http://viewchange.org Videos from ViewChange.org (Filtered by topics: Pregnancy) en-us Tue, 10 Jan 2012 10:22:00 +0000 Copyright 2011 Link Media, Inc. http://www.viewchange.org/videos/the-health-show-riders-for-health-2 Access is often the largest obstacle to healthcare. Nowhere is this more apparent than in the rugged, mountainous country of Lesotho, where much of the population lives mired in rural poverty. But one organization, Riders for Health, has introduced an all-terrain option that's linking communities in the most remote regions: the motorbike. Tue, 10 Jan 2012 10:22:00 +0000 http://www.viewchange.org/videos/the-health-show-riders-for-health-2 Lesotho, Health, Riders for Health, HIV, Africa, Sub-Saharan Africa, Healthcare, Rural area, Television, AIDS >> VOICEOVER: The mountain kingdom of Lesotho is a land of heights and extremes. The entire country stands more than 3,000 feet above sea level. The terrain and climate are harsh, and more than 75 percent of the population lives in rural areas. Delivering regular health care to those in the countryside is nearly impossible. But thanks to Riders for Health, a global non-profit, one vehicle is changing the game: the motorbike. It's rugged, it's durable, and it lets healthcare workers reach all their patients, no matter how remote. Challenges abound, but with a motorbike, distance is no longer such an obstacle. Join Rockhopper TV as it follows six people using these motorbikes to alter the terrain of healthcare delivery. >> TITLE: ViewChange >> TITLE: Riders for Health, Rockhopper TV, Lesotho >> VOICEOVER: The mountain kingdom of Lesotho in southern Africa. Here, most people live high in remote villages, far from tarred roads and beyond the reach of most vehicles. In winter, villages are often cut off altogether by snow. For most people, getting around here means walking. It's early morning, and yesterday's snow means a cold start for Thabiso Phoka. He's a nurse at Auray Health Center high in the mountains. >> THABISO PHOKA [Nurse, Auray Health Center]: I'm preparing the package for the outreach. There's a tally sheet inside and the needles as well for the immunizations. >> VOICEOVER: Today, Thabiso's getting ready to travel to the village of Hatakani to immunize babies and run an under five's clinic. It is ten kilometers away over rough ground - half a day's walk for most people - but Thabiso is lucky; he'll be going by motorbike. >> THABISO PHOKA: I always loved the idea of being a nurse because I wanted to help people in the community. The roads are really difficult, and it's tough riding when it's so cold. But now I know I can get wherever I need to without any problems. >> VOICEOVER: Thabiso's destination, Hatakani, is a very remote place. A simple lack of transport means people are often unable or reluctant to get medical help. For Thabiso, this meant diseases went untreated and children remained unvaccinated. But last year he was provided with a motorbike and trained how to ride it. But even for Thabiso, Hatakani is hard to reach, and he has to walk the final leg down to the village. >> THABISO PHOKA: Before the motorbike it was not easy to come. I think they were thinking that we were neglecting them. >> VOICEOVER: Thabiso comes here on a set day every month. Mothers from the village and surrounding area have brought their children for an under five's clinic. >> THABISO PHOKA: The most important things I do in the villages are vaccinations and giving health talks about how people should take care of themselves, because some of the illnesses they come to the health centers with are things they themselves should be able to prevent. The cases we used to see a lot were hygiene related, like diarrhea and scabies, but they're no longer here because we've taught people how to look after themselves. >> TITLE: ViewChange >> VOICEOVER: These new recruits are starting their second day of training. None of them have ever ridden a motorbike before. Isaac Monokwa, like the other trainees, works at a government-run rural health center. >> ISAAC MONOKWA [Ministry of Health, Lesotho]: I work as an HIV/AIDS counselor. My job at the clinic is to encourage people to check their status. I do the tests myself and if they test positive, I talk to them about the treatment they must follow. The motorbike will really help me. I'll be able to get around much quicker and will be able to get to more villages in a day. >> VOICEOVER: But when it comes to learning to ride, Isaac has a long way to go. It seems he'll be testing Soloman's teaching skills, and his reactions. >> SOLOMAN HLASA [Motorbike Instructor]: It's just a matter of giving him a lot attention. >> ISAAC MONOKWA: I had some difficulties changing gears at first. But as I ride more, I'm getting used to it. >> SOLOMAN HLASA: He's not yet confident standing up. >> VOICEOVER: If Isaac can't stand up on the bike, there's no way he'll tackle Lesotho's rough terrain. >> SOLOMAN HLASA: Oh, you can see he's very scared. >> VOICEOVER: But Isaac's determined. He has a very personal reason to succeed. >> ISAAC MONOKWA: I wanted do this work because I discovered I was HIV positive. When I found out, my life became miserable, and back then the treatment wasn't really available. I went for counseling and they were looking for people who weren't ashamed to come out and talk about their status. I turned out to be one of the brave ones and they gave me training. >> VOICEOVER: The weather in Lesotho can change in an instant. Today, Isaac and the other trainees are getting their first taste of riding in the rain and over rough ground. The going's tough for all the riders - but especially for Isaac. >> SOLOMAN HLASA: He comes off the bike but he gets back on very fast. He shows a lot of courage. >> ISAAC MONOKWA: I think it is determination that brought me here. I knew I'd meet these challenges and that I'd fall, but to fall doesn't mean you have to give up. You have to get back on and carry on riding. >> VOICEOVER: Gradually, Isaac starts to get the hang of it. >> SOLOMAN HLASA: So far Isaac has improved a lot, and he's making me proud so far, yeah. >> ISAAC MONOKWA: Today's training was really tough but I liked it. I'm going to sleep like a baby. I'm really tired. >> VOICEOVER: Back at his government health center, and having passed his two weeks training, Isaac's ready to hit the road. >> ISAAC MONOKWA: I'm very excited because this will be my first day. Today I'm going to a village called Gamosethe. I'm going to follow up on patients who I've not seen for over a month. I think they'll be happy because before I wasn't able to get to them, so I think they'll be excited to see me. >> VOICEOVER: And he was right. >> TITLE: ViewChange >> TITLE: Riders for Health, Rockhopper TV, Lesotho >> VOICEOVER: Takiso Setsabi is on his way to one of the seven rural health centers he serves. He's one of thirty sample transporters operating in Lesotho - the missing link between rural clinics and hospital laboratories. >> TAKISO SETSABI [Nurse]: I love riding the bike because it's not here for fun but to help the community. It makes me really proud because there aren't many of us who ride. >> VOICEOVER: At Takiso's destination, Fatima Health Center, the nurse, Tjoloba, is with one of his HIV positive patients. Mamahloli has walked for four hours to get here from her village. The drugs she takes to manage her HIV have been causing her painful side effects, so she's stopped taking them. >> TJOLOBA TJOLOBA [Nurse, Fatima Health Center]: We are going to check kidney and liver function so we can change her drugs to another first line regimen, which has lesser side effects. >> VOICEOVER: The faster Tjoloba can get the results, the sooner he can get Mamahloli back on treatment. He knows that Takiso's on his way, but that wasn't always the case. Before the motorbikes, Tjoloba would have to rely on patients volunteering to take samples to the hospital laboratory, 20 kilometers away, on public transport. >> TJOLOBA TJOLOBA: Previously there was no choice. The samples include the TB bacilli as well as HIV. If anything could happen for the spilling of those samples within the public transport that means every passenger within would be at risk of contracting some infection. >> VOICEOVER: Samples often sat waiting for someone to take them and Tjoloba had to collect the results himself. Sometimes the whole process would take two to three months. It was a delay that cost lives, especially with diseases like tuberculosis. >> TJOLOBA TJOLOBA: TB is very important to get results immediately. While we are still waiting for the results the patient could be infecting other people and we end up with a lot of deaths. >> VOICEOVER: But now, Takiso visits the health center twice a week. Today, as well as Mamahloli's samples, he's collecting blood and sputum from nine people who may have TB. He's been trained how to handle and transport these samples. >> TAKISO SETSABI: Because I ride on these rough roads every day, I know how to handle them. When I get to parts that are really pot-holed, that shake you around, I stand up. In a car, the samples would just be rattling around all over the place. >> VOICEOVER: Many samples used to be ruined by lengthy storage or in transit. But now, Takiso can get to the lab quickly, ensuring the samples arrive in good condition. >> TAKISO SETSABI: I register the samples and I also help with basic laboratory tests because they've taught me how to do that. >> VOICEOVER: A couple of days later and Takiso is returning to Fatima Health Center with the results. And for Tjoloba, there's great news about his suspected TB patients. >> TJOLOBA TJOLOBA: All the results for TB are beautifully negative. >> VOICEOVER: There's good news for Mamahlodi too. The results show her liver and kidneys are functioning well, so she can be given more suitable lifesaving treatment straight away. And for those like her who have to walk so far to get here, the reliability of sample transport means it's never a wasted journey. >> TITLE: ViewChange >> VOICEOVER: Tukula Mothonyana is a TB officer based at Maluti Hospital in Lesotho. >> TUKULA MOTHONYANA [TB Officer]: I run TB clinics here and get people started on treatment. TB is a very dangerous disease because it's so infectious. It spreads quickly and easily from person to person through the air, so it's important to get people on treatment fast. My biggest challenge is when some people default on their