http://viewchange.org Videos from ViewChange.org (Filtered by topics: Pediatrics) en-us Tue, 12 Jun 2012 10:27:00 +0000 Copyright 2011 Link Media, Inc. http://www.viewchange.org/videos/the-health-show-reversing-the-medical-brain-drain It wasn't easy for Dr. Ayodyha Wataliyadda to leave her family in Sri Lanka. But thanks to an initiative of the British and Sri Lankan governments, she is able to gain valuable work experience in the UK while eventually returning to practice medicine in her home country. Tue, 12 Jun 2012 10:27:00 +0000 http://www.viewchange.org/videos/the-health-show-reversing-the-medical-brain-drain Sri Lanka, Brain drain, Health, Physician, NHS trust, Senior registrar, Pediatrics, Royal College of Physicians, United Kingdom, Northern England >> TITLE: Huddersfield, West Yorkshire, Northern England>> DR. AYODYHA WATALIYADDA [Senior Registrar, Pediatrics]: That was my daughter. And she's 5 years old, about to start school next year.>> VOICEOVER: It wasn't easy for Dr. Ayodyha to leave her family in Sri Lanka to come and work in Yorkshire in northern England.>> DR. AYODYHA WATALIYADDA: I was working as a medical officer in field of pediatrics, as a senior house officer, then a registrar, and then I wanted to specialize in pediatrics so I have been working in the field of pediatrics for about seven or eight years.>> VOICEOVER: Ayodyha was supported to come to the UK by the Foreign Placement Coordination Center, backed by the Sri Lankan government. In return, she signed an agreement that for every year spent in the UK, she will work for at least four years back in her home country. If this doesn't happen, she will have to pay a substantial penalty.>> DR. AYODYHA WATALIYADDA: It's basically an essential requirement back in my country to get one or two years of foreign experience.>> DR. AYODYHA WATALIYADDA: Can I just have a look at your leg please? Okay, there we go.>> VOICEOVER: Five-year-old Matthew fractured his leg falling off his bicycle.>> DR. AYODYHA WATALIYADDA: Does it hurt? Can you just move your toes a little bit for me? All right. That's brilliant.>> VOICEOVER: Ayodyha also works with premature babies.>> DR. SAL UKA [Consultant, Huddersfield and Calderdale NHS Trust, UK]: At registrar level we're talking about a senior doctor who out of hours in particular would be the most senior pediatrician on site so they do need to be able to demonstrate confidence and competence in managing pediatric emergencies in particular, but also managing newborn emergencies as well. >> VOICEOVER: Ayodhya is putting her years of experience into practice. But she is also learning new skills.>> DR. AYODYHA WATALIYADDA: Back in my country, the gestational age that we start to resuscitate a baby is after 28 weeks after gestation, but here we take in 24 weeks onwards babies.>> VOICEOVER: This baby girl, born seven weeks early, is suffering from low blood sugar and anemia. The treatment is quite straightforward, but there are certain skills that Ayodyha can only learn in the UK.>> DR. AYODYHA WATALIYADDA: We lack resources there. Mainly some investigations, some equipment, and even the trained skilled people, we lack there. But here in the UK, I have seen a very well organized structure and things are in abundance.>> VOICEOVER: Only four months into her post, Ayodyha is settling in well.>> DR. AYODYHA WATALIYADDA: Usually we get the weekend off, so I manage to go to a few places around Yorkshire. I am settling in okay. I'm settling in very well, actually. I have almost fallen in love with West Yorkshire.>> VOICEOVER: Sri Lanka has a shortage of medical specialists, but this scheme means that they will benefit from highly trained doctors who are more than willing to use the experience gained to help improve the health services in their home country.>> DR. NICK BEECHING [Royal College of Physicians, UK]: I think the benefits are enormous and they go both ways. For Sri Lankans, they know that they're coming to previously approved jobs, their proper training posts, and that they'll be properly looked after when they get here. From the government point of view in Sri Lanka, they know they're going to get their graduates back. They're very expensive to produce, the old brain drain can't happen because they have a limited period here.>> DR. AYODYHA WATALIYADDA: It's not that we are going to stay here forever. We'll be gaining the experience, gaining the knowledge. At the same time we'll be doing a service to the NHS as well. So I have a duty to go back. It's my country, so I'll be going back in two years' time. http://www.viewchange.org/videos/the-edge-of-joy Nigeria, Africa's most populous country, has the second-highest number of maternal deaths in the world. The Edge of Joy follows doctors, midwives, nurses, and public health educators as they fight maternal death on every front, from preemptive family planning education to expanded blood transfusion services. Mon, 24 Oct 2011 08:06:00 +0000 http://www.viewchange.org/videos/the-edge-of-joy Nigeria, West Africa, Maternal health, Health, Reproductive health, Pregnancy, Maternal death, Family planning, Blood transfusion, Islam >> TITLE: Hafliwa Maganin Mutuwa >> TITLE: "Birth is the medicine for death" - Hausa Proverb >> TITLE: Kano, Nigeria >> KABIRU IBRAHIM: At about 5:30am, my wife Aisha gave birth at home. I rushed to borrow a car from my friend and took her and the baby to the local hospital. >> AISHA AMIRU: Aisha was bleeding. I poured lots of water over her. But it didn't help, and the bleeding got worse. Honestly, when we brought her to the hospital, in her own words she kept saying she was going to die, she was going to die. >> TITLE: Brown Doggy Pictures, in association with Woodlawn Avenue Productions, present: The Edge of Joy. >> VOICEOVER: Nigeria is Africa's most populous country. Its 140 million citizens are divided almost equally between Muslims in the dry desert north and Christians in the lush south. Nigeria is a land of extremes. The West African country is blessed with some of the world's richest natural resources, and is best known as America's fifth largest oil supplier. But this isn't the story of oil. This is the untold story of more than 36,000 Nigerian women who die each year while trying to have babies. This is the second highest number of maternal deaths in the world. Battling this daily crisis are Nigerian families and healthcare professionals working on the frontlines of maternal health. >> TITLE: Kano, Northern Nigeria >> SIGN: Murtala Mohammed Specialist Hospital >> SIGN: Labor room >> DR. BELLO DIKKO [Chief of Obstetrics & Gynecology, Murtala Mohammed Specialist Hospital]: So you are welcome to the