A thick white hoar-frost on the grass, the stone
walls, the twigs, the lichen. Low, golden winter sun picking out the last
autumnal colours of the sturdy oaks in the valley far below. A distant twisting
river, fed by sparkling springs. Sheep. Pubs with good ale, good pie, and good
fires in inglenooks. Walking trails that are steeply uphill in both directions.
Finding yourself thinking about coronary stenting and knee replacement. Blisters.
More sheep. More pubs. The Peak District on a cold winter’s day. Beautiful.
We were there with Mollie and Tom, (our third
daughter and her husband, for those who don’t know), (and for those who do),
just to spend some time together, and to breathe in some fresh hill air.
Shatton Hall, where we stayed, originated an
extraordinary seven centuries ago. (To give you a sense of scale, that was when,
in China, the Ming Dynasty was just beginning to stockpile ginger; and in
England, the peasants were revolting).
The old house lies beneath the newer build, but
even those ‘new’ rough yellow stones were laid before anyone had heard of
America, far less wanted to be President of it; and when trumps were rude
noises. The two-mile track from the village of Shatton is rutted and sunken by
centuries of use. Clean water comes from a spring, and, for many a long year,
later it found its way, gratefully used, back to the same source. (A little
further down, and a little less potable.)
England then; Tanzania now. It is salutary to think
that even in our sophisticated and highly developed England, there was a time
when most of our ancestors lived in tiny hamlets; were lucky to survive
childbirth; were ravaged by diseases with no access to medical care; and struggled
for bare subsistence. Food needed to be grown, and animals raised, or you would
starve. A bad winter after a bad harvest, and the Grim Reaper and his
pestilences would gather in the vulnerable.
Then as now, the most vulnerable were pregnant
women. In England, the peak maternal mortality rate was pre-industrial
revolution, where 1% of women died each time they had a baby. Given the lack of
contraception, and the general-held misconception that having more children was
a good insurance policy, this meant that after five or ten children, each woman
had a 5 to 10% chance of dying of in childbirth.
So here’s a challenge: what would you do about it?
If you time-travelled back three hundred years to rural England, and found this
level of tragedy in pregnancy and childbirth, how would you set about tackling
it?
(If you are a blog skimmer, and want to
cut to the chase, then send planet-friendly e-Christmas cards instead of paper
ones, donate the postage here:
https://mydonate.bt.com/
For those still with us, this is where we had got
to: making change is not as easy as it seems. Not only are rural mothers slow
to change what they have always done, and what they have always known, but so
also are we – the human race.
(An example close to home is the blight of the Sat-Nav,
to which menace my addicted wife seems oblivious. Two weeks ago for instance,
she wanted to use it to get from Yorkshire to Lancashire, and the Sat-Nav
suggested using the motorway! Huh!!! How wrong can you be!!! She wanted to
follow its tyrannical advice, instead of using my map-reading skills to look
for unlikely moorland sheep tracks to avoid the traffic.
I think she learnt her lesson. If we had used the
Sat-Nav, we would never have seen the blizzard on the Snake Pass; we would
never have had the excitement of being turned back from impassable roads; never
have had so much time to appreciate the road works of Rochdale; never realised
how out-of-the-way Halifax is; and never listened to four hours of Alan Bennett
talking wryly about all the fun things he gets up to. And she still
insists on using it!)
My route over the moors –This really is
a photo from that journey …
The history of tackling maternal mortality
highlights this human weakness, of obstinacy in the face of reason: The main
causes of mothers dying in childbirth three centuries ago were bleeding,
infection and eclampsia, (a type of blood pressure problem in pregnancy). The
breakthrough advances were ergometrine injection for bleeding after delivery;
hand-washing with antiseptics before managing childbirth; and magnesium
sulphate injection for eclampsia. These were discovered respectively in 1932;
1847; and 1924. They became routinely adopted an average of seventy years
later. In the case of handwashing with carbolic, its instigator, (Semmelweiss),
who had produced a sevenfold-reduction in maternal mortality in his unit, was
so ridiculed by the establishment, that years later, a broken man, he died in a
mental asylum.