medication. Often, they start to feel better, and so they stop taking the drugs believing they're already cured. >> VOICEOVER: Defaulters are common in Lesotho. Often they don't collect their treatment or attend check-ups because it's so difficult for them to get to their nearest health center. Tracing them quickly is vitally important, but finding defaulters can be a major challenge. Experienced rider Mathato, is taking recent trainees and fellow health assistants, Puleng and Lintle to try and track down one such TB patient. The first stop is his local council office. But there's some bad news. >> PULENG: We have just discovered that Mr. Fata Masupa has just passed away already. >> VOICEOVER: It may be too late for their defaulter, but it's still vital they find his family. There's a risk they too might be infected and could be passing it on to family and neighbors. Having been pointed in the right direction, they set off. But with no road names or house numbers, it's never that simple. >> MATHATO [Nurse]: It seems that there are two people with the same name and surname so this one is not the one we are looking for. The one that we are looking for is that one down there. >> VOICEOVER: A case of mistaken identity, so the search continues. But sometimes, patients deliberately give false details to health workers, as Tukula knows all too well. >> TUKULA MOTHONYANA: It makes it really difficult when some of them give us false names and addresses. When you want to visit them you go to the village and find no one knows them. >> VOICEOVER: But why don't they want to be found? Well, health workers Lesotho always encourage patients to get tested for HIV so they know their status. But many people here just don't want to know. Back with Mathato and her team, and they've managed to find the widow of the deceased defaulter. >> WOMEN: So sad to discover that the person we are tracing is dead. And she's still mourning. >> VOICEOVER: They suspect that by defaulting on TB treatment the dead man may have developed a more dangerous strain known as Multidrug-Resistant Tuberculosis, or MDR TB. >> WOMEN: The family, they might be infected, we don't know but we advised her to go for the checkup. >> VOICEOVER: This constant vigilance is what's needed to keep this dangerous strain of drug resistant TB contained. >> TITLE: ViewChange >> VOICEOVER: Across Lesotho, motorbikes are constantly ferrying medical samples from clinic to lab, or allowing health workers to reach the communities they serve. These services rely on their bikes day after day. But keeping them going on these tough tracks is no mean feat. In charge of keeping Lesotho's fleet of a hundred and twenty motorbikes on the road, is mechanic Thaele Seleke. >> THAELE SELEKE [Motorbike Mechanic, Lesotho]: A bike is a small thing; it's not like a car. A car can last a bit longer. But really when you look at this machine it needs you to take care of it just like a baby. Watch it closely. I've got 120 babies here to watch. >> VOICEOVER: If any of Thaele's 'babies' need serious attention - a new clutch, a set of shock absorbers or a major engine problem - he brings them here to the workshop. But most of his time is spent out visiting the bikes all over the country. >> THAELE SELEKE: It's all about preventing problems from happening. We detect them before they can happen. It's unusual because we are the only ones who are doing this kind of job here. >> VOICEOVER: This preventative maintenance is what sets Thaele and his team apart. >> THAELE SELEKE: We always do this as a routine each and every month. Check everything, service everything; make sure that it's tip-top. >> VOICEOVER: Vehicles all over Africa are in a terrible state. At hospitals, you'll often find vehicles, some nearly new that are left rusting because of a blocked air filter or a worn out tire. But Thaele and his team go that extra mile to make sure they spot and fix problems before the bikes break down. With eight bikes to get through, there's no time to waste. But Thaele gets all the riders involved. >> THAELE SELEKE: I do like very much when I work on someone's bike. The rider should be there so that we should discuss few things. I always pass my knowledge to them. >> THAELE SELEKE: What you're doing isn't right. You have to have a tape, so you know the exact measurements - about 30 millimeters. >> THAELE SELEKE: The small things - they should know how to check them on their own. >> VOICEOVER: They're all trained to do daily checks. But it's not just about keeping the bikes running. >> THAELE SELEKE: If you don't do a check you before you ride, really you are risking your life because it might lose things like bolts, or chain warn out then when it cuts off really you fall off terribly. So we make sure we prevent such things. They shouldn't happen. >> TITLE: ViewChange >> TITLE: Riders for Health, Rockhopper TV, Lesotho >> VOICEOVER: Lesotho has the third highest HIV prevalence in the world. Almost one in four people here are living with the virus. But Lesotho is fighting back and HIV counselors like Lefulesele Masokanye are in the frontline. Today she's come to St. Magdalena rural clinic. Much of her work involves trying to prevent mother to baby transmission of HIV. She's here to follow up on those suspected of defaulting on treatment or missing checkups. >> LEFULESELE MASOKANYE [Mentor Mother, Berea District, Lesotho]: I have got the list now for the people we are visiting today and the first one is a pregnant woman and she's positive. So we are going to look if she has already taken the drugs to prevent the virus to pass through to the baby. >> VOICEOVER: A lot of Lefulesele's time is spent out in the villages, encouraging pregnant mothers to attend check ups and get treatment. If they're put on prophylaxis early enough in pregnancy, there's a very good chance they won't pass HIV to their babies. But it can be a difficult job persuading people who live so far from the clinics. >> LEFULESELE MASOKANYE: When they get home they don't take it seriously. That's why we have to follow to see that they're doing the right thing. >> VOICEOVER: Lefulesele has come to see Mamojaki and her three-month-old baby girl. But soon after arriving, she realizes there's bad news. >> LEFULESELE MASOKANYE: Her mother didn't get prophylaxis at all. And even the baby didn't get it after she has been born and so the baby could be positive. >> VOICEOVER: Mamojaki says she didn't go for check ups because she's afraid people would shun her if they knew she was HIV positive. It's something Lefulesele comes up against all the time, and she understands it better than most. She's also HIV positive. >> LEFULESELE MASOKANYE: We have to tell everybody, because we have been through this so we have to stop this. I stand there, I tell them that I'm HIV positive, look at me; you can see I'm still healthy. I just tell her she should go there, don't be scared of the people. This is her life, and life comes once, and the treatment is free. She's not going to pay anything. >> VOICEOVER: Cases like Mamojaki's are very close to Lefulesele's heart. They're the reason she does this job. >> LEFULESELE MASOKANYE: I was pregnant so I went to the clinic. I found that I'm HIV positive so they said I should come back and do my checkups but I didn't go. >> VOICEOVER: Lefulesele had a baby girl. She didn't return to the clinic until a month after she was born. It was during that visit that she was asked if she'd consider working as a HIV counselor. >> LEFULESELE MASOKANYE: I heard about an interview for the mothers who are positive, so I went there and I passed the interview. But I didn't realize that when I was holding her she was already dead. I found out when I got home. >> VOICEOVER: Her baby daughter had died in her arms at just one month old. >> LEFULESELE MASOKANYE: I had a very nice girl and I miss her a lot. >> VOICEOVER: A few days later, and Lefulesele has come to check up on Relenbonile, another HIV positive mother. But today's not a nice day to be out on a motorbike. >> LEFULESELE MASOKANYE: It is very bad today, very bad. All of a sudden hailing, sunshine, cold at the same time. Even lightning! >> VOICEOVER: But for Lefelesele, it's all worth it. Relenbonile has been to all her check ups. She's taken the treatment throughout pregnancy, birth, and through to weaning. Her baby's recently been tested and is HIV negative. 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/child-survival-reaching-the-poorest-women-and-children-in-bangladesh Concern Worldwide's Child Survival Program has revolutionized maternal and child health by utilizing established local leaders to spread knowledge throughout the communities about how to access hospitals and healthcare. It has laid a foundation within the community and with local actors that is saving lives on a grassroots level. Fri, 17 Jun 2011 12:42:00 +0000 http://www.viewchange.org/videos/child-survival-reaching-the-poorest-women-and-children-in-bangladesh Bangladesh, Health, Gender, Concern Worldwide, Pregnancy, Education, Maternal health, Saidpur, Rajshahi Division, Healthcare, Public health >> VOICEOVER: In the backstreet of a slum in the north of Bangladesh, children play the chicken game. They hop and kick a stone for as long as they can without falling over. Nothing unusual here, except if it wasn't for a groundbreaking health program from Concern Worldwide these children wouldn't be alive. In Bangladesh, one in every dozen children dies before school age. But the odds against surviving are even worse in the most deprived areas of the overcrowded cities. Here almost one in seven young children die because health care just doesn't reach the majority of those living in absolute poverty. That's what Concern Worldwide is changing. Ten years has been spent developing the Child Survival Program, and it's transforming healthcare for some of the world's poorest people.