Woman Power
28th March 2014
The
answer is 1metre 80cm, (5ft 11inches). This titbit of knowledge is so
surprising, (nearly six feet!), that to call it ‘trivia’ is demeaning.
The
question to which this is the answer is, of course: ‘How tall was Mary,
Queen of Scots?’ (Eventually.) (Not counting the last couple of minutes.) Mary
Queen of Scots was the grand-niece of Henry VIII. She was Queen of Scotland
from infancy; was Queen of France un peu; and was mother of King James I of
England. She was taller and better educated than just about anyone on the
planet in the sixteenth century, and possessed compassionate beliefs and
sparkling social skills. And yet, she never had power. She was made use of by
her men; spent half her adult life imprisoned; never saw her son again after
his last breast feed; and, finally, was beheaded when they could not think of
anything other use for her.
You
do not need to be much of a feminist to feel that she had been somewhat
simon-cowelled. (Cockney rhyming slang for ‘disembowelled’ – itself a metaphor
for humiliation of the vulnerable by a dental flosser*.) (*More Cockney
rhyming.)
Before
I became an obstetrician, I was an alpha male rugby-playing surgeon, and,
rejecting the stereotype, never thought of myself as much of a feminist.
Indeed, despite living then in a world of burgeoning gender equality, I am
ashamed to say that, in my ignorance, I vaguely thought of feminists as women
who wanted to be like men. It was only when I came to a deeper maturity that I
realised that no insult could be more below-the-belt. Why would a woman want to
be like a man!? Of course, not all men historically were bombastic,
insensitive, dominant, aggressive, grumpy, sex-mad, power-crazed odd-job men,
but as a gender, over the millennia, we have indeed done our share of sulking
angrily at the lack of sexual responsiveness of a vulnerable and abused
mistress, whilst putting up a shelf. True, many of us were good for fighting
off lions, intruders and money spiders, but I have to accept the argument that
this might not have been sufficient recompense for childbirth, home-building,
and disempowerment.
Fortunately,
here in the UK we have mainly left behind the epochs of gender stereotypes, in
theory at least, and my wife these days expects me to share in the cooking,
just as I expect her to help in the turning-on of the computer, to try to fix
the black-screen-problem.
However,
this balmy concord in the division of household chores nevertheless remains the
exception rather than the rule in many parts of the world, and in particular in
rural Africa. In the recent past, men were the workers, and before that the
warriors, and roles were tough on all sides. So much has changed that it is now
impossible to make sweeping generalisations. Yet it remains a grim fact that
many women are born to a life (and death) of recurrent childbirth, bereavement,
toil, and exhaustion. This is not necessarily because men choose that it should
be so, but rather this is the way that it always was. In the sleepy heat of the
African sun, somehow things never get round to being different. It is accepted.
What
has proven most effective in changing this, in developing countries on every
continent, is the empowerment and education of women. Once women start meeting
in groups with the purpose of discussing their difficulties, and once this
process has the blessing and cooperation of the men, (which it often does),
then suddenly barriers which had seemed insuperable to the individual, melt,
like glaciers in Surrey. (A strange simile, I hear you say, but do you see any
glaciers in Surrey?) Solutions emerge. An interesting characteristic of
solutions, by the way, is that they don’t have to be right. They just have to
be tried, and the process leads you another step ahead. Suddenly people are
asking why they should have six children; why they should not have cleaner
water, nearer by; why they cannot create employment; why bare subsistence
should be the norm; why their children cannot go to school; why they should be
so susceptible to ill health; and why they have to die to bring life into the
world.
After
many iterations, the project EMBRACE (Empowering Women & Babies to Receive
Adequate Care & Equality), has now defined exactly how it plans to tackle
the complex and interwoven problems underpinning death of mothers and babies.
And it has taken its first baby steps.
The
planning of an intervention to be ‘done to’ a community is fraught with
difficulty, and, ultimately, is likely to founder in the mire of Unseen
Difficulties. This has been the troubled history of African development: “When
you do what you always did, you get what you always got.” On the other hand,
when communities have only hope rather than expectation that anything should
ever be better, how do you get them to want the interventions you have up your
sleeve?
