22. Woman Power

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:

http://vimeo.com/12427420

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.

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.