>> TITLE: Concern Worldwide (U.S.) INC. Child Survival: Reaching the poorest women and children >> VOICEOVER: Saving the lives of children means aiming the program at pregnant women, mothers, and babies too. And in the areas where the project is working it's significantly reducing what had been a very high death rate in childbirth and the first five years of life. >> DR. YEASMIN CHANDANA [Maternity Unit]: I've been working for 22 years, and fewer children are dying. The number of neo-natal deaths and the infant mortality rate has decreased from previously. >> VOICEOVER: So how's it being done? Remarkably Concern isn't actually treating anyone, or providing the medicines and equipment in the way that most development projects work. New ground is being broken with a completely new approach: investing time, expertise and encouragement to persuade communities in this part of Bangladesh to improve healthcare for themselves. >> MICHELLE KOULETIO [Health Advisor, Concern Worldwide US]: When the program first started, we looked at where the poorest people were going for advice related to health services. They weren't going to the doctors; they weren't going to nurses. They were going to homeopaths, local pharmacists, and mother in laws. So the program really starts by working with them. >> VOICEOVER: Concern is working with leaders in religion and politics. This is Friday Prayers, and the Imam is about to give health advice, passing on what Concern has encouraged him to learn. The project has reached into the very heart of the life of the region.>> MOHAMMED ZOBAYER [Imam]: Before I got training from the program, the lives of mothers and babies were very much at risk. They often died. In those days, when they came to me for help I would simply give them Holy Water. They would drink it and we believed it would be enough. Now we're all aware of what needs to be done. >> VOICEOVER: The project has taught those who've traditionally been the first port of call for the sick what medical help is available and how to send people to get it.>> DR. ALI AHMED KHAN [Homeopath]: Concern in Bangladesh gave me three days training. They invited all the homeopaths when they started the program here. They covered things like vaccinations, pneumonia, and diarrhea in babies. It has really helped a lot. Now when people come to me with diarrhea or pneumonia I treat them, but if they aren't better quickly I send them to hospital with a letter. They are admitted swiftly and lives are saved. >> VOICEOVER: Here's another life saved. Facilities in this hospital are limited but this boy is getting treatment for pneumonia, which has been one of the biggest killers. And he's getting help because a homeopath sent him here. The community has been mobilized with an army of health volunteers, a network of people like Jasmine who go from home to home offering advice. They've been given training by instructors who were trained by Concern, and it means mothers are being reached too. >> JASMINE AKHTAR [Health Volunteer]: I've been given a lot of training. How to care for mothers and babies better, how to treat the conditions that mothers and babies suffer from, basic health messages for the mothers, such as keeping the baby safe and keeping them and their things clean. We were also given training on diarrhea, cholera, birth control and vaccinations. >> RAHENA BEGUM [Mother]: Two days before my baby was due I was bleeding and in pain. I rang Jasmine on her mobile and asked her for help. It was midnight, but she came. Jasmine arranged everything, and within an hour I was in hospital. I needed blood and I had the baby at half past one. If it hadn't been for the program I would have been in serious trouble. My life was in danger. But because of the program I got the help I needed. >> JASMINE AKHTAR: Before the program began a lot of mothers and babies died in pregnancies like this. Before this, people didn't go to hospital to get help. The death rate has fallen since we started work. People are more aware about children and mothers' health. >> VOICEOVER: The youth have been engaged too. This play about polio encourages vaccinations against preventable diseases, promotes healthy and safe pregnancies, and gives advice on good hygiene. The local Ward Health Committee organizes them, groups of the great and the good set up throughout the cities. They are the champions of the Child Survival Program, pushing for more and better healthcare.>> SHAHEEN AKHTAR [Councilor, Saidpur]: This is our commitment to the community. It's now in my manifesto that the healthcare system must be improved. I promised that if they gave me the opportunity I would be a good leader. The budget for healthcare is now more than it was before the project began, but it's still not enough. We need to spend more. >> VOICEOVER: That growing commitment to providing free or affordable healthcare to the poorest people brings clinics like this, providing tests, medicines and supplements to pregnant women and helping mothers-to-be and unborn children alike. It's a direct result of Concern Worldwide's work here without actually being provided by Concern. And that's the beauty of this bold new approach -- it increases the number of people Concern's work can reach with limited resources. >> MICHELLE KOULETIO: Twenty years ago, Concern was basically running a clinic right here in this building, it was a clinic designed for the slum population. Our staff was nurses, doctors, and educated people who were out doing outreach work. Basically Concern closed this clinic and said, "Aren't there other ways to help the poorest people access health services? It's great we're working here in this one city but there's over three hundred cities in Bangladesh so what kind of impact are we having, how long is it going to last?" So our staff, who were very used to providing services themselves, all of a sudden were in a position where they had to encourage political leaders, teachers, pharmacists, homeopaths, health volunteers, and get them to come together and talk about health, get them to advocate to the mayor's office to allocate more resources. So that was a major change. >> IZAZ RASUL [Program Manager, Concern Worldwide]: A lot of talking, a lot of explaining, and a lot of time spent on talking to these people to help them understand why they would invest their time for health, how their investment would bear fruit in the future, what they can expect from this project, what would be their role. So we had to spend a lot of time explaining all these aspects. >> DEWAN KAMAL AHMED [Mayor, Nilphameri]: Back them I wasn't concerned about providing healthcare, it wasn't my headache. But when I saw what they were doing in Saidpur, the next municipality to us, where they were already running the program, the idea came to me too. Now my heart and soul are in this program. >> VOICEOVER: The idea began here, in the bustling town of Saidpur in the north of Bangladesh in 1998. There were trials here and in Parbatipur for five years and was such a success that Concern wanted to see if it could be used elsewhere. So for five more years it's been tried in another seven urban areas. But before handing them over entirely to the people involved, Concern has carried out research to see how well it all worked and how to transfer the idea right across this country and into others too. The results are just what Concern dreamed it would see.>> TITLE: Child Survival Program Achievements: Reached one million people, antenatal care dramatically improved, increased child protection against illness, health gap between rich and poor halved, thousands of lives saved. >> VOICEOVER: In five years it's reached a million people, increased the number of women getting healthcare after giving birth to one and a half times what it was, and it had the same big increase in the number of children getting vitamin supplements to protect against illness. It means the gap between rich and poor in access to healthcare has been halved, saving thousands of lives and improving countless more. >> SUSAN ROSS [Independent Evaluator]: A lot has been accomplished in a pretty short period of time. We've seen a dramatic increase in knowledge. They're very willing, and now very able, to go ahead and do these things on their own. >> RUNA LAILA [Councilor, Joypurhat]: We've learned a lot from Concern, so we know how to handle the program alone. >> SHAHEEN AKHTAR: Saidpur was a test case for this program, because we achieved so much here it was introduced to another seven municipalities. Now seven more is not enough, we need to introduce this across Bangladesh. So all the municipalities are working for good healthcare for mothers and babies. >> VOICEOVER: And it's spreading further than that. Child Survival Programs have now begun in the countries of Haiti, Burundi, and Rwanda. >> MICHELLE KOULETIO: It's exciting. Who would have believed that an organization that was running a slum clinic themselves could become a leader in defining a model that actually works to help the urban poor and could be replicated not only at a national level but also has implications for urban areas around the world. I'm really proud of what's been accomplished here in Bangladesh. >> TITLE: Concern Worldwide would like to thank its partners in the Rajshahi region of Bangladesh. This project was made possible thanks to generous donations from the general public, and the support of the United States Agency for International Development (USAID). Concern Worldwide (U.S.) INC, www.concernusa.org. http://www.viewchange.org/videos/viewchange-the-mothers-index Being a new mom is rewarding and challenging. But what extra burdens do mothers in poor and rural communities face? Take a tour of the world's best and worst places to be a mom, in this report from Save the Children and ViewChange.org. Fri, 29 Apr 2011 20:27:00 +0000 http://www.viewchange.org/videos/viewchange-the-mothers-index Save the Children, Maternal death, Child mortality, Childbirth, Pregnancy, Ashta no Kai, Education, Gender, Nepal, Malawi >> VOICEOVER: Next up: an all-new mother's day special. Being a new mom is rewarding and challenging -- but what extra burdens do mothers in poorer countries face? Come take a tour of the world's best and worst places to be a mom, in this new report from Save the Children and ViewChange.org.>> VOICEOVER: ViewChange is about people making real progress in tackling the world's toughest issues. Can a story change the world? See for yourself in ViewChange: The Mothers Index.>> VOICEOVER: You've heard the term "lottery of birth." More often than not, children born in rich countries win it, while those in poor countries lose. A child's life expectancy, health, education, and so much more hinges on where he or she happens to enter the world. But there's also a lottery of motherhood, and expectant moms in developing countries are facing the toughest odds. Every year, more than 350,000 women die from complications of pregnancy and childbirth -- most, simply because they don't have access to basic delivery care. >>WOMAN: Push hard!