Women’s
groups have provided the answer, and I have pointed in the past to this heart-warming
video:
It
was with great pleasure then that I have been receiving the emails from Elizabeth Ali, and Drs. Sion,
Ahmed and Abdallah about progress that has been made. Two points need
highlighting in particular. The first is that Sion and Abdallah met to finalise
the methodology that EMBRACE will be using. They have discovered that a village infrastructure exists, which can be tapped into, and harnessed for whatever development needs are
being addressed. We had no idea that this infrastructure of hamlet leaders,
village health workers and traditional birth attendants was already formed, but
relatively dormant, in every community. It gives us a powerful way in, for the
formation of women’s groups. Once the touchpaper has been lit, we then hope to muster,
direct and coordinate support, so that issue by issue the communities can begin
to tackle their pressing problems.
I
will post Sion Williams’ summary in full on the blog site, but here is a
distillate:
"We
must first identify areas with problems- so far this includes Berega,
Tunguli and Mnafu. This requires the mapping. Next we meet with four key groups
of people - TBAs, village health workers, hamlet leaders and village
leaders, to get them on board.
We will ask these community leaders to identify appropriate women, to become key people in the running of the groups at hamlet level.
The purpose of these
groups is to first identify problems, which will then inform the next stage of
the project- getting people to deliver in a GOOD SAFE hospital.”
The
second breakthrough has been in the mapping. It turns out that the hamlet
leaders already know much of the information that we need. This means that we
can simply go to each hamlet, meet the key people, explain what we are trying
to do, (with cautions about raising expectations too quickly), and then measure
GPS coordinates. (Look at me, using terms like ‘GPS’ as if I had been raised on
Google Earth. If the truth be known, until last September I had thought it
meant ‘Gherkin & Pastrami Sandwich’, and I had always puzzled how New
Yorkers used bread products to find their way around.)
Again
I quote Sion:
No good maps exist of the tangled
motorbike tracks and sporadic hamlets from which labouring mothers travel from
when deliveries go wrong. Today we started an innovative new project with
Mission Morogoro, Hands 4 Africa, Ammalife and Google Maps to accurately map
these distant settlements. We are visiting settlements by motorbike, recording
coordinates, and hearing the stories of the most important people- the
remarkable mothers who brave childbirth in a mud house, by kerosine lamp light,
hours from medical help.
The battle against maternal mortality starts with finding, listening and working with these women. Only then can we bring these communities into the fold of the hospital, working with them as equal partners. But ultimately it starts with the map.
The battle against maternal mortality starts with finding, listening and working with these women. Only then can we bring these communities into the fold of the hospital, working with them as equal partners. But ultimately it starts with the map.
Pictured: project technician Abdallah
Mondo records the coordinates of Kiegea village. Last year his first son was
born safely in the hospital and he is committed to helping other women do the
same.
Sion
highlights in his messages the awful consequences of the bridge collapse, and
the repercussions on the hospital. It is a double whammy: the patients cannot
get there, so income cannot be generated to pay staff; meanwhile the bill for
bringing in drugs and other resources has gone through the roof, because of the
hundreds of kilometres detour on bad roads the transport from Morogoro has to
take.
My
own hospital in Coventry is six times the size of Berega, and its annual budget
is £1bn. Berega’s budget is less than £150,000. (£1k/year is a good salary in
rural Tanzania). To save you doing the maths, that means we in the UK are spending 1000 times more per bed on the hospital - not counting GPs and all the other available health facilities. Nevertheless, in Tanzania this money is increasingly impossible to find
with the bridge down. And no money means no malaria drugs, no antibiotics, no
staff – lives will be lost. They have launched an appeal. Can you help? If so,
please email me at email.lozza@gmail.com,
and I will send you details of how to send money.
The
bridge, however, will be rebuilt this year, and we must be ready to continue
our impetus in helping make childbirth and childrearing the beautiful and safe experience we should like it to be.
We have begun the process of empowering women, and there is nothing in this continent more likely to produce good. I really hope that Mary, Queen of Scots, will be smiling down on our efforts.
We have begun the process of empowering women, and there is nothing in this continent more likely to produce good. I really hope that Mary, Queen of Scots, will be smiling down on our efforts.