labor room of Murtala Mohammed Specialist Hospital. It's one of the busiest maternity centers you can find in all of West Africa. There is at least an average of 30 deliveries in 24 hours, normal deliveries. >> VOICEOER: Dr. Bello Dikko is head of obstetrics and gynecology at Murtala Mohammed Specialist Hospital in the northern Islamic state of Kano, one of the most difficult and dangerous regions in which to be a woman. >> SIGN: Dawn shall not fall twice on a woman in labor >> TITLE: Sakina Muhammed: mother of two, in labor with twins >> AISHA BUKAR [Nurse Midwife]: I was trying to explain to her that she should bear down because she is carrying a multiple pregnancy. >> VOICEOVER: Sakina delivered her first two children at home. More than half of Nigerian women give birth outside the hospital. During this pregnancy, Sakina heard radio messages about free maternity services for prenatal care and delivery, and told her husband Muhammed. >> MUHAMMED MAKA [Sakina's Husband]: My name is Muhammed Maka. At home there is the possibility of encountering problems, so going to the hospital has its advantages. >> AISHA BUKAR: We notice she's very weak, so we set up IV 5 percent dextrose for her. >> MUHAMMED MAKA: I brought my wife Sakina to the hospital on a Saturday, and she gave birth to twins on Sunday. The first twin was a girl. >> AISHA BUKAR: No contractions, nothing. So we add just a little pitocin for her in order to encourage her to start having the pains so that she can expel the [second] fetus. >> DR. BELLO DIKKO: Because of the associated complications, the second delivery should not exceed five to ten minutes. >> AISHA BUKAR: She was telling me that the presenting part of that patient, the second twin, is breach [feet first] presentation. >> DR. BELLO DIKKO: Breach delivery, especially in a multiple pregnancy, is a very complicated delivery. There is a need for a qualified OB/GYN doctor. >> AISHA BUKAR: We even called the doctor but he was not here. But if she is about to deliver we can take the delivery. We do it. >> DR. BELLO DIKKO: The team on call -- we usually have four. Two of them must be on the ground, the doctor on duty and the first on call. So if these two are on the ground, they may likely be in the theater. So what will happen is they cannot unscrub. That is an emergency. This is an emergency. >> SIGN: Post-partum hemorrhage >> DR. BELLO DIKKO: Hemorrhage in obstetrics is one of the leading causes of maternal mortality. >> MUHAMMED MAKA: Sakina labored in pain before the second baby was born. It was close to an hour before the boy was born. He came forth having problems. >> AISHA BUKAR: He has very severe aesphesia. We need oxygen now and we don't have oxygen. I don't want the baby to die. I don't want her to miss that baby. That is why I try with all my effort to be able to help her or to help the baby too. We cannot leave him like this. He has to see a pediatric doctor. The [pediatric] unit is far. >> SIGN: Emergency Pediatric Unit >> MUHAMMED MAKA: My son needed medical attention, and we rushed into the emergency pediatric ward. >> VOICEOVER: While the second twin was being stabilized, Sakina's condition worsened. She was diagnosed with post-partum hemorrhage. >> FARIDA BABALLE [Head Nurse-Midwife, Murtala Mohammed Specialist Hospital]: She lost a lot of blood. She's a bit anemic. She has to receive a blood transfusion. They gave her this bio-plasma, about two liters, and then they gave her normal saline. I think with that, it can take her up to six hours. One of our main problems here is how to get blood. The husband has to go and donate. Before, we normally asked the Red Cross, they mobilized people to come and donate blood to the hospital. But now, due to HIV, we stopped. They have to go and check the blood group of the husband. Then they compare it to see if it's the same as hers. If it's not the same blood group -- >> MAN: "A" positive. Not the same. >> FARIDA BABALLE: -- the husband must buy the blood. So all these things take time, and delay, and it causes the death of the woman. That is the largest cause of death of the women here. >> VOICEOVER: Muhammed's search for Sakina's rare blood type took him to surrounding hospitals and private blood suppliers. One pint of blood costs 10,000 Naira, or USD$68. The average Nigerian makes about USD$94 a month. >> TITLE: Three hours later >> SIGN: Blood bag >> DR. BELLO DIKKO: It is really disheartening to see a patient dying from a preventable cause. As far as I'm concerned, hemorrhage is a preventable cause. >> SIGN: Murtala Mohammed Specialist Hospital >> VOICEOVER: Sakina received a blood transfusion in time to save her life. >> TITLE: Two days later >> TITLE: Sakina and Muhammed's second twin >> TITLE: Fatima, Sakina's mother >> WOMAN: I don't think the baby is alive. I don't think. >> MUHAMMED MAKA: We have a teaching in the religion of Islam that states, "What Allah gives, belongs to him. And what he takes also belongs to him." All of us are from Allah, and at some point, sooner or later, we shall all return to Allah. Even though we know it hurts, we can only accept its outcome. >> WOMAN: Now on examination there is color, she is pink, not dehydrated. Then the BP is 100/70 so at least it's okay. >> VOICEOVER: After eight days in the hospital, Sakina and her surviving twin daughter went home. >> TITLE: Oyo, Southern Nigeria >> SIGN: College of Medicine, University of Ibadan >> VOICEOVER: Professor Oladosu Ojengbede is Director of the Center for Population and Reproductive Health. He is one of the continent's premier women's health physicians. >> PROFESSOR OLADOSU A. OJENGBEDE [Center for Population and Reproductive Health]: One of the reasons I got into medicine was that obstetrics was a very practical subject. There's a problem, you see it, you solve it, you're happy, the family's happy, everybody's happy. I lost my mom when I was very young. I was only three years old. I saw there were very grave challenges you face when you don't have a mom. >> TITLE: Professor Oladosu a. Ojengbede, Center for Population and Reproductive Health, University College Hospital, University of Ibadan >> PROFESSOR OLADOSU A. OJENGBEDE: Most of our women live in rural areas. And so most of the births take place outside big cities. And if most births take place in rural areas, then that is where we must work. When I'm down in some villages and you think, "Could this be happening to human beings?" You become very emotional. And you feel like shedding tears. >> SIGN: Akinyele Local Government, Maternity Center, Mele >> PROFESSOR OLADOSU A. OJENGBEDE: But then you quickly remember that, look, this is something that needs