>> VOICEOVER: And the ripple effect is dramatic: when a mother dies, her children are more likely to be poor, more likely to die before the age of five, or to drop out of school if they survive. But private aid groups and governments are working hard to change the odds in the lottery of motherhood. In Sierra Leone, a place that Save the Children ranks as one of the very worst places to be a mom, a new government program is trying to turn the tide, as we see in this short film from ViewChange.>> TITLE: Where Every Pregnancy is a Gamble. Lauren Malkani and Ami Vitale, Sierra Leone>> VOICEOVER: After a brutal decade-long conflict, Sierra Leone has the highest child and maternal mortality rates in the world.>> FATIMATA KONTE [Expectant mother, Kroo Bay]: My name is Fatimata Konte. I'm 36 years old. We women suffer too much. Women in Sierra Leone suffer too much! I've lived in Kroo Bay for four years. When I wake up at 5am I get out of bed, and the kind of pain that I feel is from my waist bone down to the bottom of my belly. I cough and I'm very sick. I'm really sick but it's like this for all women. From the day a child is born, she must work. Every day I must go to the market. There I have to bargain for fruits. It's a strain to go to the market. I must sell the fruit to have money to buy food to sell for the next day. It's all I can do to survive. I work for my daughter so she can go to school. She is in class four. I want her to learn. Let her learn. I want her to be somebody.>> DR. TAGIE GBAWRU-MANSARAY [Doctor, Princess Christian Maternity Hospital]: When a woman is educated she can take care of herself, she can take care of the children, she can take care of her husband, her home. It benefits the population, the family, and it will help Sierra Leone in the long run. I'm a medical doctor, house officer here at the Princess Christian Maternity Hospital. When you're in school and you're studying to become a doctor, you read about all the fanciful techniques, all the wonderful drugs, the magic pills that you give to patients, all the different things that you can do as a doctor. When you come into the real world and you see that even basic things we don't have here -- the basic drugs, simple equipment -- and you are limited. At times you see a particular case and you think to yourself, if only I had this, if only I had that, I would have been able to save a patient's life.>> VOICEOVER: One in five children die before their first birthday, and one in eight women die during pregnancy.>> FATIMATA KONTE: I have two children and I've lost five, so this is the eighth pregnancy. So right now, I am remembering the past. I am worried this one can die too. My biggest fear is that this child will die.>> VOICEOVER: The one referral hospital in the capital of Freetown services a population of over 400,000 people.>> DR. IBRAHAM THORLIE [Doctor, Princess Christian Maternity Hospital]: Hello, good afternoon. My name is Dr. Ibraham Thorlie. In this hospital we have four gynecologists. One doctor can serve over 100,000 people.>> VOICEOVER: Though the hospital is severely understaffed, it is not the only reason so many people are dying.>> DR. IBRAHAM THORLIE: The delay starts from home. If a woman is pregnant, she wants to give birth, and the husband is not around, she cannot be taken anywhere without the husband coming, because he gives the money. If you come too late, we cannot help you.>> VOICEOVER: And, often, those patients who come too late are very close to death.>> DR. IBRAHAM THORLIE: It's a big dilemma. If the patient can pay you, then it's good. But when they cannot pay you, you need to help them.>> VOICEOVER: Rather than watching their patients die, many doctors and nurses like Rebecca pay for the worst cases from their own small salaries.>> REBECCA MASSAQUEI [Nurse, Princess Christian Maternity Hospital]: I'm a poor nurse. I don't have money to take care of this baby. But the baby should have died, because there was nobody to take care of the baby. So that's why I decided to take the baby. He will live to tell this story. So he's the victory child. That why I call his name Victor.>> VOICEOVER: Victor is one of the few lucky survivors in a place where so many die. However, the government has just launched a program providing free healthcare for pregnant women and children under five.>> DR. IBRAHAM THORLIE: Now things are picking up with the pronouncement of the free healthcare system. It's a big incentive and we hope that will surely bring a difference. But to sustain it is not an easy thing.>> FATIMATA KONTE: We women are all very happy that women will finally get treated.>> TITLE: On April 16, 2010 Fatimata Konte gave birth to a healthy baby boy.>> TITLE: [end credits]>> VOICEOVER: So where are the best and worst places to be a mom? For its "State of the World's Mothers" report, Save the Children studied 164 countries, and compiled a "mothers index." At the top of the index, women have what they need to thrive: excellent medical services, plenty of skilled health workers, and opportunities for education and advancement. But the gap between the top- and bottom-ranked countries is stark. At the bottom, one in three children suffers from malnutrition, and one in 30 women will die from pregnancy-related causes. And how does the United States stack up? Number 31. America's maternal mortality is the highest of any industrialized nation. >> VOICEOVER: But the study is also clear about solutions that work. And the very best solution for helping moms and children? More health workers on the front lines. The equation is simple: more doctors, more midwives and community health workers means more mothers and children surviving childbirth and the early years of life. Nowhere is this more clear than a place like Nepal, which is ranked 133rd on the Mothers Index. This ViewChange short film from Living Proof tells the story. >> TITLE: In one of the world's poorest places, the day a woman gives birth is the most dangerous day of her life, and her child's life. Can one woman and her baby beat the odds?>> TITLE: Dangerous Day. Living Proof, Nepal>> TITLE: Western Nepal >> TITLE: People scratch out a living in the Himalayan foothills, and life is hardest for women>> MAHESWORI: My name is Maheswori. I'm 19 years old. My husband went to India to work. Here there is no food, no rice, no nothing. Around here, there's no work. >> TITLE: Maheswori is pregnant and past due.>> MAHESWORI: I am very, very scared. Everyone has been asking about it, and that makes me even more scared. My first child was breech born, and I might just die this time. If I will live, I will live. If I will die, I will die. >> TITLE: The nearest hospital is four hours away. >> MAHESWORI: Some said take her to the hospital, some said drive her down. Everyone had opinions. But how would you get a car without money?>> TITLE: She plans to deliver in the same place she gave birth before.>> MAHESWORI: In November my daughter was born. I had the baby in our cow shed. >> TITLE: By local custom, mother and child are quarantined as "unclean.">> MAHESWORI: For 12 days after the birth, the baby and I were kept in the cow shed. On the 13th day we were allowed out. You can't take a newborn in the house, God gets angry. You're better off in the cow shed. >> TITLE: Because of Maheswori's high-risk pregnancy, an aid worker traveling with the camera crew makes a case to village elders. They consent to having a birth attendant, and she won't give birth in the cow shed. >> MAHESWORI: I am going to die. Oh my mother! I am dying ...>> WOMAN: Get me the gloves, quickly.>> MAHESWORI: I am dying ... am dying. Please ... I can't.>> WOMAN: It's a complete breech situation. Push hard!>> INDUKA KARI [CARE Program Officer]: She was completely unaware of the fact that she would need medical care because her first child was breech born. >> TITLE: She gives birth to another daughter, Seema. >> INDUKA KARI: If she hadn't gotten proper care by a trained birth attendant, she would've died. >> MAHESWORI: I'll rest for seven days, but then it's back to work. I have to pound the rice, carry water, cut grass, and chop wood. Life is tough here. >> TITLE: Living Proof. Real Lives. Real Progress. >> TITLE: In Nepal, 80 percent of births occur at home with no skilled birth attendant like Maheswori had. But support from global partners is helping train Nepal's 45,000 female health volunteers, and they are dramatically improving Nepal's health outcomes. >> VOICEOVER: If there's one overwhelming success story in maternal and child health, it can be found in Malawi, where almost half the county -- 40 percent -- lives in poverty. But, for years, the government has been investing in all sorts of new plans for life-saving care. The result? The number of deaths in children under five has been cut in half over the past 20 years. Malawi's striking results are strongly linked to efforts on the ground, house by house, community to community, to give mothers the support they need. Living Proof has this success story from Malawi>> TITLE: Grandparents Shaping Safe Childbirth. Living Proof, Malawi >> TITLE: Wacapati = Pregnancy>> TITLE: In Malawi, the word for pregnancy also means 50/50. Conventional wisdom says there is just a 50/50 chance a woman will survive childbirth. >> TITLE: Agogo = Grandparent>> TITLE: Agogos are known as the guardians of wisdom and are responsible for passing on tradition.>> TITLE: Can agogos help improve the odds of wacapati? >> TITLE: Ekwendeni, Malawi>> LYTON CHAWINGA: My name is Lyton Chawinga, and I have six grandchildren. I was born at home, in 1948. In previous days, pregnant mothers were using unsafe methods. Some would have their babies in grass huts. After giving birth, they would leave babies on the ground in the cold. We didn't know better. We had a lot of deaths. One day, hospital workers asked us to be a part of the Agogo Program.>> TITLE: The Agogo Program teaches village elders about proper natal care and helps agogos pass along those messages to their communities. >> LYTON CHAWINGA: We go to their house. We talk to both the man and the woman. We are here to chat with you about the importance of going to the hospital when you are pregnant. We show them pictures and tell them what can happen if they give birth at home. That the mother or baby can fall sick or die. >> WOMAN [Agogo]: After three months, start going for checkups. Escort each other. Many husbands refuse to escort their wives, which is not good. >> TITLE: Agogos also use traditional methods to teach modern messages. >> WOMEN: Pregnancy doesn't kill, the hospital is good, and all our children should be taken there.