Rx for Survival — A Global Health Challenge

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Dispatches from the Field:

Dr. Houleymata Diarra

Champion for Child Survival

By Dr. Houleymata Diarra
Bamako, Mali

June 2005

One day when I was 17, I was visiting my mother at the hospital where she worked as a nurse. A little six-year-old boy named Moussa was brought in. He had convulsions and tremors, and the mother said evil spirits possessed him. A traditional healer had been giving the boy herbs and other medicines for 15 days, but his condition had only worsened. By the time his mother brought him in, it was too late. Moussa died that day — of malaria. He could have been saved with medicines that cost about a dollar.

That was the day I decided to become a doctor. For more than a decade now, I have been working as a pediatrician and public health worker in Mali, where the health situation is among the worst in the world. It has 11 million people, most of them poor and living in rural areas without electricity or telephones or access to safe water, and with no schools or health clinics nearby. The people mostly make under $2 per day, and half of them are under 15 years old. If you are sick, the only way to get to a doctor is by walking, riding a donkey or bicycling over dirt roads.

This is an especially serious problem for Mali's women. Too many of them marry very young and start having babies before their bodies have fully developed, so when they go into labor they often have complications. But the traditional birth attendants have no clean water or sterile equipment, and they have no training on how to deliver babies safely or recognize danger signs in time to make the trip to get help. It is no surprise then that childbirth and its complications are the number-one killer of Mali teenage girls. More than 1,500 women die in childbirth in Mali for every 100,000 live births. Compare that to America's rate of 17 per 100,000 live births. Americans will probably find this hard to believe, but it is the truth.

And when a mother dies in Mali, her baby almost always dies as well — 80 newborns die every day there. It is so common that to reassure families people say, "the jar has a leak, but it is not broken; it can be repaired." This means the family may be hurting, but the woman can always have another child.

Babies are not even named in Mali until they are a week old. But even newborns who survive are at high risk. The country's child mortality rate is the world's sixth highest: one in five never sees his fifth birthday. The biggest killers are malaria, diarrheal dehydration and respiratory illnesses like pneumonia. Like maternal mortality, these are all killers that Americans would never see as threats to themselves or their own children.

The sad truth is that we could prevent most of these deaths. Simple and affordable medicines and health care steps could do it, if we had the resources. A good example is tetanus infections. These are a major killer of mothers and newborns, often resulting from the use of a dirty knife to cut a baby's umbilical cord, or putting unsanitary shea butter on the cut. But a simple vaccine for the pregnant mother immunizes both her and her baby. So in 2001, Save the Children led a tetanus immunization campaign by several partners, including UNICEF, the World Health Organization and the Mali Ministry of Health. The goal was to immunize women of childbearing age against tetanus in one-third of Mali. Health workers went to clinics and traveled door-to-door in villages to give three shots of a vaccine over a one-year period, and 80 percent of the women have now been immunized. The health ministry has expanded the campaign to the rest of the country and is using the same approach to reach children under five with vaccines for polio and measles.

Projects like these cost only pennies per vaccine, but they require political will. The First Lady of Mali, Madame Toure Lobo Traore, is showing the way here. She is a midwife by profession, and she is leading the first ladies of all western and central Africa in an effort to promote steps that will cut maternal and newborn deaths in their countries by half by the year 2010. They are also encouraging their husbands to increase funding in national budgets for maternal and child health programs. And in the past ten years, the budget has risen in Mali, so that the number of women and children who have access to health centers has increased from 20 percent to 65 percent. This is a good step, but we have a very long way to go.

As I see it, the world is one house. We are all women. Countries and continents make no difference. Mothers in Mali say to me, "I don't want to be afraid of pregnancy. I don't want to die; I don't want my child to die. I want my children to grow, to be healthy, to get an education." This is the same way mothers in America feel, and everywhere. I think that once American families learn about the situation in Mali and other places where women and children are dying needlessly, they will want to do something about it. They can support more U.S. foreign assistance and other international programs that will help provide the simple tools needed to save many lives and let more children grow up. It is only necessary to let them see.

About the author:

Dr. Houleymata Diarra manages Save the Children's health programs in Mali, a country in western Africa. She is a trained pediatrician and has dedicated her life and career to improving the survival and health of children in Mali through national health policy and program efforts. As a recognized expert in her field, Dr. Houley serves as a technical advisor to Mali's national committees on maternal health, child survival and newborn health.

A nurse examining a one-day-old baby in Bougouni, Mali.

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