to be resolved. And you are one of those who have made up their mind to resolve it. >> VOICEOVER: Professor Ojengbede is pioneering low tech and affordable health solutions. He says these innovative tools are essential to keep women from dying of preventable causes. >> WOMAN: So this is the garment we have brought that helps to save women's lives. >> VOICEOVER: One of the most effective life-saving solutions is the anti-shock garment. This full-body suit, first conceived of by NASA, is being adapted for hemorrhaging women. The professor and an international team of colleagues have proven this suit can be used to treat shock by shunting blood from the extremities and back to vital organs. Bleeding to death is the number one killer of pregnant women, including those who live in this remote village of Mele. >> PROFESSOR OLADOSU A. OJENGBEDE: In a remote area like Mele, to get immediate access to superior care may be a challenge. Mele actually in full means, "Mele-mu-cu," which means, "I will not choose death." I love the name of this village, because what we're here for is to prevent death and promote life. >> PROFESSOR OLADOSU A. OJENGBEDE: Hello! How are you and the baby? Is the baby sleeping? >> RACHEL OLATUNJI [Pregnant with fifth child]: Yes, the baby is sleeping. >> PROFESSOR OLADOSU A. OJENGBEDE: We saw a couple. The wife is currently pregnant, and she had a two-year-old baby on her back, with scabies infections on the head and arm. >> PROFESSOR OLADOSU A. OJENGBEDE: What is his name? >> RACHEL OLATUNJI: Matthew. >> PROFESSOR OLADOSU A. OJENGBEDE: Matthew! This is scabies. >> PROFESSOR OLADOSU A. OJENGBEDE: This woman says she has five kids, and indeed the current pregnancy was really not planned for. And the question was, if it was not planned for, how come they couldn't prevent it? >> TITLE: Olurim Olatunji, Rachel's Husband >> PROFESSOR OLADOSU A. OJENGBEDE: According to the gentleman, he said, "Well, I'd rather stay with my wife than go out to find another wife for sexual responsibility." It is global knowledge that the higher the number of births beyond five, the risk increases, but even doubles from five or more. And the closer the pregnancies are, shorter than two years between birth and the beginning of another pregnancy, the higher the risk. Not just for the woman, but also for the born baby and the previous births, because they are all related. >> RACHEL OLATUNJI: I have tried on my own to prevent pregnancy, but it is to no avail. Unfortunately, I wind up with unplanned pregnancies. >> VOICEOVER: Rachel, like most Nigerian women, has five children. For Rachel, like most, at least one of those pregnancies is unplanned. >> RACHEL OLATUNJI: I am very fertile. I tried to abort a pregnancy on my own with local herbs. I started having severe diarrhea, and I lost a lot of weight. I almost died. After a while, it became evident that I was still pregnant, so I started prenatal care and I accepted my fate. >> TITLE: Sunday morning church service >> ELIZABETH ADESINA [Community Birth Attendant]: When we speak of family planning, the husbands think this is a secret way of encouraging their wives to be unfaithful and start sleeping around. But if the emphasis is on preserving their wives' lives and the care of their children, they will understand. >> PROFESSOR OLADOSU A. OJENGBEDE: The men in this village are eager to improve the reproductive life of their families. >> PROFESSOR OLADOSU A. OJENGBEDE: What do we do -- what do we know so that we can make love to our wives but not have pregnancy occur? First, you can use tablets. If you use condoms all the time, they are very effective. >> PROFESSOR OLADOSU A. OJENGBEDE: We are seeking a dialogue with the men today, to have an in-depth introduction in contraception, how it impacts on health, how it impacts on the family, on income, on development. >> MAN: If a person can calculate the days very well, can there be a mistake between this time and this time for ovulation to take place? >> PROFESSOR OLADOSU A. OJENGBEDE: Well, we didn't create this place where the egg comes from, and though there's a time range, it can vary. That is why it is better not to take the risk at all. So if you're waiting for that time, and you really want to make love to your wife, what are you going to do? There's nothing you can do to satisfy the need so that a man cannot wait! And if the wife says at that very moment, "Wait, you said we shouldn't get pregnant," the man can't think right! We should not guess. We should have a decisive method. >> VOICEOVER: Every Thursday morning in Mele, preacher and community birth attendant Elizabeth Adesina opens her prenatal class with a prayer. >> TITLE: Elizabeth Adesina, Community Birth Attendant >> PROFESSOR OLADOSU A. OJENGBEDE: Faith-based practices probably see more patients in this country than the public sector facilities, simply because they provide the services within the context of understanding the values and the norms of the community they are serving. >> ELIZABETH ADESINA: Glory be to your name that she will not suffer. We will always praise your name, Father, in Jesus' name, amen. >> TITLE: Kano, Northern Nigeria >> FARIDA BABALLE: I started practicing midwifery in 1986, almost twenty-something years as a midwife. I was posted here October 2007. I was on leave at that time. When I came down there, they said they are taking me to the labor room. I said, "I don't want labor room now. All my years of service, my experience, has finished in the labor room, so please can you change me now so that I can have another area." They said no. They wanted me to be here. "We need something from you to come out and implement it here for us." I said, "It's okay." That is how God willed for me to help my fellow women. So when I came back, I sat down and said, "Oh," I asked them, "What are your statistics?" So I took three years of the register. I picked three things. What is the problem there, in the ward? And I write what my observation is there. So from that, we'll do our own assessment. This will tell us if it's the problem of the midwife, the problem of the doctors, or the problem of the community. >> FARIDA BABALLE: You see, January of last year we had eleven maternal deaths. So you know there is a problem here. >> VOICEOVER: Women die in the north because their culture often forbids them from travelling without a male escort, even when they're bleeding to death. Aisha Ibrahim, who gave birth to her eighth child at home, is one of them. In fact, knowing this precept, her husband Kabiru stayed with her. >> KABIRU IBRAHIM [Aisha's Husband]: My wife Aisha bled too much with her last two deliveries. So I made