the one thing that really set the hospital apart was that there are trained professionals. There were two doctors, maybe even three. They were very aware of everyone’s condition. They were following people closely. Although the hospital looked pretty basic, I did feel as if the doctors knew what they were doing. That was actually quite reassuring, because in some of the hospitals I’ve been in there are times when there are only midwives present, and there are no doctors. So when there are complications, the women have nowhere to go.

Click here to for the full article: From One Maternity Ward, a Growing World

Jaya Singh: SAM's India-Based Director of Research and Program Development

It is a hot September day in Musafirkhana, Uttar Pradesh.  We’ve been driving on the Lucknow-Benaras highway for several hours before swerving off onto a dirt path, rice fields on either side, our driver honking away the few bicyclists and pedestrians we encounter.  The car pulls up to a temple that rises abruptly from the fields.  Next to the temple is the asbestos-roofed shack that serves as an assembly hall.  We’ve reached our destination: a meeting of women from 4-5 adjoining villages with Save A Mother Swasthya Sakhis (health activists).

I am prepared for the smell of grime, and the heat and dust that pervades rural India.  I am unprepared for the reception – bouquets of hibiscus and marigold encased in thin pink and white paper before being ushered onto a dhurrie to face the audience.  About a hundred women stare back, most of them in saris, glass bangles gleaming at their wrists, many with a thick line of bright orange vermilion in their hair.  They sit in perfect order, cross-legged in rows of eight each.  A handful of girls in salwar kameezes, dupattas neatly pinned, sit in the first two rows.  Some stare straight at us, a few giggle and hold hands looking down at the grey cement floor.  A girl who could be anywhere from  twelve to fifteen is seated in the front row wearing a black, short-sleeved T-shirt and blue jeans.  Change is afoot in Musafirkhana.

A Swasthya Sakhi, her hair coiled into a knot on her uncovered head, stands.   “I was nine when I got married.  Sixteen when I had my first child.  They bathed my child in cold water after it was born.  He died.  My second child also died.  No one told us what to do.  Now that we know, staying healthy is the most important work we can do.  Whether girls or boys, we cannot be careless about our children.”  The hall reverberates with applause.

A second woman rises.  No more than forty years of age, she is bent over.   “I was married at five.  I had my first child at fourteen.  My labor lasted four days.  The pain . . . ”  Her voice catches.  “After four days, they brought a woman to help, she cut the cord with a blade.  For ten days I remained in a dark room, in the same clothes, without bathing.  My child died.”

A third woman stands.  You sense the determination in her stance before she utters a word.  “I do not want to share my story.  Perhaps you’ll cry if you hear it, perhaps I’ll cry.”  She pauses.  Her voice breaks.  Her eyes flash.  Breakdown.  She resumes, “I do not want to share my story, just that now we want to educate our children.”

She starts singing a song.  I recognize the popular film tune, but the lyrics are about immunizations during pregnancy.  About five things to do during pregnancy and child birth.  About cord care and kangaroo care in newborns.  The crowd joins in the chorus.

Another song.  Am I hearing this right?  She just sang that using dirty cloth pads during menstruation can cause germs to traverse the birth canal and lead to infection, even cancer.

Another song by a Mehr un Nissa, a Muslim woman standing on the grounds of a Hindu temple, sings about marrying after age twenty and having a child only after twenty-one.

The constant refrain in the meeting?  We will not let our daughters suffer what we went through.  The energy in the room is electrifying.  The determination palpable.

The meeting concludes with a Q&A session.  A scrawny teenager, eyes sparkling, body twitching with energy, stands up and says in perfectly enunciated Hindi:  “I heard you’ve come from America on an airplane.  Give us the formula to become rich so that we may take an airplane to go to America to see you.”

Are you up to her challenge?  Change is afoot in the villages where Save A Mother works.

Get Involved http://saveamother.org/getinvolved

Donate http://saveamother.org/donate

Email info@saveamother.org

A Hospital in Mumbai

Malaria has swept Mumbai.  An average of 48 new cases per day was recorded for the month of May, a marked rise over previous months.  The BMC (Brihanmumbai Municipal Corporation) claims those most affected by the disease are migrants from malaria-endemic areas, suggesting that Mumbai citizens have nothing to fear.  Given that India has one of the world’s highest malaria rates, the official response has been a little surprising.  At least some councilmen warn that if this “lackadaisical” attitude toward the disease persists, the city might not have the capacity to handle a more severe outbreak.  To achieve the Millennium Development Goal of eradicating malaria, or at the very least, prevent large-scale outbreaks, more drastic measures are needed.  As DNA India reports:

“Monsoon has not yet started in the city. There is no case of water logging so far. The ones suffering from malaria are those who have migrated from the malaria endemic states like Karnataka or Orissa,” said Manisha Mhaiskar, additional municipal commissioner.

