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+ INNOVATION // BRINGING DEFINITION TO THE PROBLEM
OF FISTULA
THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST
WHY WE ALL SHOULD BE
INVESTING in MOTHERS
Mother and baby receive care at Sumbawanga District Hospital in western Tanzania.
HELPING MOMS IN THE U.S. AND
AROUND THE WORLD
SPECIAL REPORT:
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DIRECT RELIEF. ORG
&TAKE THE MATERNAL HEALTH QUIZ
MOTHERS ARE CRITICAL TO THE HEALTH OF FAMILIES, communities, economies, and humanity itself.
That’s why it’s staggering that a woman dies every 90 seconds from complications during pregnancy
or childbirth—more than 350,000 women each year worldwide. Pregnancy is often a time of joy and
trepidation, but in developing countries, it is a life-threatening condition, as pregnancy and childbirth are
the second leading cause of death among women of reproductive age.
Many of the risks for expectant mothers in developing countries are related to general conditions
of poverty, nutrition, and severely limited health resources and access. That’s why Direct Relief’s
humanitarian health efforts place particular emphasis on protecting women through the critical periods
of pregnancy and childbirth.
4 »HERE ARE
SMART INVESTMENTS IN SAFE MOTHERHOOD WE CAN ALL GET BEHIND
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WE MOTHERS
2 DIRECTRELIEF.ORG SPRING 2012
SUPPORTING MIDWIVES
IN 2012, DIRECT RELIEF WILL ENABLE
BY EQUIPPING 200 MIDWIVES IN
SIERRA LEONE, SOMALILAND, UGANDA, AND NEPAL.
1O,OOO SAFE BIRTHS
1 THE BEST WAY TO KEEP
MOTHERS SAFE in developing
countries—where 99% of maternal
deaths occur—is to make sure every
birth is accompanied by a trained and
equipped professional. Midwives are
the first line of assistance, managing
the health needs of mothers and
newborns during pregnancy, delivery,
and beyond. A well-trained midwife
can provide high-quality care during
routine deliveries, manage basic
complications, and recognize when
to refer a mother to higher-level
emergency obstetric care.
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Graduating midwives at the School of Midwifery in Makeni, Sierra Leone.
LEFT: A midwife examines an expectant mother at Xela Aid Clinic in San Martin Chiquito, Quetzaltenango, Guatemala.
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EQUIPPING THE NEXT GENERATION OF MIDWIVES IN SIERRA LEONE
School of Midwifery, Makeni
SIERRA LEONE IS ONE OF THE MOST DANGEROUS PLACES IN THE
WORLD TO BE A MOTHER. In 2011, it was listed 12th from the bottom
on the Mothers' Index, which analyzes health, education, and economic
conditions for women and children in 164 countries.
Conditions for mothers and their children are grim in Sierra Leone.
The lifetime risk of a woman dying from pregnancy-related causes
is one in 21, largely due to the fact that only 42 percent of births are
assisted by a skilled birth attendant.
Fortunately, programs are in place and underway to help train
more skilled health providers who can change what it means to be a
mom in Sierra Leone.
April 22, 2012 was graduation day for the first class of 69 midwives
from the School of Midwifery in Makeni, Sierra Leone. Direct Relief has
been working with the school in partnership with Medical Research
Centre, a local organization focused on improving maternal and
child health care at rural government health centers. The School of
Midwifery at Makeni is only the second school in the country to provide
midwife training. Equipped with new midwife kits from Direct Relief,
the new midwives will play a pivotal role combating some of the
highest maternal mortality rates in the world.
WE MOTHERS
SPRING 2012 DIRECTRELIEF.ORG 3
2IN 15 PERCENT OF DELIVERIES WORLDWIDE, COMPLICATIONS WILL
ARISE. WHEN THIS HAPPENS, IT IS ESSENTIAL THAT MOTHERS HAVE
ACCESS TO LIFE-SAVING EMERGENCY OBSTETRIC CARE, INCLUDING
A CESAREAN SECTION. SUCCESSFUL EMERGENCY OBSTETRIC CARE
REQUIRES THREE THINGS:
›› Trained providers who know how to manage —and when to refer—emergency cases;
›› Availability of the proper equipment and supplies to manage such cases; and
›› A functioning referral system that can move a mother quickly to the appropriate level of care.
PROTECTING MOTHERS WHEN SOMETHING GOES WRONG
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Mother and baby receive care at the Direct Relief-supported Edna Adan University Hospital in Hargeisa, Somaliland.
BELOW:
Mother and baby receive care at Leogane, Haiti’s Polyclinique Camejo—one of 115 Haitian health facilities to whom Direct Relief has provided 1,000 tons, $70 million in life-saving medicines and medical supplies since the 2010 earthquake.