sure during this delivery I would stay close by to support her. >> VOICEOVER: But in the midst of the crisis, his car broke down, and he left to repair it. Stranded and hemorrhaging blood, Aisha had to wait for her father-in-law's permission to take a taxi to Farida's hospital with another male relative. >> AISHA AMIRU [Aisha Ibrahim's Sister-in-law]: I was there. They said she had lost so much blood. There was no more blood, that her blood was all gone. Honestly, when we brought her to the hospital, in her own words she kept saying she was going to die, she was going to die. >> NURSE: We checked her BP [blood pressure]. The BP is 70/query [too low to measure]. Some patients even die with that. >> FARIDA BABALLE: They just come at their dying minutes. They set a drip-normal saline and isoplasma for her. Then we applied the anti-shock garment. Then once you put it on, within a short time, when you check the vital signs, you find there is BP, there is pulse. The woman is coming back. >> DR. BELLO DIKKO: The anti-shock garment is just a way of buying time before you can procure blood for the transfusion of this woman. >> FARIDA BABALLE: The time that we didn't have this anti-shock garment, the woman will just go, will just die, because there is nothing we can do to help her. The only thing we can do is just to elevate the foot off the bed. Apart from that, there is nothing we can do. >> VOICEOVER: Aisha's husband, Kabiru Ibrahim, is a taxi driver in Kano and a father of thirteen. >> KABIRU IBRAHIM: When I arrived here at Murtala Mohammed Specialist Hospital, they told me about the garment they applied to control the bleeding. Then they told me she was in need of blood. >> NURSE 1: The blood is her immediate need. >> KABIRU IBRAHIM: My brother and I searched all around for her blood type. But there was none available. My calmness was rattled, of course. I was thinking, before I'm able to find the blood, I would return to find her dead. I was grateful to Allah that I had the means to purchase the blood, but it was nowhere to be found. >> NURSE 1: The minute she came, we took her blood sample for relations to go look for her blood. But still yet you can see, how many hours ago? No blood yet. >> VOICEOVER: After searching for five hours, Kabiru found two pints of Aisha's blood type. >> NURSE 2: Blood pressure is 120/80 -- it's normal. >> HALIMA BEN UMAR [PATHS2]: She was telling me how this was the worst, she suffered the most out of all the seven she had. Then I said, "Have you thought about family planning, I mean child spacing?" Then she said, "Yeah...ah, uh huh. Is it something you can do?" She said her husband would not allow her to stop giving birth. I said, "No, I'm not saying stop, I'm just saying space." Islamically, it is wrong for you to say you want to have two children, you want to have four, but Islamically you can space. >> FARIDA BABALLE: The reason why most of our people don't believe in this family planning is because sometimes they misquote religion. They say God has said, "Deliver us many and they multiply the world." >> HALIMA BEN UMAR: Sometimes I felt maybe should I talk about family planning? But I know I spaced my children. If I hadn't, I would probably have had fifteen. That would have been disastrous. >> FARIDA BABALLE: I hope a lot of things that happen will change. >> HALIMA BEN UMAR: The change is coming gradually. But I think we need to move a little faster than the rate we are moving. Islam moves with civilization. >> FARIDA BABALLE: Yes, this is what I think. >> VOICEOVER: Kano is one of the twelve northern states in Nigeria governed by Islamic law, or Sharia. Daily life in this ancient city revolves around Islamic culture. Improving reproductive health requires a delicate interplay between Islam and modern medicine. >> SIGN: Allah is the greatest >> HALIMA BEN UMAR: In this part of the country, you need to work with the religious leaders. If you want to achieve your objectives, your aims, then you need to look at, what does Islam say? How do you do it so that it becomes more acceptable? For me, I have always been an advocate of family planning. People see it as a western idea; people see it as the west trying to impose their ideas on us, so it becomes a little bit difficult. >> SAKINA MAKA: Assalamu Alaykum >> FARIDA BABALLE: Wa Alaykum Assalam. How is your day? >> SAKINA MAKA: I'm well, and how is your day? >> TITLE: Sakina and twin daughter, four months after delivery >> FARIDA BABALLE: So, what we do here is family planning birth control. Do you know what that means? >> SAKINA MAKA: It's like having control between deliveries. For example, two and a half years before having another baby. >> FARIDA BABALLE: Within those two years, your husband will save up some money. You see? If you have a baby and then, in a year, another and another every year, he wouldn't save any money, and then you're not in good health and the baby will not be healthy. That's why we use family planning. >> FARIDA BABALLE: Now there's a lot of awareness of family planning for our people. Our women are coming on their own. They don't wait for their husbands. They decide on their own health, instead of waiting for their husbands to decide on their health. >> KABIRU IBRAHIM: Aisha stayed in the hospital for sixteen days until she regained her health. Then she was discharged and we went back home. That's what happened. >> VOICEOVER: Kabiru's first wife died giving birth to their seventh child, and he has never used birth control until now. He attributes this behavior change to a deeper understanding of safe motherhood in the Islamic community. >> KABIRU IBRAHIM: Before this delivery I didn't agree with the idea of a woman taking a break, because rest comes from Allah. If Allah does not grant a break, you will surely give birth. The Muslim religion allows that she take a break to save her life, because she might lose her life in the process. That is why I agreed. >> AISHA IBRAHIM: Trial birth causes all sorts of mishaps and problems. It brings all kinds of thoughts to mind, like either you retain your life or you lose it. >> PROFESSOR OLADOSU A. OJENGBEDE: You can say, women's rights should be well protected, but the truth is, for now, we have not put in place all the structures that protect women's rights completely in developing countries. And that's what we must put into context when we're fashioning out programs and projects that would serve women. We need to find the appropriate way and culturally acceptable way of circumventing the obstructions. That challenges are enormous, and sometimes they're depressing. The frustrations are everywhere, but the resolve is