>> LYTON CHAWINGA: Deaths have decreased, diseases have decreased, and life has improved. I am really happy because if the student fails you are not a good teacher. I see fruits of what I teach and I am proud that I am a good teacher.>> TITLE: Living Proof: Real Lives. Real Progress. >> TITLE: With support and funding, 4,000 agogos have been trained in Malawi.>> TITLE: As a result, Ekwendeni Hospital has seen a 60 percent increase in pregnant women seeking antenatal care.>> TITLE: To accommodate them, the hospital is building a new, larger maternal ward.>> VOICEOVER: Access to health care isn't the whole story, of course. Helping women must include an investment in education. In rural Bangladesh, communities are learning the real value of empowering women. This film from Save the Children shows that giving girls a voice can be the most powerful solution of all. >> TITLE: Shilpi's Story. Save the Children, Bangladesh>> TITLE: This is Shilpi's story. Tiler Char, Barishal, Bangladesh.>> VOICEOVER: Shilpi's father died when she was very young. Her mother worked as a maid to support Shilpi and two younger sons. She earned only enough to feed them one meal a day. When Save the Children started the Girls' Voices project nearby, Shilpi joined. She met with other teenage girls to build self-confidence and learn new skills, like making a budget and saving money. Shilpi realized she could help support her family, even without working outside the home. She started her first business weaving mats. >> SHILPI: Later, I thought about how I could use the money I earn from weaving mats to do more. So I bought a small cow. After a year it gave birth. At that time we got 2 to 2.5 liters of milk from the cow every day. I sold that milk and used the money for my family. Later, when I had earned more money from weaving mats, I saved it. Our house was very small. It was awful to live there during the rainy season. So I decided we should build a new house. I sold the calf and used the money from my savings to build this house. If I had not joined "Girls' Voices" I would have been married by now, like all the other girls. Then I would not have been able to build such a big house or buy a cow. Now my plan is to buy a piece of land since we do not have any. The other plan I have is for my brother. Because he is handicapped, I am supporting his studies. That way he can get a job and earn his own living. My mother used to think if I had been a son instead of a daughter our life would have been much easier. But now she thinks "my daughter has done more for our family than a son would ever do.">> VOICEOVER: Around the world, communities are coming together, not only to save the lives of mothers and children, but to improve them. To give women real opportunities to change the courses of their lives. Basic health care can solve the most urgent crises, but a bigger sea change -- one that empowers women to learn, to marry later, and to decide when to have children -- will ultimately close the gaps in the odds that mothers face. Those changes are happening every day, country by country, and girl by girl. Sometimes, in places like India, something as simple as a bicycle can make all the difference.>> TITLE: Hubub Films Presents>> TITLE: Sone Sangvi, India>> TITLE: Pedal=Sight. Jacob Seigel-Boettner, India >> BHARATI PHAKAD DATE: My name is Bharati Phakad Date. I am 14 years old. I live in Sone Sangvi. I am going to Nimgaon Bhogi High School. I am learning in the ninth standard [grade]. My favorite actor is Mithun Chakrabothy because he always plays a humanitarian, someone who helps other people. My favorite actress is Rani Mukherjee. I like her husky voice. There are a lot of people who live on the streets. I will help them. There are so many people in this world who do not even get one meal a day. I will help them. >> TITLE: Pedal = Sight>> ARMENE MODI [Director, Ashta No Kai]: For about a couple of years, we only focused on adult women and literacy for them, and I noticed many of the girls who came to the class were very, very young girls with mangalsutra, which is a gold-and-black beaded necklace, around their necks, which in India is a symbol of matrimony, and they had babies on their hips, and I started to ask, "What's going on?" and, "Why are such young girls married off already?">> BHARATI'S MOTHER: My life, my generation, was full of darkness. I have to make sure that my daughters get a good education. It is our duty. If you are uneducated, then it is as if you only have one eye. >> ARMENE MODI: In many villages, there were only schools until seventh grade. There were no high schools. So we worked in 10 villages at that point of time, and there were only three high schools. So then I asked the parents, the mothers, "Well, what happens to the boys? How do you send the boys to school?" And they said, "Well, we give them bicycles." And I said, "Well, what about the girls?" And they said, "Oh, no. It's a waste of money to give a bicycle to a girl. She's going to turn around and get married." There's a famous Indian saying: Why water a plant that's going to grow in a neighbor's garden? So, I thought, my God, if it's only a bicycle that's keeping girls from going to school, let's go ahead and give it to them. >> BHARATI PHAKAD DATE: The bike has been really useful. Now, the time that I save commuting to school can be used to study. Also, now I can ride to school with my friends. It's a lot of fun. I used to have to walk to school. >> BHARATI'S MOTHER: Initially, she had to walk to school. It took her more than an hour. Now she can ride to school in 15 minutes. She now feels very motivated and enthusiastic to attend school. >> BHARATI PHAKAD DATE: I want to become a District Supervisor, because then I can make big decisions, and also have the power to implement them. I would be able to make decisions regarding the welfare of the poor and downtrodden. I would be able to help transform society. My name is Bharati Phakad Date. I am 14 years old. I live in Sone Sangvi. I want to eradicate poverty from this country. >> TITLE: [end credits]>> VOICEOVER: Like what you saw? Then visit ViewChange.org, Link TV's brand new multimedia website. Watch over 200 stories about new solutions to the developing world's biggest challenges, get involved with the issues, share the stories with friends, and help change the world, all at ViewChange.org>> VOICEOVER: To read the full 2011 "State of the World's Mothers" report, and to learn more about Save the Children, visit savethechildren.org.>> TITLE: [end credits] http://www.viewchange.org/videos/one-in-six One billion people in the world face hunger and malnourishment on a daily basis. The international community has long sought to tackle this problem. But what if everything we thought we knew about how to erase hunger was wrong? Concern Worldwide and Valid International brought their innovative ideas and faced off against entrenched interests to change people's perceptions of this problem. The result was a sea change in how the world looks at hunger. Tue, 12 Apr 2011 08:52:00 +0000 http://www.viewchange.org/videos/one-in-six Malnutrition, Agriculture & Food, Concern Worldwide, Africa, Water & Sanitation, Foreign Assistance, Non-governmental organization, Tom Arnold (economist), Community Therapeutic Care, Food security >> VOICEOVER: Every night, almost one billion people go to bed hungry. Global economic chaos and ongoing climate change is pushing that figure even higher. But in the last decade, thanks to the efforts of a group of courageous and determined people, the lives of those worst affected by starvation have been transformed. Hundreds and thousands of lives have been saved. Of all the continents, Africa carries the heaviest burden of hunger, and of all the people, African women bear by far the heaviest load. To most of us this is wrong. But to some, it is simply unacceptable.>> TOM ARNOLD [CEO, Concern Worldwide]: I think for most of us, who actually have never really been hungry for a sustained period of time, it can be hard to convey how awful this is as a daily reality. But it is a daily reality for maybe close to a billion people in the world. Everybody, as a basic human right, has a right to food. It's almost as basic as life itself.>> DR. STEVE COLLINS [Director, Valid International]: All I know is that starvation is an obscene fact in the modern world. People should realize that people are starving unnecessarily. There's enough food in the world. We can put probes on Mars, you know, we can definitely treat hunger with basic food, you know, it's not rocket science.>> TITLE: One In Six>> VOICEOVER: Over the past 20 years, Steve Collins, a medical doctor who specializes in nutrition, has worked in every major famine emergency in Africa. Nowadays he works from a small farm on the southwest coast of the last European country to have experienced famine: Ireland. >> VOICEOVER: In 1998, Steve was awarded an MBE for his work in adult malnutrition. But it was when he teamed up with Concern Worldwide in 2000 that the way the world viewed and treated malnutrition was challenged and changed for good. They sought a new way to treat an old problem, and they found it in the form of Community-based Therapeutic Care, CTC. It is a remarkably simple, yet revolutionary, idea that restored the treatment of malnutrition to African mothers.>> WOMAN 1 [Mother]: I become anxious when there's no food in the house. I don't have enough money, I wander here and there and then I give up and I can't do housework. I have no energy.>> WOMAN 2 [Mother]: I feel bad when my child is ill and refusing food. I don't eat either because I feel sad.>> WOMAN 3: It's miserable when you're hungry and there's nothing to eat. Your vision is blurred and even your heartbeat changes.>> VOICEOVER: Until recently, these mothers and their babies would have been treated in centralized feeding centers. Traditionally, these centers were set up to administer famine relief to starving people, and were considered the gold standard in treating malnutrition. To overturn this system, Steve Collins and Concern would have to take on the medical and aid establishment and prove that their approach was more effective. In 1996, Steve Collins went to Liberia to set up a traditional feeding center. What followed was an outbreak of cholera, which was to herald the end of these centers for good.