The statistics from the public health department state that in January around 1397 cases of malaria were registered, with 6 deaths. February witnessed 1194 cases and 3 deaths, while March recorded 1629 cases and 2 deaths. The figures in April subsided to 1450 cases and no deaths. In contrast, the figures soared this month.

Click here for the full article: Malaria Cases Rise in Mumbai due to Migrants

The Academy for Educational Development (AED) notes HIV typically spreads from mother to child in one of three ways, each of which can be prevented through early detection and responsible action on the part of the mother.  The first means of transmission occurs during pregnancy.  Because the placenta acts as a barrier against infection, transmission in utero is relatively rare.  However, if the placenta becomes infected or if the woman has only recently contracted HIV, the virus may then be able to cross the placental barrier and infect the fetus. The risk of transmission can be reduced when HIV-infected mothers remain healthy and apply a steady course of antiretroviral drug therapy. Antiretroviral drugs are used to keep the viral load – the amount of HIV virus present in the woman’s blood – at a minimum. Further research conducted by AED confirmed that proper adherence to antiretroviral therapy will notably decrease the risk of placential infection, prohibit the mother’s immune system from deteriorating, and ultimately lessen the chance of HIV virus passing onto the child.

The second route of HIV transmission occurs during childbirth.  The release of fluids into the mother’s body increases the odds that the fetus will come into contact with the virus and become infected. The risk of transmission during childbirth is far higher in women who have not received antiretroviral therapy.  For this reason, women should get tested early and begin antiretroviral treatment at the first sign of infection.

The third and increasingly more common route of HIV transmission from mother to child is through breastfeeding. Because remnants of the virus are present in breast milk, the risk of contracting HIV is significant. According to a recent report by the Maternal & Neonatal Health program, roughly 10-20% of babies born to HIV-infected mothers will become infected through breastfeeding. But even in HIV-positive mothers, the benefits of breastfeeding often outweigh the risk of infection.  Breastfeeding improves bone development, strengthens the infant’s developing immune system, and decreases the risk of contracting diseases found in infants nursed on formula.  Once the decision to breastfeed has been made, the consumption of breast milk without the introduction of outside food sources actually strengthens the infant’s immune system against HIV infection.  HIV positive mothers who choose to breastfeed should therefore do so throughout the child’s infancy.

Receiving adequate care before, during, and after pregnancy can dramatically lessen the potential for spreading HIV from mother to child.  Early detection and acknowledgment of the presence of HIV enables trained health workers to enact measures designed to interrupt the transmission. The strength of the child comes from the mother, but women can only act on what they know.  Educating new and expectant mothers on the importance of getting tested and the methods of transmission is crucial to winning the battle against mother-to-child transmission.

Click here to read “Global Activists Seek Improved Nutrition for Pregnant Women, Infants.”

Photo via Creative Commons / Ragesoss

But what appears like a boon to the impoverished can carry unseen risks.  Because clinical trials are bound only by the host country’s ethical regulations, the more stringent standards of developed nations like the United States and Great Britain do not apply, and the potential for abuse runs high.  In Andrha Pradesh and Gujarat, seven girls died following a recent trial of the Human Papilloma Virus (HPV) vaccine, causing the study to be suspended.  Although the vaccine was ultimately ruled out as a cause of death, serious ethical violations were uncovered, and publicity surrounding the investigation contributed to a global scare about vaccine safety.

The findings were all the more troubling given the high-profile organizations involved.  The trial was funded by the Bill & Melinda Gates Foundation and co-run by the international health charity PATH and by the Indian Council of Medical Research.  When even the best-intended and well-funded trials violate ethical norms, perhaps it is time to ask whether the human cost for new treatments is simply too high.

Click here to read “The Other Half: Too bitter a pill to swallow.”

Click here to read “Vaccine trial’s ethics criticized.” (log-in required)

Photo via Creative Commons / Ekta Parishad.

US Army Medical Researchers at a rural dispensary in Kisumu, Kenya

The government of Goa recently commissioned ten “rural medical dispensaries,” or RMDs, to service remote rural areas in India’s fourth most populous, but geographically smallest, state.  Each one of these RMDs is equipped to provide medical services such as dental services, ultrasounds, blood checking, diabetes treatment and registration, and, in some locations, dialysis.  In a state where only 22% of doctors serve rural areas and medical professionals are few and far between, it is hoped that even these rudimentary facilities, which are staffed around the clock by at least one doctor, will help reduce the instance of highly infectious diseases such as malaria.

Click Here to Read “Goa to have Rural Medical Dispensaries for remote areas”

Image via Flickr / US Army.

Bhandara district is among the few districts of the state where birth rate has declined.

Officials have attributed this significant achievement to the pioneering work of National Rural Health Mission in the rural sector.

Click here to read the rest of the article

Photo used under Creative Commons from rajkumar1220.

As the summers approaches, accredited social health activists (ASHAs), who are involved in taking care of the health of women and children in the rural areas, will be trained to implement the malaria control programme in Ramabai Nagar district.