stronger than the frustrations. >> TITLE: Murtala Mohammed Specialist Hospital >> DR. BELLO DIKKO: Welcome to Habibu Sadouki Blood Transfusion Center, Murtala Mohammed Specialist Hospital. What you have is a blood bank fridge, which has the capacity of keeping about 300 units of blood. It will be tested, filtered, stored, and the ones that will be needed in the maternity will immediately go to maternity. >> MAN: My message to you all is: please help keep our women alive. >> VOICEOVER: Frustrated by the lack of blood supply for maternity patients, Dr. Dikko successfully lobbied health officials for a separate maternity blood bank. Since opening in February 2009, waiting times for maternity ward patients in need of blood has been reduced by 75 percent. >> DR. BELLO DIKKO: If you go inside the blood bank now, the two fridges that you saw the other time are almost packed full. >> FARIDA BABALLE: A lot has changed. It reduces the delay in having the blood. The midwives draw the blood, they send the blood, and then it quickly saves the lives of the patients. You can see the results in our reduction of maternal mortality. There are very few deaths now. It's very low. >> VOICEOVER: The maternity blood bank began collecting blood donations one week after Sakina gave birth to her twins. >> DR. BELLO DIKKO: Each and every one of us, whether a man or a woman, came out of a woman. As long as there is one maternal death, it's a family mortality. Not an ordinary mortality. If you can reduce maternal mortality in Kano State, then definitely the denominator in the issue of maternal mortality in the whole country will definitely reduce. And if it reduces, then it will be my greatest achievement, and I can even resign and go home. >> TITLE: Dr. Bellow Dikko is part of a landmark effort to train religious leaders about reproductive health. He advocates for the right of pregnant women to travel without male escorts, and free maternity services. Farida Baballe's observational study showed maternal deaths have been nearly cut in half, from 196 in 2008 to 102 in 2009. Professor Ojengbede and international colleagues, led by Professor Suellen Miller at UC San Francisco, have tested the anti-shock garment on more than 3,000 women in Nigeria, Egypt, and Mexico. They found that women who received the anti-shock garment lost 50 percent less blood and have 64 percent fewer deaths. Pathfinder International, a non-profit organization, has trained more than 4,000 Nigerian health care providers to prevent, treat, and diagnose post-partum hemorrhage. Pathfinder has distributed 456 anti-shock garments and is collaborating with federal and state governments to scale up the project. While documenting these stories, the filmmakers worked in unison with families and healthcare workers to accurately portray pregnancy and childbirth. Several times we affected outcomes by contributing resources for transportation, cell phones, and pharmaceuticals. In the case of Sakina Maka, her husband Mohammed, an Arabic teacher, was unable to procure funding for blood after hours of searching. We gave Mohammed the 10,000 Naira needed to buy the blood. >> VOICEOVER: What do you want to be when you grow up? >> GIRL 1: I want to be a doctor. >> GIRL 2: I want to be a doctor. >> GIRL 3: A nurse. >> TITLE: Brown Doggy Pictures, in association with Woodlawn Avenue Productions: The Edge of Joy. Director and Producer: Dawn Sinclair Shapiro. Narrator: Eliza Griswold. Executive Producer: Tod Lending. Editors: Michael S. O'Brien, Melissa Sterne. Director of Photography: Nicola B. Marsh. >> TITLE: [End credits] http://www.viewchange.org/videos/living-proof-nicaragua-a-vaccines-remarkable-journey Follow the life of a vaccine from its creation in a lab in Pennsylvania to the mouths of newborns in impoverished Nicaragua. This innovative film touches on every step that a pharmaceutical drug must take in its difficult journey to reach those who need it most. Wed, 02 Feb 2011 10:18:00 +0000 http://www.viewchange.org/videos/living-proof-nicaragua-a-vaccines-remarkable-journey Rotavirus vaccine, Pediatrics, Nicaragua, Managua, Immunization, GAVI Alliance, Public health, Living Proof, ONE Campaign >> TITLE: Journey of a Vaccine>> TITLE: Rotavirus kills 500,000 children under five every year. Thirty years ago, one pediatrician began a journey. >> TITLE: Pennsylvania: 1 dose; 2 milliliters; 10 years of research; 16 years of development; 1 billion dollars; the best minds in science>> SIGN: Nicaragua Ministry of Health, Policlinica Oriental Ministeri de Salud 40 Metrros Abajo, Managua, Nicaragua>> SIGN: Managua, Nicaragua>> TITLE: Below 35F it freezes; above 46F it spoils; 2,254 miles>> TITLE: A new journey begins>> TITLE: The first rotavirus vaccine arrived in Nicaragua three years ago. There have been no major outbreaks since. By 2015, the Global Alliance for Vaccines and Immunizations [GAVI] will introduce the Rotavirus vaccine to 44 of the world?s poorest countries, covering 60 percent of all newborn children. http://www.viewchange.org/videos/kill-or-cure-saving-lives <p>The Advance Market Commitment scheme, formulated by the GAVI Alliance, aims to provide more vaccines to the developing world by fixing their price over a 10-year period. Is it going to deliver, what will be the result, and how did global health institutions and the big pharmaceutical companies manage to agree on such a deal?&nbsp;</p> Wed, 07 Jul 2010 22:59:00 +0000 http://www.viewchange.org/videos/kill-or-cure-saving-lives GAVI Alliance, Pneumococcal vaccine, Africa, Pharmaceutical industry, Developing country, Vaccination, Vaccine, Pneumococcal conjugate vaccine, Orin Levine, Julian Lob-Levyt >> TITLE: Kill or Cure >> VOICEOVER: In the summer of 2009, an historic agreement was struck to save millions of children from a deadly disease. >> DR. JULIAN LOB-LEVYT [CEO, GAVI Alliance]: Each year, pneumonia kills more children than HIV, TB, and malaria put together. >> VOICEOVER: The vast majority of victims are in the developing world, where there's no money to pay pharmaceutical companies for a vaccine. >> BUSAYO OGUNBODE: My baby has pneumonia and the baby died because of the pneumonia. >> VOICEOVER: Now, the international community has agreed to fund a vaccine to prevent such tragedies in the world's poorest nations. >> ANDREW JACK [Pharma Correspondent, The Financial Times]: It's creating a guaranteed market, a form of reassurance to those developing new vaccines, including those specifically for the developing world, that there will be a market at the end of the day. >> VOICEOVER: Five nations and the Bill & Melinda Gates Foundation agreed to pay USD$1.5 billion in the hope of