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In Nigerian Maternity Wards, Preventable Causes Claim Many Lives

April 28, 2011 at 12:00 AM EST
In "The Edge of Joy," filmmaker Dawn Shapiro goes inside a busy maternity ward in Nigeria, where maternal deaths are among the world's highest. The documentary is the first in a series of independently produced films from around the world aired in a partnership between The Economist magazine and the NewsHour.
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TRANSCRIPT

JIM LEHRER: Finally tonight, the start of something new, our partnership with “The Economist” magazine to showcase the art of filmmaking.

Together, we have chosen examples of independently-produced documentaries from around the world.

The first is from a film called “Edge of Joy” by filmmaker Dawn Shapiro. It takes us inside a busy maternity ward in Nigeria, a country where maternal deaths are among the highest in the world.

A warning: This film contains graphic, disturbing images and events.

DR. BELLO DIKKO, Murtala Mohammed Specialist Hospital: It’s one of the busiest maternity centers you can find in all of West Africa. There is at least an average of 30 deliveries in 24 hours.

NARRATOR: Dr. Bello Dikko is head of obstetrics and gynecology at Murtala Mohammed Specialist Hospital in the northern Islamic state of Kano, one of the most difficult and dangerous regions in which to be a woman.

MOHAMMED MAKA (through translator): My name is Mohammed Maka. I brought my wife, Sakina, to the hospital on a Saturday, and she gave birth to twins on Sunday. The first twin was a girl.

DR. BELLO DIKKO: Because of the associated complications, the second delivery shouldn’t exceed five to 10 minutes.

AISHA BUKAR, nurse midwife: OK. OK. Is it coming?

MAN: Yes.

WOMAN: What just happened?

AISHA BUKAR: She was telling me that the presenting part of that patient, the second twin, is breech presentation.

DR. BELLO DIKKO: Breech delivery, especially in multiple pregnancy, is a very complicated delivery. There is a need for a qualified OB-GYN doctor.

AISHA BUKAR: And we even called the doctor, but he was not here. But if she is about to deliver, we can take the delivery. We do it.

MOHAMMED MAKA (through translator): Sakina labored in pain before the second baby was born. It was close to an hour before the boy was born. He came forth having problems.

AISHA BUKAR: We need oxygen now. And we don’t have oxygen here.

MOHAMMED MAKA (through translator): My son needed medical attention, and we rushed him to the emergency pediatric ward.

NARRATOR: While the second twin was being stabilized, Sakina’s condition worsened. She was diagnosed with postpartum hemorrhage.

Bleeding to death is the No. 1 killer of pregnant women.

FARIDA BABALE, chief nurse midwife: One of our main problems here: how to get blood. The husband has to go and donate. Before, we normally asked Red Cross. They mobilized people to come and donate blood to the hospital. But now, due to this HIV — so we stopped this. They have to go and check the blood group of the husband. Then they compare if it’s the same with her own. If it’s not the same blood group…

MAN: Not the same.

FARIDA BABALE: The husband must buy the blood.

NARRATOR: Mohammed’s search for Sakina’s rare blood type took him to surrounding hospitals and private blood suppliers. One pint of blood costs 10,000 naira, or $68 U.S. dollars. The average Nigerian makes about $94 a month.

Three hours later:

DR. BELLO DIKKO: It is really disheartening to see a patient dying for a preventable cause. As far as I’m concerned, hemorrhage is a preventable cause.

NARRATOR: Sakina received a blood transfusion in time to save her life.

Frustrated by the lack of blood supply for maternity patients, Dr. Dikko successfully lobbied health officials for a separate maternity blood bank. Since opening, the waiting times for maternity-ward patients in need of blood has been reduced by 75 percent.

Kano is one of the 12 northern states in Nigeria governed by Islamic law, or Sharia. Improving reproductive health requires a delicate interplay between Islam and modern medicine.

HALIMA BEN UMAR: In this part of the country, you need to work with the religious leaders. If you want to achieve your objectives, your aims, then you need to look at, what does Islam say? How do you do it so that it becomes more acceptable?

For me, I have always been an advocate of family planning. People see it as a Western idea. People see it as the Westerners are trying to impose their ideas on us, so it becomes a little bit difficult.

I said, have you thought about family planning, I mean child spacing? Then she said, yes. Is it something that you can do? She said her husband will not allow to stop giving birth — I said, no, no, no, I’m not saying stop. I’m just saying space.

Islamically, it is wrong for you to say you want to have two children. You want to have four. But, Islamically, you can space.

WOMAN: Yes.

HALIMA BEN UMAR: I know I spaced my children. If I hadn’t, I would probably have had 15. And that would have been disastrous.

I hope a lot of things that happen, will change. The changes are coming gradually, but I think we need to move a little faster than the rate we are moving. And Islam moves with civilization.

WOMAN: Yes, this is what I think.

WOMAN: I don’t think the baby is alive.

WOMAN: You don’t think?

WOMAN: I don’t think.

MOHAMMED MAKA (through translator): We have a teaching in the religion of Islam that states, what Allah gives belongs to him, and what he takes also belongs to him. All of us are from Allah. And at some point, sooner or later, we shall all return to Allah. Even though we know it hurts, we can only accept its outcome.

JEFFREY BROWN: That was an excerpt from the documentary film “Edge of Joy.”

And on our website, you can read the director’s reflections on filming difficult subjects like maternal mortality. “The Economist” Film Project is designed to highlight the work of independent producers on the PBS NewsHour.

And you can learn more about the project or submit your film at film.economist.com.