“Ramabai Nagar district has a population of about 20 lakh, comprising areas of Bhognipur, Sarwankheda, Rasoolabad and Akbarpur. In the first stage, 55 ASHA workers were imparted training in malaraia eradication programme,” district magistrate Mayur Maheswari said.

District malaria officer, RK Mishra said: “We are engaging ASHA workers in to control malaria for the first time. Our objective is to train ASHA workers so that they could carry out mass awareness programmes like maintaining cleanliness to tackle malaria.” As of now, ASHA workers are implementing various activities in the primary health sector in the rural pockets under the National Rural Health Mission. But considering their reach and achievements, the role has become important in tackling other diseases as well, said another senior health officer.

The focus will be on underprivileged sections who are poor and marginalized.

Click here for the article.

GE Healthcare recently unveiled two advanced, cardiac care solutions designed and developed in India for India with an aim to help provide better, affordable early cardiac diagnosis for more people. These innovations – GE MAC 600 and GE VIVID P3 reinforces GE”s healthymagination commitment to provide better healthcare for more people in India and around the world at affordable costs.

John Dineen, President & CEO, GE Healthcare, who unveiled the new innovations at Bangalore said, “When we launched healthymagination two years ago, our vision was to provide better health for more people at lower costs. Through the use of powerful technology, innovation and talent of our people, we are addressing global healthcare needs – reducing costs, increasing access and improving quality – in real and relevant ways. We are tremendously proud of our initial achievements: 29 healthymagination validated products, $ 700 million in research and development investment and more than 135 million lives touched in new ways in the first two years.”

Click here for the article

The discovery of the New Delhi superbug has brought into focus the urgent need for a national policy on antibiotic prescriptions.  It all started with a report in Lancet in August 2010 of a new microbe discovered in India, nicknamed New Delhi metallo-b-lactamase-1, or NDM-1.  The enzyme NDM-1 makes bacteria resistant to almost all antibiotics, including carbapenems, antibiotics of last resort.

Antimicrobial resistance is generally the result of misusing medication.  In the absence of guidelines from the government and easy over the counter availability, antibiotics are used indiscriminately in India.  While doctors may prescribe antibiotics without assessing needs, people also self medicate without attention to course of treatment.   Not finishing a prescribed course of treatment, low-quality medicines and wrong prescriptions all contribute to drug resistance, making infections caused by drug resistant microorganisms difficult to treat.

Although viewed as a problem exacerbated by the developing world, developed nations are also recognizing the urgency of antibiotic resistance.  The US has begun to support measures to address the issue of antimicrobial resistance: Policy Statement 9908 advocates educational programs for providers and patients on appropriate antibiotic usage as well as recommendations for increased and improved oversight.  Amongst developing nations, Chile has banned over-the-counter sale of antibiotics and a prescription is now mandatory for access to antibiotics.  China will also launch a nationwide campaign this year to regulate the antibiotic use.

In response to the global outcry over NDM-1, the Health Ministry in India formed a 13-member expert panel in September 2010 to create a proposal for an antibiotic policy.  The proposal was submitted to the Union Health Minister Ghulam Nabi Azad earlier this year and is currently being finalized.

To start with, the new national antibiotic policy is likely to be piloted in three government hospitals in Delhi: Lady Hardinge Medical College, Safdarjung Hospital and Ram Manohar Lohia Hospital. It will also be mandatory for antibiotic drugs to be sold against prescriptions.  In addition, doctors will have to write prescriptions for antibiotics in duplicate with pharmacists having to retain a copy for a year from the date of sale in order to facilitate verification and audit.  Implementation of such rigorous regulation and government policy is likely to be effective as proven by example in other countries.

For most Americans, tuberculosis conjures clichés of Victorian-age heroines succumbing to a mysterious wasting disease, often in the midst of passionate but doomed romance.  Tagged with the ominous-sounding moniker “consumption” – because it seemed to “consume” the patient from within – tuberculosis was considered incurable and was almost invariably fatal.  It was also indiscriminate, victimizing rich and poor alike, especially those who lived in the crowded filth of industrialized cities, where the disease thrived throughout the nineteenth and early twentieth century. Then, suddenly, it was gone.

Almost overnight antibiotics turned tuberculosis into the stuff of bygone melodrama and forever changed the treatment of infectious diseases – at least in the countries who could afford to develop them.  It is easy to forget that antibiotics were first discovered less than a century ago and, within a matter of decades, had effectively eradicated tuberculosis throughout the United States and most of Europe.  In 1987, the American Medical Association predicted that it would be extinct worldwide by 2010.  Unfortunately, in this case the cure really could be worse than the disease.