saving up to seven million lives. >> TITLE: Drug Money >> VOICEOVER: Dr. Orin Levine leads a team from the renowned Johns Hopkins Bloomberg School of Public Health in the USA, dedicated to providing a vaccine against the world's deadliest threat to children. His job takes him all over the globe in the fight against pneumococcal disease, which kills more children under five than any other illness. >> DR. ORIN LEVINE [Johns Hopkins Bloomberg School of Public Health]: We have safe efficacious vaccines against a terrible disease that just aren't being applied. So, not only is it a huge disease, but it's a problem with a solution >> VOICEOVER: Today Orin is visiting Rwanda, a country just emerging from a tragic recent past. Rwanda is staging a huge party and Orin is guest of honor. >> DR. RICHARD SEZIBERA [Minister of Health, Rwanda]: Pneumonia is a leading cause of death among under fives in our country, accounting [for] over 25 per cent of all infant deaths. >> VOICEOVER: The Rwandan minister of health is presiding over a ceremony to mark the introduction of a vaccine to prevent pneumococcal disease. >> DR. RICHARD SEZIBERA: We as a government are determined to make sure that children attain their fifth birthday, their 10th birthday, their 40th birthday, and -- why not -- their 70th birthday. >> VOICEOVER: The minister inaugurated a program to distribute the vaccine for free. A doctor, he delivered the ceremonial jab himself. The project was launched by the Rwandan Government and GAVI, an alliance of international organizations, countries, and companies dedicated to spreading the benefits of vaccines and immunization. Dr. Levine's team helped GAVI make the case for the deal. >> DR. ORIN LEVINE: Today is a historic moment because today with the access to pneumococcal vaccines that's been given Rwandan children, we're going to begin the first program through the GAVI Alliance to prevent this important disease in low-income countries. >> VOICEOVER: In cooperation with GAVI, pharmaceutical company Wyeth donated enough doses of the pneumococcal vaccine Prevenar to immunize all Rwandan infants under the age of one. >> JIM CONNOLLY [Head of Vaccines, Wyeth]: This is our personal opportunity to make a difference in this world and we have an opportunity with Prevenar to dramatically change the course of the disease that is a significant killer of children and adults on a worldwide basis. >> VOICEOVER: Wyeth's gesture is cause for celebration in Rwanda but it's only a first step. The Rwandans have been given a vaccine widely used in rich nations. It protects against seven strains of the disease. Developing nations ideally need a more powerful vaccine. And another 70 of world's poorest nations eligible for GAVI help don't have a pneumococcal vaccine at all. In Nigeria, two-year-old Olajumoke lies seriously ill with pneumonia. Without a vaccination, doctors rely on increasingly ineffective antibiotics to treat the illness. She's watched over by her mother, Blessing, who's desperately anxious. Pneumococcal disease kills 1.6 million people every year, and nearly 1 million are children under five. So what exactly is this threat to the world's infants? Pneumococcal bacteria lurks in the back of the throats of 80 per cent of all people. If it breaches a natural barrier formed by mucus, it can cause pneumonia or meningitis, both potentially lethal. The need for a vaccine is much greater in the developing world where more than 98 per cent of fatal cases occur. But it's up to the pharmaceutical industry to develop vaccines, at substantial cost. The industry, historically, has sold its goods to those countries who can pay the most. >> ANDREW JACK: In order to recoup hundreds of millions of dollars that the drug companies have put into developing these products, they've tended to focus therefore on maximizing the returns, having high prices, concentrating on the large, developed markets of North America, Western Europe, and Australia and Japan. >> VOICEOVER: A free market in vaccines has failed to address the needs of the majority of people in the world. The situation was even worse 10 years ago. >> SHANELLE HALL [Director, Supply Division, UNICEF]: We had global shortages of even the basic vaccines: tetanus, measles, DTP. I remember a year, we were short by 80 million doses and I mean this was for 70 to 80, 90 countries, and we were in the midst of a major departure of many of the big pharma companies from producing vaccines for developing countries. >> DR. JULIAN LOB-LEVYT: There was a market failure for public goods, global public goods, and a vaccine is a classic global public good. >> VOICEOVER: Historically, developing countries have had to wait 15 to 20 years for prices to fall after R&D costs have been recouped before they can afford to provide vaccines for their children. Since 2005, Dr. Orin Levine and the GAVI Alliance have been working on an ambitious program to speed up the provision of vaccines to poorer nations, starting with an injection to protect against pneumococcal disease. Today, he's on a research trip to Nigeria. >> DR. ORIN LEVINE: I'm a parent. I've got two daughters. They both got pneumococcal vaccine. Why should children who just happen to be born in an African country be denied access to a life saving vaccine for that reason? One of the most important things that we can do during our visit here in Nigeria is to hear directly from the pediatricians who take care of children with pneumonia and pneumococcal disease, to hear from the parents and families who've been affected. >> VOICEOVER: He's visiting University College Hospital in the city of Ibadan, where Olajumoke lies ill. He's meeting with senior pediatricians at the hospital. >> DR. ORIN LEVINE: Do children in Africa deserve access to these life-saving pneumococcal vaccines as much as children in the West? >> PROFESSOR ADEGOKE FALADE [Senior Consultant Pediatrician, UCH]: I feel upset, because I think that vaccine is needed more in developing countries like Nigeria than in Europe and North America where it's not an immediate problem today. >> PROFESSOR KIKELOMO OSINUSI [Head of Pediatrics, UCH]: There are some conditions that make children in this country, in Nigeria, particularly susceptible to pneumococcal disease. We now have a critical mass of children who have some immune depression or whose immunity is not good enough. >> VOICEOVER: On the emergency ward, Orin meets Blessing and her two-year-old daughter Olajomoke. >> DR. ORIN LEVINE: What was she like when you brought her here. Why were you worried for her? >> BLESSING: When I came here she was convulsing, so maybe I get scared. She ... she was unconscious. Because