>> DR. STEVE COLLINS: Liberia was a difficult situation. We were trying to set up nutritional treatment centers across two front lines. There were so many factions in Liberia -- it was 1996 -- so we arrived to lots of death, lots of destitution, and we started setting up a center. At the beginning I asked, you know, "Is there cholera?" and people said, "No, there's no cholera." And I actually asked the wrong question. I'd asked a sort of close-ended question. I asked, "Is there cholera?" and they said no because there wasn't cholera that week. But actually cholera's endemic there. Had I asked, you know, "What do people usually die of?" They would have said, "Oh, cholera." But I hadn't asked the right question. And that one mistake meant that I didn't-- because can't do everything at once, you prioritize different things-- so I prioritized the feeding-- because I'd seen people dying of malnutrition-- over putting more effort into the water and sanitation. So, when people arrived for the treatment, it meant that you had a lot of people who didn't know the village, they didn't know where people normally drank, so they started to drink downstream of the village, of course getting all the polluted water. And so, the day it started we had two cases; the next day, I think we had ten. And then we were treating about thirty cases the next day. And the war started up, and we could actually hear the shooting in the background, and we had to leave. And we couldn't go back for two days. And when we came back, I think there were twenty dead people. And that made me realize there are so many dangers involved in having centers that I started to try and look for a different way of doing it.>> VOICEOVER: Around the same time, Anne O'Mahony, who has worked in emergency situations with Concern since the 1980s, was struggling with the shortcomings of feeding centers in Sudan.>> ANNE O'MAHONY [Concern Worldwide]: Our dilemma was that if we set up centers to cater for these malnourished, we would be open to aerial bombardment. We were also worried about ground attacks, and we felt that by setting up a center it would be an attraction in itself to insecurity. And I suppose more and more, it became clear that center-based care wasn?t the solution. Up to then, I suppose, the big constraint to having community care or enabling women to feed their babies in their homes, malnourished children, was the fact that there wasn't suitable food that could be used in this circumstance. Anything we were giving out had to be mixed with water.>> VOICEOVER: In 1996, a French nutritionist, Andre Briend, invented a product called Plumpy'nut, a peanut butter-like supplement rich in vitamins and minerals. This was a major breakthrough in the fight to prove the value of the community-based approach.>> DR. ANDRÉ BRIEND [Nutritionist]: My hope when I was developing this product was to start a revolution in the management in acute malnutrition, because the solution before that was quite unsatisfactory. So this is what we wanted, to have something that could be used at home. Developing the food was not enough. It?s a little bit like inventing the computer without adapted software. We needed some program adapted to that, and Steve Collins was very much involved in program management, and he was a key person to change the approach.>> DR. STEVE COLLINS: I think the invention of Plumpy'nut was a key breakthrough. It's an oil-based product, there's no water in it, and so bacteria can?t breed in it, and so having this perfect nutritional product that could be used safely at home really facilitated CTC.>> VOICEOVER: But in order to develop a more community-based approach, Steve Collins knew he needed to have a thorough understanding of the people, and in particular the women, he wanted to help. If the mistakes of Liberia had taught him anything, it was to ask the right questions.>> DR. STEVE COLLINS: So is the pump broken? How long has the pump that is in the village been broken? One of the key things that struck me when we were developing CTC and looking at life in Ethiopia was the incredible workload that women have. We did lots of studies looking at how women spend their days, because obviously that's vital, you have to know what women are doing. If you're going to say you?ve got to come for a day to a center, you have to know what they're going to miss. >> HEKUAT KAHSAY FANTA: I wake up at about 5 AM and I clean my house. I grind grain until 8 AM. Then I work in the field. Carrying stones, plowing the soil and preparing the land. When it gets dark, I work by lamplight.>> VOICEOVER: Hekuat Kahsay Fanta lives with her family in a remote part of Tigray in northern Ethiopia. She is a mother of six and, like other African women, is busy from before dawn until after dusk working in the fields and looking after her house and family.>> HEKUAT KAHSAY FANTA: My daughter is 14 months old. She started coughing and getting sick last year. Maybe it's because I didn't feed her properly. I worry that this could be the cause of her illness. I think about this all day long.>> VOICEOVER: When one of her children is sick, Hekuat struggles to get them the care they need. The isolation of her home and the fact that she has no form of transport means that any journey she undertakes is long, arduous, and on foot. >> DR. STEVE COLLINS: I realized from very early on that the main limiting factor wasn?t the medical care; it was how people could get into the program. And so to do that you have to talk to people, you?ve got to find out, "where do you live? Are there rivers in the way?" Or, "how many children have you got, what happens if you leave your children behind, who?s going to take care of them?" Obviously if it?s harvest time, people don?t want to have to walk for two days and miss their harvest because someone might steal it, or birds might come in. So all these questions about what are their lives like? What is their reality?>> ANNE O'MAHONY: Well, very often, when we go to visit the villages, we do find that Mother X?s child died last week. You ask her why she hasn?t brought in her child, and she would say there was nobody to look after the children. And we got that, story after story. And that?s quite common. And taking a mother out of their home scene leaves a huge gap. So who's going to feed the other kids? Who's going to provide the care and nutrition and nourishment that the rest of the family needs in the absence of the mother? And very often it doesn't happen. It?s a question of mothers making these decisions that are so difficult, that no mother should be asked to make. >> WOMAN 4 [Mother]: I feel very bad when I see my baby sick, I feel depressed.>> WOMAN 5 [Doctor]: If you go to the hospital with this child, what will happen in your home if you're not there?>> WOMAN 4 [Mother]: My children are very small and there is nobody that can prepare food for them. If I leave my other children at home, I close the door on them. To save one life, I can lose the rest of my children.>> WOMAN 5 [Doctor]: Do you want to ask your husband what to do?>> WOMAN 4 [Mother]: He doesn't care.>> VOICEOVER: With a better understanding of the difficulties confronting these women, it became obvious to Steve why so many mothers did not make it to feeding centers. Plumpy'nut made it possible to develop a program that would allow malnourished children to be treated in their own communities. By using a simple band to measure the width of a child?s upper arm, Steve argued that anyone could tell if a child was malnourished. The child could then be admitted into a CTC program to receive ready-to-use food and drugs. Instead of having to leave their family and livelihood for up to six weeks to stay in a traditional feeding center, mothers could return home and make weekly visits to the health center for monitoring and therapeutic food. Children who had lost their appetite completely could still be admitted to a hospital for care until they too could be sent home with the necessary supplements. This system made it possible to reach and support far more women and children. But many people had put a lot of time, energy and investment into the traditional feeding center model, and were far from convinced by this new approach.>> ANNE O'MAHONY: When children are sick, especially large numbers of children who are sick with malnutrition, there?s a tendency to keep them all together, to give them food, to give them medicine, to bring them back under our care so that they can then be released back into home. And the idea of CTC was, sending these children home with the correct food and the care that went with it so that the mothers could actually take care of them themselves. This was a mind-blowing idea in some ways.>> VOICEOVER: Many of the more clinically minded professionals had ethical problems with the radical nature of what Steve was proposing, people like Professor Michael Golden, a world-renowned nutritionist who lives on the northwest coast of Ireland.>> PROFESSOR MICHAEL GOLDEN [Nutritionist]: To me there is an ethical problem about taking risks. If you know there?s a risk, you do it step by step, and you do it extremely carefully, and you do it with a few children that you know, and then you build on that. You don?t suddenly tear down everything and go out and create a whole structure, involving thousands of children, which may or may not work. I don't think that we have the right to take risks with other people. We take risks with ourselves, but I mean why should we take the responsibility ourselves of taking a risk with someone else's life?>> VOICEOVER: Despite Steve Collins' conviction that his new community-based approach to treating malnutrition, CTC, could save hundreds of thousands of lives, he needed proof. He happened to be working in the Walta region in Ethiopia in 2000, when in the middle of yet another desperate famine he saw an opportunity to try CTC out. The government had banned the setting up of traditional feeding centers, as they believe them to be ineffective. Concern was working in a neighboring district, and when Steve suggested that they try CTC and study the results, they agreed. >> TOM ARNOLD: In a way, when the CTC idea come along, it came along at the right time, because a sufficient number of people were asking questions about the effectiveness of the traditional model of dealing with malnutrition. So then the challenge was that over a period of time, could you actually demonstrate, with evidence, that this was indeed a better way of dealing with it? And that?s what we set out to do.