Recent, widespread abuse of antibiotics has given rise to deadly new “superbugs,” strains of bacteria, viruses, and certain parasites resistant to existing medicines.  This phenomenon, called Antimicrobial Resistance or “AMR,” affects both the developed and developing worlds, but is most prevalent where antibiotics are used without adequate supervision or regulation.  If, for example, the traditional multi-drug regimen used to treat tuberculosis is followed for the full course of treatment, the patient is recovers.  But when the patient stops treatment – either because he feels better, cannot afford further treatment, or simply mistrusts the medical establishment – the remaining disease can become resistant to traditional drugs.  In contrast to the typical six-to-eight month regimen, multi-drug resistant tuberculosis requires 18 months of treatment using drugs that are more toxic, more expensive and ultimately less effective.  About 440,000 new cases of multi-drug resistant tuberculosis emerge each year, and that number continues to grow.

In other cases, antibiotics are distributed without a prescription or on the black market, creating ample opportunity for abuse and misuse.  As a result, resistant microorganisms such as the potent “NDM-1” enzyme, which is immune to even the most powerful antibiotics, threaten to precipitate a global epidemic.  Many of the drugs used to treat AIDS may also become ineffective as greater numbers gain access to retroviral drugs.  If this trend continues, we risk returning to a pre-antibiotic world, in which infectious diseases become untreatable and uncontrollable.

The outlook can seem bleak, but unlike many of today’s most pressing health issues, we already know the solution.  Increased regulation and restrictions on the use of antibiotics can control the incidence of AMR and slow the spread of resistant organisms.  India, for example, is developing a national antibiotic policy intended to regulate drug use in hospitals, and the effect of government intervention can already be seen in countries such as Chile, where antibiotics are no longer available over the counter, and the Netherlands, where comprehensive guidelines dictate the distribution and use of antibiotics.

The problem, then, is one of implementation.  For the developing world in particular increased regulation can cut both ways.  In areas where doctors and hospitals are scarce, requiring a prescription to obtain antibiotics can result in a total denial of treatment, or encourage resort to the black market.  An effective national policy must take into account weaknesses in the existing healthcare infrastructure, and as that infrastructure improves, be prepared to police the use of antibiotics as they become available to a wider class of patients.

Activists are optimistic that a renewed focus on AMR will lead to policies that encourage conservative treatment without denying access to underserved populations.  On this year’s World Health Day – April 7, 2011 – the World Health Organization will call on policymakers, practitioners, the pharmaceutical industry, patients, and the general public to fight AMR through the adoption of a six-point policy package designed for global implementation.  For once, the question is one of will rather than ability, of protecting what we have rather than creating anew.  But nothing short of universal cooperation will suffice.  Together we can ensure the continued triumph of science over disease; apart we will set civilization back a century.  The clock is ticking.

I have been volunteering with Save a Mother since August 2010 when I started the Save A Mother Club at my high school.  Our primary goal is to spread awareness of the lives of poor women in India.  Using the tools that can be found on the Save a Mother website, our club has taught many students at our high school of the troubles these women must endure and how they can help the cause.  Doing so has not only brought a sense of awareness at our school, but has also encouraged students to take an active role in helping the cause.  We plan to start a fundraising program through selling custom Save a Mother shirts, auctioning items from India, and a car wash.  Regardless of what we choose to do, the important part is that all of the proceeds will benefit the cause and help change the lives of several women and children in India.  That is the real push factor behind our club; knowing at the end of the day that we are not only positively changing the life of a mother, but also that of a child who has limitless potential.

In the future, I hope to see a world that isn’t so crowded with hate and mistrust. As idealistic as it is, I hope that one day a society can be born that would raise a generation filled with empathy and benevolence. A generation that would be able to look beyond the background of an individual, and instead, see them for who they are, one just like themselves.

We crossed our target of training 400 new health activists in 2009 by November. December trainees will be an added bonus. Over 1,000 women have attended training sessions in 2009 and 412 have been designated as health activists. We have loftier targets for 2010.

We have expanded to a new district. Our team of trainers went to Babina, Jhansi and trained over 20 women. We are attempting to replicate our program there. We will also launch our program in Azamgarh on 6th January, 2010. Starting this month we are for the first time expanding our work to another state, Karnataka. Our trainers will conduct their first training in Chikbalapur, Karnataka. Our training books are currently being translated into Kannada. Mr Kamalkar Hallambi, Ex-Director of the Rural Literacy Mission of Karnataka will lead this program.

We are evolving into a health literacy organization with maternal mortality as our entry point into a community. Recognizing our potential to promote health literacy, our program is getting noticed. The Ministry of Health has asked us to participate in a national health literacy program through a national health portal.  The Ministry of Health will own and manage the portal with private-public partnership. We have already started on this project and in the next few months we will see the launch of the national program to spread health literacy.