I was being transferred from a clinic. So she was unconscious but still convulsing when I get here. >> VOICEOVER: When Orin revisits the following day, Blessing is still there. She's now been at her daughter's bedside for six days and nights. The lengthy stay has cost her 30,000 naira [NGN]. That's a very substantial sum of money. Ninety per cent of Nigerians live on less than 10,000 naira per month. >> BLESSING: It's very difficult for me to get the money to take care of her. Sometimes I'll borrow. I'll do all kinds of things to get the money. >> VOICEOVER: But Blessing is praying that she won't have to pay a much higher price: the life of her daughter. In part two: the new initiative that could spare millions of children like Olajumoke their suffering. >> TITLE: Kill or Cure >> VOICEOVER: For the past two years, the GAVI Alliance has been working with donor governments to provide a pneumococcal vaccine for the developing world. They came up with a plan known as the "advance market commitment" or AMC. It's designed to guarantee pharmaceutical companies a market for the vaccine in poorer countries. In the summer of 2009, GAVI chief executive Julian Lob-Levyt announced that funds were finally in place. >> DR. JULIAN LOB-LEVYT: This has been an astonishing international collaboration of political leadership, technical participation at the individual level, financially within the markets, with industry, and with public health community. It really is a very historic moment. >> SHANELLE HALL: Now through the AMC we have an innovative approach to ensure the necessary quantities of pneumococcal vaccines are produced for children in developing countries at an affordable price. >> VOICEOVER: Italy, the UK, Canada, Russia, Norway, and the Bill & Melinda Gates Foundation signed a deal to provide USD$1.5 billion for the vaccine. And GAVI will contribute a further USD$1.3 billion. Unicef, the World Health Organization, The World Bank and the Johns Hopkins Bloomberg School of Public Health helped GAVI to construct the initiative, designed to appeal to both profit-driven companies and the recipient nations. >> DR. JULIAN LOB-LEVYT: There've been some extremely smart economists working out of Harvard who've, you know, made almost a lifetime's work in The World Bank and elsewhere to really research the model and see how it works. >> ANDREW JACK: The AMC is essentially designed as a financial incentive to vaccine manufacturers to say: if you develop vaccines that are relevant to those in the developing world, to the world's poorest, there will be a market for those products, so you don't have to worry that you'll spend tens or maybe hundreds of millions of dollars developing something, and then find that none of these poorer countries are willing or able to pay for them. >> VOICEOVER: The architects of the AMC reckon they're tackling the world's most immediately pressing cause. >> DR. JULIAN LOB-LEVYT: The two biggest killers of children at the moment are pneumonia and diarrheal disease and pneumonia is by far the biggest killer, it's a no-brainer quite frankly. >> DR. ORIN LEVINE: If we have a serious, common, and preventable disease, shouldn't that be at the top of our to-do list in global health? >> VOICEOVER: Orin's now visiting another mother whose baby son also contracted pneumonia. >> BUSAYO OGUNBODE: The baby is two months old. The baby started with a cough, no, with catarrh and a cold. The cough is very serious. He's two months old. If he's coughing he will be straining all his body like this, all his body was stiff. You know, I'm a woman. So if something is draining my baby, it means the thing is draining me. You understand what I say. >> DR. ORIN LEVINE: I do, I'm a parent also. You feel when your children are sick >> BUSAYO OGUNBODE: I feel the pain. When he's coughing, I feel the pains. And I couldn't sleep. He was always crying in the middle of the night, so that's why I took him to hospital >> VOICEOVER: Busayo and her husband spent nearly 50,000 naira on a hospital bill for their baby. >> BUSAYO OGUNBODE: We go through a lot of stress. We borrowed, we sell a lot of things, because we are not OK. We borrowed ... we beg, even beg. We did not think about the money, but we were trying to save the baby's life. The baby died because of the pneumonia. So you go through a lot of stress before the baby die. I would spend a lot of money to save the baby's life, but the baby died. So we lost the baby, sure. >> DR. ORIN LEVINE: See, it's unconscionable to me that the technologies that we've helped to develop are reaching only the children who can afford them, who are arguably the children who need them the least, and failing to get to the children who need them the most. >> VOICEOVER: The AMC will come too late for millions like Busayo and her baby. But with funds secured, the process of inviting pharmaceutical companies to bid for contracts under the AMC has begun. Unicef is handling purchase of the product. >> SHANELLE HALL: We're seeing a number of applications, which is fantastic, both from the multinational companies and also from emerging market companies, which is very healthy. >> VOICEOVER: It was crucial to set up competition between the companies. >> DR. JULIAN LOB-LEVYT: You absolutely need competition in this world whether it's drugs or vaccines or soap powder, in order to get the best product and to get it at the best price. >> VOICEOVER: And there's another vital objective which GAVI has set. Current pneumococcal vaccines were developed to guard against varieties of the disease found in rich countries. GAVI is seeking more powerful vaccines to protect against other strains which threaten the poorer nations. The aim is to prevent 80 per cent of infections worldwide. So how has the pharmaceutical industry responded to the challenges and opportunities? The Wyeth corporation, which gave away its seven-strain vaccine to Rwanda, is keen to get involved in the broader plan to sell the improved version to all the poorest countries. >> JIM CONNOLLY: Companies like Wyeth and other pharmaceutical companies have an obligation to make their products available to as wide a population ... With financing mechanisms like the AMC, we think there's a way that's both affordable from a country's perspective and sustainable from a shareholders perspective, and I think we can strike the right chord from a pneumococcal vaccine perspective. >> VOICEOVER: Wyeth and two other pharmaceutical companies, GSK [GlaxoSmithKline] and the Serum Institute in India, are developing pneumococcal vaccines which could be used for the AMC, if they meet standards required by the World Health