>> DR. STEVE COLLINS: And so, we worked together to design another CTC program in the district where Concern was working. And in this one, we put in some extra monitoring, so that we could actually start to produce concrete data. That program ran, I think, for eight or nine months, and was a success. The mortality rates were 4.5 percent, whereas the standard you aim for in emergencies is 10 percent, and the norm in a developing country hospital is 20 to 30 percent mortality rate-- that?s twenty to thirty percent of every child that?s admitted dies-- whereas our mortality rates were only four percent. So it was obvious it was working, and the numbers were quite high. She's feeding him three times a day. And what will she feed them at lunchtime? Will people here still be eating teff? Is there still enough to eat? After 2000, after the two trials we had in Ethiopia, I realized that CTC would work, and that it would be the future. And in a way I became a bit obsessed by it, I think. So I actually went round to all the agencies I could think of-- I went obviously back to MSF [Médicins Sans Frontières], I went to Oxfam, I went to Save the Children, Action Contour la Famme-- all these different agencies saying this is the future, this is what we should be developing. Unfortunately, I think it was too threatening at that stage; it was too much of a change, and probably, to be fair, at that stage there probably wasn?t enough evidence.>> VOICEOVER: But one person who did agree with Steve that there had to be a better way was Concern's director of policy and evaluation, Howard Dalzell.>> HOWARD DALZELL [Concern Worldwide]: I suppose when Steve first put it to us, I don't think he realized the full potential of it. And I don't think he realized what would be involved in actually getting it accepted internationally. And he wanted to do quite a small trial, and I actually said to him, "Steve, I think you're missing the point. I think you're being too conservative. If you really want to make it work, we've got to have loads of evidence in loads of different places, and therefore we need to do big trials, not small trials.">> DR. STEVE COLLINS: He was the first person who really realized the potential for this change. He realized it needed to be a coherent research program. In the month before I'd gone to DIFID, the UK government donor, with a project proposal for a hundred thousand. And they had refused, and it was Howard that saw that actually you need a program, you need a research program.>> VOICEOVER: What Howard understood was that in order to make real progress, they would need more than just nutritionists in the research team. They would need food economists, sociologists, anthropologists, and social workers who could mobilize a community. But Howard believed in Steve's ideas, and agreed to support him in his search for the necessary funding. >> TOM ARNOLD: Well, Howard came to me with this idea about CTC, and he explained it and the principles underpinning it. He was very convinced that this was a potentially important way to deal with hunger, and particularly severe acute malnutrition. And he then had the idea that in order to get further support, we would try and get support from Irish Aid, and he went and spoke to Irish Aid, and said critically we?re prepared to put some of Concern?s money in this, and would you, Irish Aid, put your money in it, and we would work together. And obviously crucially the core idea that was from Steve Collins.>> BRENDAN ROGERS [Director General, Irish Aid]: So when Howard came to me and said, "Look, we have an innovative project here, we think that through CTC we can change the architecture of emergency response," my eyes lit up, of course. In the early part of this century, thousands and thousands of people were coming together because of the results of conflict, or the results of natural disasters, and the UN system and NGOs had put in place a system that was very well-run logistically, providing food, shelter, water and sanitation to thousands and thousands. Yet, there were great dangers in that. People were coming long distances, particularly women and children could have lost their lives in those journeys, and there was the possibility of cross-infection, of communicable diseases, the issues of HIV and AIDS and of sexual exploitation with large amounts of food being distributed in situations of great famine. So we wanted to challenge that, we wanted to determine, "Could we address those issues closer to people's homes, closer to their communities?" But this essentially was a real challenge to the accepted wisdom. We took that risk.>> TOM ARNOLD: Equally important at this time was the support of USAID and the Office for Foreign Disaster Assistance. They had come to the same conclusions as Irish Aid about the potential impact of CTC, and their support at this time allowed the expansion of the program into Ethiopia, South Sudan, and Malawi. So it was the combined effect of the Irish and US funding that really catalyzed the expansion of CTC, and led to the increased acceptance and legitimacy of this program in the wider international community. >> CAROLINE ABLA [Public Health Advisor, USAID]: Once we had enough evidence that this new approach really does work, it was time to bring it up to scale if we could. And we'd been working with Concern on the pilot phase, and having had Concern basically write the manual of how to do CTC, they were the best partners that we had to go ahead and scale it up.>> VOICEOVER: In 1999, Steve Collins had set up Valid International to research and evaluate the effectiveness of aid programs. With the success of the trials in Ethiopia, and with funds from the Irish government and Concern, Valid assembled a team of research specialists who, together with Concern, were finally able to take CTC to Malawi in southern Africa. >> DR. STEVE COLLINS: We started implementing in Malawi. There we had another key person who got involved, Theresa Banda, who was the Ministry of Health nutritionist. She has worked in malnutrition for many, many years, and she'd seen the problems with centers, and she was willing to stake her reputation and take a chance on giving us a district where we could do a pilot.>> THERESA BANDA: We were in the process of reviewing national guidelines. When Dr. Steve Collins came in, we had a meeting with him in the office, and he brought in some evidence from Ethiopia. So that really got us interested. At that time we were looking for innovative ways to improve nutritional status, innovative ways to deal with the influx of malnutrition due to the food crisis. We decided as a ministry that we should use one district to implement this and learn from it.>> VOICEOVER: With the go-ahead from the Malawian government, Concern and Valid had for the first time a real opportunity to gather hard evidence. They were assigned the Dowa district in Malawi, where they treated almost two thousand children within the first year.>> DR. STEVE COLLINS: Has she seen it used before?>> WOMAN 6 [Interpreter]: She has not seen anybody use this.>> VOICEOVER: But it was the work of sociologists and anthropologists that uncovered the most significant and far-reaching obstacles to treating malnutrition.>> EMMANUEL MANDALAZ [Anthropologist]: One main issue was the cultural issues surrounding malnutrition with, for example, people believe that malnutrition is caused by parental sexual behavior. If a father goes out and sleeps with some other woman, that brings a spell on the child. >> DR. STEVE COLLINS: When the child had the problem with the stomach before, she took the child to a traditional healer who burnt the child. What did the traditional doctor say to her? What did the traditional doctor tell her to do about this illness? >> WOMAN 7 [Interpreter]: He said it was abdominal parasites.>> DR. STEVE COLLINS: Abdominal parasites. I think that the fact that she's waited for a month now... >> EMMANUEL MANDALAZ: Usually, mothers, even if there's treatment at the health center, they wouldn?t bring the child immediately, they would wait. First of all, they would try to consult a traditional healer until they have failed. That?s when they will come back to the program. So, later on, we try to engage with these traditional healers. Say if a mother sees a child maybe in the nearby vicinity, whose child is malnourished, they would encourage them. And that's one of the secrets with CTC: there's mother-to-mother transmission of information about treatment, where to go get it, and all those things, and how best they can take care of their children.>> GRACE NIKHOMA: The child was sick. He was refusing to eat and had diarrhea. He was looking malnourished and my friends helped me to get CTC. There was a great change when he started receiving peanut butter. The loss of appetite and diarrhea stopped, even his malnourished appearance improved. It took the child one month to change.>> VOICEOVER: In the two years following the program in Malawi, the team developed a database of over 23 thousand cases. They had run 21 programs in four different countries. Their mortality rates remained under five percent, but more importantly they reached over 70 percent of those in need, a massive improvement on the old system, which never reached more than 10 percent. They were ready to present their findings to the international community, and push for change in international policy.>> HOWARD DALZELL: We felt we had enough evidence, enough strong evidence to go public. And we obviously needed to convince the rest of the international nutrition community that these results were solid. So we organized a conference in October 2003, to present the results, and to have a discussion with the rest of the nutrition community.>> DR. STEVE COLLINS: The Dublin conference was really the turning point, I think. We really wanted to get the data on CTC to the agencies in a more formal manner, and give them a chance to respond and feedback.