So, you read the newsletter, bought the T-shirt, and came to the fund-raiser… but you feel as if you could do so much more to help your charity of choice! I was in your shoes over two years ago, when the usual avenues of giving back to my community were simply not enough. That’s when I decided to create my own website so that I may be able to attract attention and funding, inspire similarly-minded individuals, and ultimately help a great cause. Starting a website can be a wonderful experience of self-discovery and personal growth, but as I learned very early on, you have to venture out of your comfort zone to really get what you want. Before you dive into your mission of saving the world through online activism, you should get familiar with the following rules:

1.  Terminology and Languages: Learn to understand both the terminology and programming languages (at least to some extent) so that you may be able to perform maintenance without seeking professional help. As a rule of thumb, you want to be comfortable with the use of HTML tags. Other languages that are common for start-up websites are CSS, PHP, and Java.
2. Hosting: Find hosting that best reflects your space needs and financial situation. A web host is a server where your website’s directories, files, graphics, etc. reside. Should you go with paid or free hosting? This depends largely on how media-rich you plan to make the site. Are you going to be including a lot of high-resolution images, videos, music? Remember, only get as much space as you know you need.
3. Site Name: Choose a specific name that reflects your purpose, or perhaps a name that has a special meaning to you. The goal here is to create a relevant and consistent message for your users, as well as to make your site easily indexable on the major search engines.
4. Organization: Use a seamless and intuitive layout with a clear indication of the main areas of your site. Generally, it’s important to include an About page and a Contact page, so that your users are not confused by your intentions or validity.

 The above tips are fairly simple to follow, but are guaranteed to save you the headache down the road. If you are ready to become an online activist through starting your own awareness site, take the time to learn and understand the necessary components of such an undertaking. Be patient and you will succeed!

Mariya Nikiforova is an SEM specialist with isoTree LLC, a search engine marketing and consulting firm. Mariya is passionate about non-profit work, and participates in her community through various organizations and activities, such as Habitat for Humanity, YMCA Adult Basic Literacy Education, and an awareness website she started 2 years ago, called PledgeForMoms.org. The website is tailored to encourage the online community to take part in raising awareness about maternal mortality, gender inequality, and the suffering of girls and women across the globe.

According to our plan for 2009, we had planned to pilot test our program in a new district to see if we can replicate our work and methods outside Sultanpur district of Uttar Pradesh. The plan is on schedule. We are expanding to a new district: Jhansi. Our staff will travel to Babina, Jhansi to train new health activists from 26th to 29th November. We have also received requests from other states to start our program there. We may do this in 2010 depending on our resources and experience in Babina, Jhansi. We are currently drawing up our plans for 2010, which we will publish in our January 2010 newsletter.

This fall’s major Save A Mother fundraising event was a Masquerade Ball held on Saturday, October 24th, at the InterContinental Hotel on Chicago’s Magnificent Mile. The first of its kind for Save A Mother’s Chicago chapter in size and scale, the event exceeded its fundraising targets and attracted a noteworthy guest list. The evening featured a silent auction and a fashion show arranged by local fashion designer Poonam Kamdar, with proceeds from the sale of showcased creations going toward the charity. Vocalist Suchismita Das performed a colorful variety of Indian musical pieces, and the evening closed with the tunes of local DJ Sunny Singh.

The event helped further increase awareness on the issue of maternal mortality in high-risk areas in India, while raising sufficient funds to sponsor the training of hundreds of more health activists in Uttar Pradesh. The funds raised will help Save A Mother extend its work to new districts in Uttar Pradesh. The organization extends thanks to the evening’s generous corporate sponsors, including National Republic Bank, Acreete, RedBull, and Quality Inn and Banquets of Burr Ridge. We extend special thanks also to Dr. Abbasi, Ajay Goel, Patricia Dominguez, Tara-Shamo Swaminathan, Sudesh Khosla, Reena and David Reynolds, Desh and Mini Thakkar, Drs. Prema and Brij Malani, Sudesh Vohra, Anita Singh, Miguel Bautista, and Dr. Surander and Vijay Singhal for their generous donations to sponsor health activists in the field.

Save-A-Mother plans to continue the tradition of an annual fundraiser during the Diwali season, with the goal of using proceeds to not only intensify the fight against maternal mortality, but also to begin growing other organizational causes such as tuberculosis eradication.

Incredible Solutions From Around the World: Meet the outstanding winners of The New York Times’ Half the Sky contest. Read on to learn how it is truly possible for one individual to bring about desperately needed change and impact the lives and futures of so many.

• In September, we conducted four, three-day long trainings for new health activists. We trained 79 new activists in all
• We conducted eight refresher training courses for those already in the field
• We are now working in 459 villages and will reach our target of 600 villages by the end of December 2009

REPLICATION

• Our project manager visited Phoolpur in Azamgarh district in Uttar Pradesh to conduct a preliminary survey. The district does not have a larger NGO for us to piggy back on, as we are doing in Sultanpur district. But the district does have a well run girls school, so we will launch our Save A Mother program (health education, trainings, activism) in that school and see how far we can progress. This is a new district for us with a new twist
• Jhansi district in Uttar Pradesh has a micro-credit NGO of moderate size. We will enter this new district by launching our program using that NGO’s support base

LINKAGE WITH ASHA

• Our project manager attended a master training program for training ASHA (Accredited Social Health Activist) workers (they are part of the Government of India’s National Rural Health Mission). The program was conducted by Shabhagi Kendra and PATH in Lucknow. This gives us a better understanding of the ASHA methodology and stronger links with ASHA workers in our area.