Organization. In a statement, GSK said that it would review the terms and conditions of the AMC and consider whether to deliver a pneumococcal vaccine to developing countries under the framework. Under the AMC, GAVI will sign 10-year deals, paying USD$7 per shot for the first 20 per cent of vaccinations provided. This will allow the companies to recoup the cost of new factories and manufacturing equipment. After that, the price falls to USD$3.50 for the rest of the contract. >> DR. JULIAN LOB-LEVYT: Once those research and development costs have been absorbed, that vaccine is provided to the poorest countries in the world as at near to production costs as is technically feasible. >> VOICEOVER: So is the industry now interested more in doing good and less in making money? >> ANDREW JACK: All of the big companies have started saying that we can and we should morally and economically make medicines available more affordably to the poor. And in the process we can make some money, we can make this sustainable, but above all many more patients can benefit >> VOICEOVER: Orin makes his last visit to Blessing and Olajomoke. >> DR. ORIN LEVINE: Have you seen any progress in this child since the last couple of days? >> DOCTOR: Yes, we have. Initially we had to feed her with a tube and we've been able to take that out. She's feeding by cup and spoon now. And she's very much alert and she's doing very well. She's done very well. >> BLESSING: I am very very happy that she has made it and she has responded to the medicines which have been given to her. >> VOICEOVER: Blessing and Olajumoke have gone through a terrible ordeal. But it's so much worse for all the millions of families whose children don't recover. The AMC may offer real hope that a solution is to hand, but much needs to be done before the first child is injected. The pharmaceutical companies need to develop the vaccines to meet the necessary standard, and the recipient countries need to demonstrate the ability to distribute the vaccines. But Dr. Orin Levine believes the challenges can be overcome. >> DR. ORIN LEVINE: The AMC could be delivering life-saving pneumococcal vaccines to children in the poorest countries of the world as early as the end of 2009 or early 2010. >> VOICEOVER: The AMC will lead ultimately to the vaccination of one billion children, saving seven million lives by the year 2030. And that's not all. >> DR. JULIAN LOB-LEVYT: If this model works it should be applied to other vaccines for other diseases and perhaps for drugs to treat other diseases, so this is an innovative instrument. Potentially this could be saving millions of lives, now affected by tuberculosis, by malaria, and so that's the second reason to be quite excited by this pilot >> VOICEOVER: The hope is that the AMC will ensure that children like these and millions more like them will grow up to fulfill all their dreams and ambitions. >> DR. ORIN LEVINE: What else, what else does somebody want to be when they grow up? >> CHILDREN: A doctor! / A nurse, a nurse! / Doctor! >> DR. ORIN LEVINE: A nurse, a lot of doctors, and nurses. Really. Doctors ... Nobody wants to be a football player? >> CHILDREN: Yes! >> VOICEOVER: So how welcome would a pneumococcal vaccine be in the countries which need it? >> PROFESSOR KIKELOMO OSINUSI: A lot of time will be saved for treatment of other conditions, and many other savings would be carried out: the cost of looking after the children, the time of the parents who stay in the hospital with children, and all the anguish of losing the children. I think I will be very happy, when ... if this is introduced into the country. >> DR. ORIN LEVINE: What would you say if I told you that in a few years we think there's going to be a vaccine that could prevent the kinds of pneumonia that took the life of your baby? How would you feel about that? >> BUSAYO OGUNBODE: I would be very happy if such a thing could happen. >> TITLE: [end credits] >> TITLE: rockhopper TV http://www.viewchange.org/videos/unicef-fighting-pediatric-aids-in-cote-divoire With almost a five percent HIV prevalence, C&ocirc;te d&rsquo;Ivoire is one of the countries worst affected by HIV/AIDS in West Africa. UNICEF helps sustain a health center in Bouake that treats over 800 HIV/AIDS orphans and vulnerable children as well as provides social and educational support. Wed, 09 Jun 2010 20:47:00 +0000 http://www.viewchange.org/videos/unicef-fighting-pediatric-aids-in-cote-divoire Côte d'Ivoire, AIDS, HIV, Abidjan, Bouaké, Vertical transmission, UNICEF, Pediatrics, Health, Yopougon >> VOICEOVER: Young Emily is HIV positive. AIDS took both her parents and now she lives with the daily reality of the disease. She stays with her aunt in the one-time rebel capital of Bouake in central Côte d’Ivoire. Here, AIDS has picked up where the civil war left off, continuing to take innocent lives. Daily chores leave Emily exhausted and reaching for her lifeline, her medication. Her aunt is unemployed and there is rarely enough money for food, never mind medicine. But she’s one of the lucky ones. Every few days she sets off alone for a special center in central Bouake. Here, doctors that specialize in pediatric AIDS examine her; these regular visits allow them to track her progress. For nearly ten years UNICEF has worked with this center to provide support to those affected by AIDS. >> DR. SORO OUATTARA PAULE [Pediatric Specialist]: Because of the poverty and the fact that our sick patients can’t work, the center has to take care of the patients not only medically, but also socially. We give food to parents and their children. >> VOICEOVER: The center is also home to a youth outreach project. Members go door-to-door, visiting families affected by AIDS, offering emotional and psychological support. To those families unaffected, they offer awareness and advice. >> JEAN CLAUDE [Peer Educator]: Sexuality is a taboo subject in African culture and usually it’s easier for young people to talk about it and find answers because we share the same daily experiences. >> VOICEOVER: At this UNICEF-supported clinic in Yopougon, outside Abidjan, HIV positive pregnant women undergo treatment to prevent mother to child transmission of the virus. After giving birth, their babies undergo testing to determine whether or not the treatment was successful. These centers and clinics are critical to the health of a nation. Ninety percent of infections in children are the result of mother to child transmission. Reducing the country’s infection rate is the ultimate goal. Existing projects have been successful, but more needs to be done. This is Amy Bennett, reporting for UNICEF Television. Unite for children.