Here is an upbeat take on things, however, with
profound relevance for Tushikamane: Despite these stories of the mind-numbing obduracy
that we humans display in accepting that we might be wrong in our assumptions,
in the late nineteenth century, maternal mortality began to fall.
By the twentieth century it was tumbling. Between 1900 and 1990 maternal mortality dropped
nearly one-hundred-fold. In the same period, a woman’s life expectancy in the
USA rose from 48 to 80 years. The fall from peak levels had begun before 1900,
and then, in 1940, before the introduction of antibiotics, when the
majority of women still delivered at home, and the world was at war, the
downward trend became even stronger. Is it a coincidence that the fall began
with the start of female emancipation? And that the 1940s were the first time
in England that women were really taken seriously, occupying the
responsibilities of their fighting men, and often out-performing them? Is this
just feminist rant?
No, it is not. It only takes a little thought to
realise that the answer to making an impact on maternal
mortality of course begins with the women themselves. In the days when women, filled
with habits and traditions and myths and superstitions, were given in marriage
to be baby machines and housewives; with no voice, no education, and sometimes no
hope; no progress could occur. For advancement of society, women had to accept
the need for hygiene in childbirth; to see the need to be well-nourished in
pregnancy; to be willing to accept and pay for pay for skilled antenatal and
intrapartum care; to live healthier life styles and so boost immunity to
infections; to recognise the need to limit family size; and to thirst for the education
which might enhance all these advances.
The profoundly dramatic changes in
the health of women and their babies which has taken place in the last century
and a half – in some countries at least – have been made possible by the
awakening and empowerment of women.
In rural Tunguli and Msamvu, women
have truly awoken. There is now an energy, and a passion to climb out of the
wretchedness of their situation: as many mothers and under-5s die still die, as
used to die in England at our pre-industrial peak.
This awakening is called ‘Tushikamane’
– ‘working together, we are empowered’. In the blog page below, you can find
details of the eleven women’s groups and their aspirations, as observed by
seasoned Tanzanian NGO workers, who recently visited and came away immensely
impressed:
What is beginning to emerge should
have been obvious: each hamlet has different needs, different resources,
different characters, different priorities. Some have too much water; some need
a pump to be fixed. Some need wire for the chicken run; some need troughs for
the pigs. Some want machines for sewing; some want seed for the garden.
By awakening the latent energy
within each, we suddenly find that they are beginning to fix their own problems,
and are beginning to be passionate about self-determination.
There has also been an
unlooked-for and profound development, however. Suddenly, when women’s groups
have been formed, educated and given a voice, there has been an astonishing
enhancement of engagement – with health, with each other, and with those
government agencies responsible for development. Many children have been immunised.
Many more women are engaging with health services in the pregnancy. New, young,
vocal female champions and leaders are beginning to find their feet.
Even more encouragingly, this
awakening of engagement seems to be mutually-enhancing: Those involved in
health care, who have been deeply involved in the Tushikamane project, are now
looking beyond the walls of the clinic, and have helped the groups together to
formulate the first draft of a three-year plan:
Dr Alex Gongwe –
Tunguli Health Centre doctor, and now leading light of Tushikamane, working
under Wilbard Mrase, head of Berega School of Nursing, and Isaac Mgego,
Director of Berega Hospital.
This extraordinary achievement,
within less than a year from taking the first steps, shows how much energy can
be unleashed in rural Africa, when the right steps are taken by the right
people.
If you would like to support this
wonderful wave of hope, and you have not yet sent your Christmas cards, then
you can get out of all that addressing of envelopes and licking of stamps by
sending the money to:
This year for Christmas, why not
buy a Tanzanian village a chicken; or some seeds; or a trough?
Thank you.
Post script
After 30 months of blogging, we have reached an important way-mark in the story of how we progressed from trying to improve labour ward skills, to trying to engage with rural hamlets through women’s groups.
After 30 months of blogging, we have reached an important way-mark in the story of how we progressed from trying to improve labour ward skills, to trying to engage with rural hamlets through women’s groups.
I wonder if I should publish these 45 blogs as a book: The Birth of Tushikamane'?
Thoughts welcome.
Then, the next book will tell us if we made a difference …
Thoughts welcome.
Then, the next book will tell us if we made a difference …