USA CHAPTERS

• We are launching a Los Angeles chapter on 7th November, 2009. The chapter will have a small function in Niravana Restaurant
• Our New York Chapter will have a gathering at Sundaram Tagore Gallery on 11th November, 2009. Our Board Chairperson, Ms. Shabana Azmi will attend
• Our Chicago chapter will have a fundraising event – a Masquerade Ball – on 24th October, 2009
• We are exploring chapters in Toronto, San Francisco, and Philadelphia

OTHER UPDATES

• Our Chairperson, Ms Shabana Azmi spoke at FICCI (Federation of Indian Chambers of Commerce and Industry) in Delhi in September on health care and talked about Save A Mother’s work. A full transcript of her speech can be found here
• This is an amazing, inspirational story about what one person can do to bring about change to the lives of so many. And, that one person is only 16 years old!! Introducing Babar Ali…

One of our objectives in 2009 is to expand to another district. We conducted our first survey of Phoolpur in Uttar Pradesh to understand local need. Even though membership of the local NGO is not large, we will start a small pilot program. Our program manager Anoop Pant and I will visit the area to start the program at the end of November.

Anoop Pant will also attend a training program in Lucknow, conducted by PATH – an international NGO. Subsequently, he will become a master trainer for ASHA workers of the National Rural Health Mission. This will bring us even closer to the public health workers in our area, with whom we already have a working relationship. We will supplement the public health programs sponsored by the government.

Solution: Changing the lives of women and girls in the developing world can change everything. The empowerment of women could help solve many of the world’s problems, from poverty to child mortality to terrorism. Click on the link below to read how – contributed by Hemant Kashyap

Which got me to wonder why do we get involved? Usually, we can relate to the cause in some way, but, for me, as a lawyer, it’s because I can see the results. I believe that in tough times like this while each of us have a limited amount of capital to invest in the things that interest us, the organization or cause that shows tangible results will succeed more rapidly than the one based on good intentions or slick marketing.

I chose to get involved in the Save a Mother cause not just because of the passion of its founder and some members, but because of its budding use of social media. Before you snidely think “oh so because they are on Facebook/Twitter, you joined?,” let me clarify. To me, it represented several things that most well meaning organizations consistently fail to do.

Transparency: Anytime, anyone actively becomes part of a media that is built on communication, information, and community it is forward thinking and showing a willingness to be an actor in that world rather than just soliciting. Don’t get me wrong, creating a profile can be done by any 14 year old (case in point, my nieces), however participating, disseminating information, and laying it out for all to see shows great faith, trust, and confidence in what the organization stands for.

Viral Marketing: the greatest promise of social media is its ability to connect others with similar interests anywhere across the world. It is as, author Malcolm Gladwell stated, a great “flattener.” In a sense, social media marketing is about giving your fans a platform to talk about you in a positive way – something Facebook makes seamless. If a fan of your Facebook business page decides to comment on something you’ve posted, their friends will see that action in their news feed. If your fans mark a photo as something that they “like” then their friends will see that, likewise, if they sign up to attend an event by sending in their RSVP, it shows up for all of their friends to see. In this way, Facebook can make any content viral.

Participation: Any community is only as good as its communication. If you only talk about yourself, and do not interact with others, you are guaranteeing very few followers and worse, a push back into the closet mentality. Everyone can speak, but what’s important is what you are adding to the conversation. Using social media is an opportunity to grow, and that expansion can only happen if people like you, and want to hear from you. That occurs only when it’s a 2 way conversation. If that doesn’t appeal to you, then social media is not for you.

Examples: So you signed up, you are ready to make change happen in the world, but you are not exactly sure what to do. I have always believed that copying is the sincerest form of flattery, and my initial research took me to http://www.gauravonomics.com/ , a great resource on using social media to create social change in India.

Perhaps the best example that’s stuck with me was this: On April 14, 2009 actor Hugh Jackman pledged to give AUS $100,000 to the charity that could best convince him, via Twitter, that it was deserving of the award. On Friday, Jackman announced that, unable to decide, he had chosen two winners to split the prize: Operation of Hope, a medical foundation that donates surgical procedures to children in developing countries born with facial deformities, and Charity: Water, a non-profit dedicated to providing safe drinking water in developing countries. One of the winning tweets came from Charity: Water president and founder Scott Harrison, who tweeted a link to a photo of a group of Ethiopian children holding up a hand-made sign with the simple message “Dear Mr. Hugh Jackman, thank you for helping us!” Harrison added: “dear @realhughjackman — just snapped this near Eritrean border at a school of 1400 w/o clean water.” (courtesy of PBS.org).

And that is the power of Social Media.