IN UGANDA, where 16 women die in childbirth every day,
Direct Relief fully equipped the new operating
theater at RUGARAMA HOSPITAL in Kabale. Prior
to Direct Relief’s investment, there was only one
operating theater to provide emergency cesarean
sections for the entire district of 600,000 people.
In the first six months after the theater opened,
the hospital averaged 40 DELIVERIES PER MONTH, INCLUDING 15 CESAREAN SECTIONS, AND NO MATERNAL DEATHS.
IN HAITI, Direct Relief is increasing the emergency
obstetric care capabilities of 8 HOSPITALS that will serve 60,000 MOTHERS over the
next three years. Direct Relief provided exam
tables, operating tables, sterilizers, instruments,
baby monitors, scales, IV stands, exam lights,
ventilators, ultrasounds, and hundreds of
incentive kits to encourage more women to
deliver at the facilities.
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4 DIRECTRELIEF.ORG SPRING 2012
VIEW THE GLOBAL FISTULA CARE MAP AT GLOBALFISTULAMAP.ORG
RESTORING THE HEALTH OF INJURED MOTHERS & DEFINING THE LANDSCAPE OF FISTULA CARE
DIRECT RELIEF FISTULA CARE SUPPORT
Medical and surgical
supplies to 11 facilities in 8
countries providing fistula
repair to approximately
3,000 women each year
$1.3 million in medical
resources from leading
healthcare companies
such as Johnson &
Johnson, Ethicon,
Covidien, BD, CR Bard,
Hospira, and Henry
Schein, to help fistula
surgeons treat women
in need
With private foundations
such as The Fistula
Foundation, established
a surgical theater in
Somaliland for fistula
treatment, and trained
health providers in Western
Kenya in fistula care
Supported a new fistula
treatment facility in Danja,
Niger that will care for
2,500 women with fistula
and train 30 doctors in
fistula repair over the
next 5 years
AN ESTIMATED TWO MILLION WOMEN worldwide are suffering
from a condition few people know about. The condition is
obstetric fistula, and it is entirely preventable and treatable.
Direct Relief, in partnership with the UNFPA and The Fistula
Foundation, developed the Global Fistula Care Map—the first-
ever worldwide map of this devastating childbirth injury—to help
better understand the current fistula treatment capacity to more
effectively target scarce resources to where they are needed most,
and identify where gaps in service may exist.
THE GOAL IS TO ENSURE EVERY WOMAN
WITH OBSTETRIC FISTULA RECEIVES A LIFE-
RESTORING SURGERY AND THAT ALL FUTURE
CASES ARE PREVENTED. UNDERSTANDING
WHERE THE PROBLEM IS AND WHERE TREAT-
MENT IS AVAILABLE TODAY ARE ESSENTIAL
STEPS TOWARDS THAT GOAL.
Q/A WHAT IS FISTULA?A hole in the birth canal caused by prolonged and obstrutcted labor.
WHY DOES IT MATTER?Fistula causes chronic incontinence and can lead to severe medical problems and social ostracization.
WHOM DOES IT AFFECT?Impoverished women in remote areas, far from medical care.
WHAT CAN BE DONE?The number of women with fistula far surpasses the global capacity for treatment, but fistula can be prevented when women have access to a skilled attendant during childbirth. Reconstructive fistula repair surgery can also be provided by a trained surgeon.
« MEET SELFA…Just outside Mumias, Kenya,
Habiba Mohammed (right) works to identify, refer, and support
women like Selfa (left) who require treatment for obstetric fistula. Habiba referred Selfa to
life-restoring surgery after Selfa suffered from incontinence due to fistula for eight years. Now free of fistula, Selfa is happy, active, and a new mother to a healthy baby boy, earning income to support herself
and her family through poultry, fish, and banana farming. Selfa has also
become an advocate, helping to refer another woman in her village
who had suffered two decades with fistula to restorative care.
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SPRING 2012 DIRECTRELIEF.ORG 5
DIRECT RELIEF USA STRENGTHENS THE
SAFETY NET FOR MILLIONS OF WOMEN Direct Relief is the only nonprofit working with more than 1,000
clinics in all 50 states, providing free medications and supplies
for clinics’ ever-growing number of low-income and uninsured
patients.
As the first and only nonprofit licensed to distribute
pharmaceuticals in every state, Direct Relief has provided $300
million in medicines and supplies to U.S. clinics since 2004.
TRANSPARENCYPRECISE MAPPING OF EVERY DONATION SENT TO EVERY CLINIC PARTNER IN THE U.S. ›› DIRECTRELIEF.ORG/USA
100% OF CONTRIBUTIONS GO TO PROGRAMS.
