Saturday morning’s panel featured three women who have taken hands-on approaches to health care in their respective fields. Those in attendance learned about their respective endeavors through individual presentations and a Q & A. Though their approaches differ in nature, they share common senses of compassion, initiative and ability to recognize situations of dire need.
Chenoa Hamilton, a certified midwife herself, spoke about the role of midwifery in global health. Hamilton recently returned from Jacmel, Haiti, where she worked for Mother Health International. This small organization was formed just weeks after January’s devastating earthquake, functioning solely on volunteer work and donations. The staff includes midwives, OB/GYNs, nurses and visiting alternative health care practitioners such as acupuncturists and chiropractors, all of whom use as little technology as possible. The array of services provided is vast, ranging from the prenatal to the postpartum.
While word of mouth has helped the client base expand to about 800 women (about three new mothers each week), the clinic faces a great deal of challenges in maximizing its impact. For one thing, many women have trouble getting there.
“We’re lucky if we see them two to three times during their pregnancy,” Hamilton said. Cultural beliefs can also clash; for instance, many women believe breast milk to be poisonous for the first three days of the child’s life, and fears of sorcery discourage nighttime travel, even if labor is imminent. Additionally, scarce access to water and electricity prove problematic in maintaining cleanliness and preventing the spread of disease.
While care and treatment are primary concerns, education is also a key component of MHI’s initiative. Along with mandatory HIV testing for all mothers, volunteers provide patients with information on nutrition, hygiene and infant care. They also try to involve fathers as much as possible in order to encourage involvement throughout the child’s life.
Hamilton emphasized the value of comfort, support and trust in a trained and knowledgeable staff for expectant mothers. “When they feel love,” she said, “they usually give birth quite well.”
She hopes that her patients’ interest in midwifery will help to perpetuate the clinic’s success and further empower women in Haitian communities. A wider distribution of midwives throughout the country could have a massive impact on mothers’ quality of life and the infant mortality rate.
“The World Health Organization (WHO) estimates that 700,000 midwives are needed worldwide to ensure universal coverage. That puts us at a 50 percent shortfall,” Hamilton said. “It really comes down to education throughout the world.”
After such an emphasis on education, it seemed fitting that Lisa Adams, assistant professor of medicine at Dartmouth, would follow. Adams, who is also the coordinator of the department’s section of infectious disease and international health and director of the college’s global health center, is part of a 10-year research collaboration between Dartmouth and Muhimbili University in Tanzania. The goal: “the expeditious development of an improved vaccine to prevent HIV-associated tuberculosis.”
Adams illustrated the need for such research with the help of some truly frightening statistics.
“There are 33 million people living with HIV,” she began. “A number that may resonate more easily is that every day, more than 7,000 people are infected. If you were to line the world’s population up single file, every third person would be infected with the Tuberculosis bacteria.”
As part of the search for effective treatment, the Dartmouth-Muhimbili collaboration was initiated in 2000. It is known as the DarDar program — one “Dar” for Dartmouth and another for “Dar Es Salaam.” It also sounds very similar to dada, the Swahili word for “sister.”
One of the project’s major trials focused on HIV-related TB. Over the course of a year, researchers tested a new vaccine boost (or a placebo) five times on HIV-positive individuals who had been primed with the bacille Calmette-Guerin (BCG) TB vaccine. The study, conducted using a random sample and double blind format, was actually ended early due to strikingly positive results. The vaccine was shown to reduce disseminated TB by 47 percent and definite TB by 39 percent.
Because the team was doing research on latent forms of TB, they were able to help those who would have otherwise faced great health challenges, as resources for those with active diseases are already scarce. Therefore, in addition to making major strides in the research sector, they had discovered an opportunity to provide hands-on treatment.
“What you realize is that it’s hard to provide very narrowly defined care,” Adams said. “We sort of evolved without any intention into primary care providers.”
The overall mission of the resulting clinic consists of caring for patients, training, counseling and research. At any give time, there are seven faculty members, four undergraduate students, three medical students and five fellows and residents on site.
“It’s really provided the launching pad for our global health initiative — a springboard for a much greater involvement,” Adams said.
Caitlin Cohen was an undergraduate student volunteering at a maternity ward in Mali when she found the void she needed to fill.
“My job was to catch things,” she half-joked. “Babies, surgical equipment … I’d sterilize things–ish,” she added, referring to the difficulty in maintaining cleanliness with a dearth of available resources. After experiencing the current health care system firsthand and maintaining contact with one of her coworkers throughout the following school year, Cohen was convinced to return to Mali.
“There was a disconnect between the care that we could provide and the cure that we needed,” she said.
With the help of a $1,500 loan from her father, she founded the Mali Health Organizing Project with the intention of providing primary care for all possible ailments.
“When you run disease-specific campaigns, so much of the time in places that are incredibly poor, they are ineffective because people can be killed by so many different things,” she said. “You need a comprehensive, holistic approach.”
Today, the clinic serves about 5,000 people annually, and it is the closest source of primary care for approximately 250,000. In addition, the Project comprises a variety of additional programs, including a plastic recycling effort employing about 30 locals and a text messaging system to monitor the health of young children from afar.
Cohen believes that these children should be a top priority, the basis of the “free care for under fives” policy.
“One in five kids die before the age of five,” Cohen said. “That means nothing until you actually see it, and then it becomes devastating. It has an emotional burden that is really difficult to comprehend.”
After building this organization from the ground up, Cohen is all too familiar with the struggles of fundraising. “What everything boils down to is money and where it’s going to come from,” she said. Her advice is to ask for more than you need and don’t be afraid to admit mistakes.
“People are often unwilling to admit when they have failed,” Cohen said. “If we don’t publicize our failures, we will repeat the errors that people have made time and time again.”
The Clifford Symposium: “‘Doing’ Global Health Work — Different Perspectives”
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