Sanjay Sabarwal is a Save A Mother volunteer. He is also the General Counsel as well as co-owner of Ziba Beauty, a chain of brow lounges in Southern California that specializes in The Art of Threading ® and The Art of Mehndi.

100% of the proceeds from the event went towards training village health activists to reduce maternal mortality and improve health in rural Uttar Pradesh, in India.

Solution: In Africa and South Asia pregnancy and childbirth complications are still the leading cause of death for women. 85 percent of maternal mortality occurs in sub-Saharan Africa and South Asia. Click on this link to learn more about the problems and solutions of maternal mortality in the developing world today – contributed by Shiban Ganju

The participants came from Sultanpur district and two other districts: Azamgarh and Jhansi. The syllabus included extensive interactive training pertinent to rural health. We hope that these participants will help in carrying out further training in their regions with minimal outside help. We will closely monitor the progress and take action to improve. They will also assist with our ongoing training program.

We also continue to train local women to be village health activists who educate and assist the villagers. In July 2009 we will conduct four training sessions at Bhadar, Gauriganj, Amava, and Singhpur Blocks in Uttar Pradesh. 15 to 20 participants will attend each training and the recently trained trainers will assist. 

We will continue to keep you informed of our progress through our newsletters.

Maternal mortality, as defined by the World Health Organization (WHO), is “death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” It is worth noting that 45 percent of these deaths occur within the first 24 hours of delivery. There is direct maternal death which is caused by complication of the pregnancy, delivery, or the management of the birth. Indirect maternal death is pregnancy related death caused by a pre-existing or new medical condition. Some of the major causes of maternal death are bacterial infections, gestational hypertension (pre-eclampsia and HELLP Syndrome), obstetrical hemorrhage, ectopic pregnancy, amniotic fluid embolism, and complications of unsafe abortions. In the developing world, 20 in 100,000 births lead to maternal mortality. It is 400 in 100,000 worldwide and 440 in 100,000 in the developing world. The Maternal Mortality Rate has decreased from 520 to 308 per 100,000 live births in India over the last 40 years. However, many regions of India still maintain a mortality rate of over 500/100,000 such as Sultanpur district in Uttar Pradesh, where Save-A-Mother works. This breaks down to 160 women in India a day dying giving birth. This is very high, even in relation to other developing countries, including nearby Sri Lanka that has a rate of 58/100,000. China has a rate of 46/100,000 births and a developed country such as the USA has a rate of 8.9/100,000 births.

While these are the main causes of maternal mortality; unavailable, inaccessible, unaffordable, and poor quality of care also are major causes of many preventable cases. This is generally from lack of nearby medical care and poor nutrition. These include malnutrition, anemia, infection, sepsis, lack of immunization, excessive bleeding, and difficult labor. Every pound less a child is born than the average doubles the risk of complications. This is precisely the case in Uttar Pradesh. This is where Save-A-Mother comes in. The project, in conjunction with local NGOs, is committed to the education of mothers about pregnancy, nutrition, immunization, delivery, and care of the child through trained health activists. Human care is a fundamental right and through education we believe that society will demand proper care. By starting off on a small scale, the plan is to educate and track maternal progress on an individual basis to ensure maternal safety. The health and safety of children will be followed as well. This data will be collected on a village by village basis to measure progress. This will start off with 190 trained health activists in 150 villages. By the end of 2009, the plan is to have more than 400 volunteers educating about sanitation, infectious disease, AIDS, adolescent health, and reproductive health. Ultimately, the hope is through this methodology as well as fresh innovative ideas that come through over time to expand the program through other villages and states in India to other parts of the world.

Ultimately, success will be measured by a few different avenues. Obviously, a decrease in maternal mortality is tantamount. However, we want a maximal number of mothers to register and be educated through us. As they have more success in child delivery; through word of mouth more mothers join the program and reap the benefits of education. Awareness, education, nutrition, and access to healthcare as well as to institutional delivery are fundamental to the project. Mothers will become accustomed to and demand the newer ways of maternal health as it becomes the norm. The measure of success will not take months but years. But through constant hard work, collaboration, and innovation we know it is possible. We are looking to achieve a 50 percent reduction of mother mortality in 5 years in our pilot project area. The plan is to then expand this to replicate this model in 2 more districts in 2 years and then to parts of India where maternal mortality is higher than average for India.

There are several ways one can help. We are a purely volunteer organization so there is no overhead. One can donate some time, effort, keep others informed, and educate others about maternal mortality. Donations are also welcome. Merely 7 dollars a month will help us develop a master training facility where we can educate health workers to go out to the villages and to pass on the knowledge to help prevent maternal mortality. All donations are tax deductible.

Every woman has a right to go through pregnancy and child birth without the danger of disability and death… Through some simple changes and education we know this is possible. We want to give every mother the safety and facilities to minimize suffering and death associated with the child bearing experience. In turn, we ensure that their children have a mother’s love in life. Many children die before the age of 2 when a case of maternal mortality strikes. No child deserves a life without a mother. Together we can help ensure more mothers survive and are able to have a rich life filled with mutual love with their children. It will take a change in attitudes, hard work, and a little luck to ensure success. With the undying human spirit, anything is possible. So much has already been done over the years of humanity to prevent maternal mortality and now we want to further that progress to every corner of the world. Welcome to Save-A-Mother.