DONATE AT DIRECTRELIEF.ORG
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Community Health and Social Services Center, Detroit, Michigan
*
* 5.2 MILLION WOMEN AGED 20-49, WERE CARED FOR AT FEDERALLY QUALIFIED HEALTH CENTERS IN 2010, MANY OF WHICH ARE PART OF DIRECT RELIEF’S 1,000-CLINIC STRONG NETWORK
More maternal health facts from some of Direct Relief’s clinic-partner network:
›› 299,516 WOMEN had a mammogram
›› 1,808,992 WOMEN had a Pap test
›› 489,883 WOMEN were seen for prenatal care visits
›› 68,372 MOTHERS gave birth (All stats, 2010 Health Resources and Service Administration Uniform Data System)
FAMILY PLANNINGTeva Pharmaceuticals provided Direct
Relief with $3 million worth of the women’s health product ParaGard®, an intrauterine copper contraceptive,
to be distributed among Direct Relief’s 1,000-clinic network treating low-
income and uninsured women.
HEALTHY SMILESThe Healthy Smiles Dental Program
addresses the number one unmet health
need in Santa Barbara County—oral health.
Limited access to dental treatment is
widespread among low-income families.
Healthy Smiles bridges the growing gap
of available oral health education, disease
prevention services, and treatment for low-
income children throughout Santa Barbara
County, with 1,800 kids served since 1994.
THE LARGEST CHARITABLE MEDICINES PROGRAM SERVING LOW-INCOME AND UNINSURED
MOTHERS IN THE U.S.
helping MOMS
in the
U.S.4
6 DIRECTRELIEF.ORG SPRING 2012
— Charity Navigator
— Forbes
100% OF CONTRIBUTIONS GO TO PROGRAMS.
DONATE AT DIRECTRELIEF.ORG
rick wartzman, Drucker Institute Executive Director:
“ [Direct Relief’s] fundamental insight—to take the best in private-
sector technology and uniquely adapt it for the social sector—has
greatly strengthened a weak link in the medical supply chain…Its
efforts demonstrate that social-sector organizations can achieve the
very highest levels of efficiency.”
100% EFFICIENT. AMONG THE 20 MOST EFFICIENT LARGE U.S. CHARITIES.
2011 PETER F. DRUCKER AWARD WINNER FOR NONPROFIT INNOVATION
TEST YOUR KNOWLEDGE
OF MATERNAL HEALTH ››
1// Every day, an estimated _____ women
die from preventable causes related to
pregnancy and childbirth.
a. 100
b. 500
c. 1,000
d. 1,500
2// ______ of all maternal deaths occur in
developing countries.
a. 29%
b. 49%
c. 79%
d. 99%
3// Rank the following countries from
fewest to most maternal deaths.
a. U.S., Albania, Singapore
b. Albania, Singapore, U.S.
c. Singapore, U.S., Albania
d. Albania, U.S., Singapore
4// The probability that a woman will
eventually die from a maternal cause is 1 in
____ in developed countries, versus 1 in ____
in developing countries.
a. 4,300; 120
b. 2,000; 300
c. 1,700; 460
d. 1,100; 500
5// In high-income countries, virtually all
women are attended by a trained health
professional during childbirth. ____ of
women in low-income countries are not
assisted by a doctor, nurse, or midwife
during childbirth.
a. 30%
b. 40%
c. 50%
d. 60%
1. c 2. d 3.b 4. a 5. d (All stats, WHO)
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THE LARGEST CHARITABLE MEDICINES PROGRAM SERVING LOW-INCOME AND UNINSURED
MOTHERS IN THE U.S.
SPRING 2012 DIRECTRELIEF.ORG 7
27 S. LA PATERA LANESANTA BARBARA, CA 93117TEL: 805.964.4767 TOLL-FREE: 800.676.1638 FAX: 805.681.4838www.Directrelief.org
BOARD OF DIRECTORS
CHAIR Thomas J. CusackVICE CHAIR John RomoSECRETARY Rita MoyaTREASURER Patrick Enthoven
Kendall Bishop • Jon E. Clark • Lawrence Dam • Patty DeDominicHon. Paul G. Flynn • Gregg L. Foster • Dorothy Gardner • Ernest J. GettoJ. Michael Giles • Bert Green, M.D. • Raye Haskell • W. Scott HedrickPriscilla Higgins, Ph.D. • Angel Iscovich, M.D. • Ellen K. JohnsonNancy Walker Koppelman • Donald J. Lewis • Mari Mitchel • Jeanne Newman Mary Louise Scully, M.D. • James Selbert •Ayesha Shaikh, M.D. George Short • Gary R. Tobey
INTERNATIONAL ADVISORY BOARDLawrence R. Glenn • E. Carmack Holmes, M.D.S. Roger Horchow • Stanley S. Hubbard • Jon B. LovelaceDonald E. Petersen • Richard L. Schall • John W. Sweetland
HONORARY BOARDPRESIDENT EMERITUS Sylvia KarczagCHAIR EMERITUS Jean HayDIRECTOR EMERITUS Dorothy Adams
PRESIDENT & CEO Thomas Tighe
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8 DIRECTRELIEF.ORG SPRING 2012