Photo taken by Save-A-Mother staff.

Solution 1: Click on this link to read about the internationally renowned Ela Bhatt and her Self-Employed Women’s Association (SEWA), an empire for poor working women in Ahmedabad, India created using a Gandhian approach – contributed by Rima Shah

Solution 2: Read about a successful micro-planning initiative in Thane District of Maharashtra, implemented by Population First, an NGO working on population and health issues within the framework of women’s rights and social development – contributed by Ashvini Bommakanty

While a number of South Asians actively engage in philanthropy a large segment of the community hesitate to donate to charity fearing how their money will be spent. Will corruption misappropriate the funds into the hands of people that don’t need help? Will it go to pay the salaries of staff employed by the non-profit or will it be used for necessary services? While these are valid concerns, the answers to these questions can be found with just a few minutes of research. What needs to be emphasized is that there are a large number of non-profits engaging in positive and necessary work. These organizations are run by dedicated people who have the sincere intent of helping out those in need.

With a little investigation, people can verify how donated funds are being spent. Organizations like Charity Navigator and American Institute of Philanthropy track and investigate how wisely charities use and spend their contributions.   Through Charity Navigator one can plug in the name of an organization and see a pie chart breakdown of how funds are being spent on services to those in need vs. administrative costs and fundraising expenses. Also included is a 4 star rating system to let people know how efficiently charities perform. The amount of revenue the charity brings in is documented for the public to see along with how much is spent on overhead costs and what’s allocated for services. For those non-profits not yet listed on sites like Charity Navigator, the potential donor can spend a few minutes researching an organization online. It helps to research whether these organizations have won national or international awards for their work, have had news stories written about their success, or citing other credible sources that track charity work. With this transparency a reluctant person who’s unsure about contributing their time or money can decide which non-profit is most capable of putting their donation to use.

Save-A-Mother (SAM) is one such organization with low administrative costs. Funding has been used strictly to train several hundred local health activists in Uttar Pradesh. These women monitor and educate expecting mothers to prevent pregnancy complications. Health activists also encourage mothers to seek health care from local medical facilities to ensure safety for both the mother and child. All other administrative needs are taken care of by volunteers of chapters in various cities.

Outreach efforts for SAM have helped increase its membership and made the organization more visible. Online social networks like Facebook and Linked-in have proved to be valuable tools in raising awareness about SAM’s life-saving work. A recent wine tasting event hosted by Master Sommelier, Alpana Singh, and sponsored by Chicago based non-profit Ekya also helped raise funds for SAM. Coming up on May 2nd, SAM will be hosting an annual fundraising event at Mars Gallery in Chicago (see back for more details).

SAM’s progress to reduce maternal mortality will be largely successful as more and more members of the South Asian community discover the importance of philanthropy and giving back.

As support grows, Save-A-Mother expects to expand its program on a larger scale by training even more health activists, increasing its reach by working in additional villages, and raising even greater awareness of reducing maternal and infant mortality.

Photo taken by Save-A-Mother staff.

Solution 1: The Pancham Mahila Vikas Sangathan along with various healthcare and philanthropic organizations collaborated together to bring efficient healthcare services to the women of Kutch, Gujarat. A survey conducted by the Sangathan showed that various health issues had proven to be problematic and detrimental to the women living in the area. This was largely due to the lack of government and private healthcare facilities; therefore, a new system had to be developed to attend to these health issues. As a first step, nurses were sent to the impoverished areas on behalf of the Sangathan in order to perform physical exams and provide basic medical education to the women. Click on this link to read more about how the Sangathan molded itself into successfully delivering healthcare to the women of Kutch.

Solution 2: For a population of over 8 million, Tehran offers exemplary primary health care and sanitation, with vaccination rates at 100%, close to universal access to clean water, and 80% of pregnant women examined three times during their pregnancy. The Women Health Volunteers (WHV) program is an integral part of Iran’s primary health care plan. It includes a network of 100,000 women who help the government with health and hygiene in urban areas like Tehran. Women volunteers are trained in the program’s health centers and then sent out to educate their families and neighbors. Click on this link to learn more about this path-breaking program whose chief architect, Dr. Hossein Malek-Afzali, won the U.N. Population Award in 2007.

• Trained 32 new women health activists from different villages
• Conducted three refresher training courses for activists who have been trained in the past
• Signed a collaboration agreement with the International Institute of Health Management Research, Delhi, to train 40 block level trainers who will conduct trainings for village activists in their locations. This is an effort to scale up the program

Please visit Save-A-Mother Volunteer page to find out how you can get involved today!

 

Photo taken by Save A Mother staff.