>> HOWARD DALZELL: That turned out to be a tension-laden conference. I would have to say it generated more heat than light. There were people who'd worked for two or three decades on refining and improving therapeutic feeding centers, and then there was the new fringe doing the community therapeutic care approach.>> DR. STEVE COLLINS: Treating starving children is a very emotive subject, and here were we, saying that we could actually do so much better, and there's an implied criticism of what was going on before.>> PROFESSOR MICHAEL GOLDEN: I think that there was a resistance by some NGOs for everyone to jump into bed and do the same thing and abandon what they were doing. They wanted to see how the risks that were being taken would pan out before they did the same thing. So there was a reticence for everyone to copy and say, "We're going to abandon everything that we've done in the past, and we're all going to do exactly the same as Concern.">> DR. STEVE COLLINS: A lot of opposition came from large agencies based around volunteers, and I think they probably felt a little bit threatened that we were saying that the volunteer model, as well, didn?t really fit with CTC, where you actually only need one professional, and it?s much better if they're a local person who knows the environment, rather than a lot of enthusiastic volunteers. >> TOM ARNOLD: There were still people on both sides of the argument at that stage. But what was beginning to emerge was that the evidence was beginning to accumulate. And with that, of course, the argument began to tilt towards the CTC.>> DR. STEVE COLLINS: After the Dublin meeting, when they had seen the strength of our data, I think people realized that they could no longer use just ideological objections, and I think they realized in a way that the CTC train was leaving the station, and they were either on board or they were left at the station.>> HOWARD DALZELL: Well, after that conference we continued to do trials, and we also extended the work to other agencies, so it wasn't just Concern doing it: MSF was doing it, Tearfund was doing it, Save the Children was doing it, so other agencies following that conference decided that they were going to give it a real try, and see could it work for them, and it did.>> VOICEOVER: It isn't just children, however, who benefit from CTC. It has also transformed the lives of thousands of people with HIV/AIDS. In 2005, Ortiz Primetime visited Malawi and met Akim, who was then close to death. He had been abandoned by his family and had even been moved to a hut close to the graveyard. >> AKIM BONZO: I go searching on my own for food, my relatives are not interested in me.>> VOICEOVER: Less than three years later, Akim has a new life, thanks to the potent combination of Community-based Therapeutic Care and antiretroviral drugs.>> AKIM BONZO: At first, when I started receiving therapeutic food, I used to have abdominal pains and diarrhea. After taking the food, I picked up and I could feel energized. The difference between then and now is that I can work on my garden and at home.>> MUONERETU BANDA [Akim's Wife]: The happiest time is when we chat together. If there's food, we cook and eat together and spend time in the garden. >> AKIM BONZO: The most important thing is to have love. Loving your partner the way you love yourself. I think that attitude keeps us together as a family.>> VOICEOVER: But the real success of CTC could only be measured when and if the United Nations and the World Health Organization endorsed it. This was the next crucial and defining step. In 2005, a meeting was held at the WHO headquarters in Geneva that would decide whether or to replace the traditional feeding center model. Although some trenchant resistance remained, the majority of those present supported the more community-based approach, but there was still one main stumbling block: the way child malnutrition is measured. >> DR. STEVE COLLINS: The evidence has always been extremely strong that Middle Upper Arm Circumference (MUAC) is a great predictor of mortality in young children. But there is a large group of people who thought, "No, no, we need to do mathematics, we need to do weight and height, basically because that's what we've always done," I think.>> DR. ELIZABETH MASON [World Health Organization]: The factor that you could consider is perfect being the enemy of the good. So if we consider weight for height, and you get Z scores, standard deviation, you've got the the perfect gold standard. But on the other hand, you have a simple upper arm circumference that, yes, it's not perfect, but it is a good measure to use for a community screening. And when we're looking at public health and when we're looking at options for the community, then we will choose the good over the perfect.>> VOICEOVER: In 2006, only six years after the initial trails were carried out by Concern and Valid in Malawi, CTC received the ultimate endorsement from the United Nations. This achievement was the culmination of years of work by the staff of Concern and Valid, and of many other agencies, such as Medecins Sans Frontieres, Save the Children, and the Tearfund. The pressure was now on African governments to adopt the new approach. Malawi was the first to take up the challenge. But Concern and Valid realized that local manufacture of ready-to-use food was critical. To achieve this, Concern supported the setting up of Valid Nutrition, a new kind of charity based on ethical business practices. With no shareholders, all profits are reinvested into local production and economies. >> DR. STEVE COLLINS: We want to produce a whole range of ready-to-use food, both for treating severe starvation, but also for treating moderate starvation and preventing malnutrition, from this factory, made locally in Malawi, by local Malawi people, using ingredients grown by local Malawian farmers. Effectively, you've got a local system to address malnutrition rather than having to depend on external interventions. >> DR. MARY SHAWA [Department of Nutrition, Malawi]: The advice I can say to everybody who is interested in this is traditionalize the CTC program, have the highest political commitment, and make sure that the private sector is also given room to take part in the production of the product. We have 201 facilities running the CTC program. Our target is to cover the whole country. And we believe if we can do that, we'll reduce the problem to zero. And that's our target: we want zero malnutrition in Malawi.>> VOICEOVER: Community-based Therapeutic Care, the radical new approach pioneered by Dr. Steve Collins and championed by Concern Worldwide, has transformed the treatment of severe acute malnutrition throughout the world. Although this required conviction, courage, and dedication, and has saved hundreds of thousands of lives, it is only part of the picture. Severely acute malnourished people make up only 10 percent of the world's hungry. The other 90 percent, the chronically malnourished, are far less visible. These are the hidden hungry, people who may not be in immediate danger of dying, but who are nonetheless suffering the effects malnutrition. Apart from the daily torment of going without food and all that entails, these people are also burdened with the life sentence of stunting, the affects of which only become apparent later in life.>> DR. STEVE COLLINS: When a child is born, its nervous tissue grows fastest. And if you don't have the right nutrients in the first couple of years of life when the brain is being wired, then the brain never reaches its full potential. So a child that was born to be an Einstein ends up not being able to cope with primary school. And once you miss that two years, and you miss that brain development, it's gone forever. You can't get it back by good nutrition.>> DR. ELIZABETH MASON: In the Western countries, we're now used to opening a jar or putting a whisker in the food and actually having energy-rich complementary feeds. So the first feeds the child gets are very energy-rich. Whereas the first feeds that the baby gets in many African countries is diluted porridge.>> PROFESSOR MICHAEL GOLDEN: There are 40 important essential nutrients, at least 40 essential nutrients. You need every one of them, all 40 of them, to be healthy. All you do is miss one of those 40 out, and you will not be able to resist disease, you will become sick, you will lose your appetite. You just sit there like a zombie. One of the worst things about malnutrition is that the child doesn't cry. How do you know if your child is hungry? He cries. How do you know if he's thirsty? He cries. If your child doesn't cry, and you think, "Oh, I'm a wonderful mommy, I love my child but my child doesn't need for anything, I can go about my other work, I can go and collect the wood, I can prepare the food," and the child just sits there. So the mother doesn't stimulate the child. So you have these two things. You have the stimulation, and you have then the nutrients that have to make those connections in the brain. But the connections won't be made if it's not stimulated, so you need both. You need good food, and you need stimulation.>> TOM ARNOLD: Stunting is something that I don't think enough is known about. Stunting means you're cutting off somebody's life prospects. You're reducing the economic future of many of these countries. And countries themselves need to know that, unless they've worked to prevent stunting, they're actually putting a burden on their own potential for decades to come. >> WOMAN: I ask God to give my children and me a healthy life and for the means to feed my family, to give me grace, health and to help me lead a decent life.>> TOM ARNOLD: Preventing hunger is actually a good investment for individuals and for countries. Now what to be done, where should the policy focus be? It should definitely be on better nutrition for pregnant women and children under two, massive intervention programs to deal with that problem.>> VOICEOVER: CTC provided a window into the world of the severely malnourished, and in doing so revealed the shocking reality of the daily lives of many African women. Most importantly, it highlighted how their unequal status is contributing to their own and their families' vulnerability to hunger. Not only are they fully responsible for the care of their children and home, they also do 80 percent of the agricultural work. They have few rights and even less choice. They are usually the last to eat at meal times, and the first to go without food when it is scarce. They are often anemic during pregnancy and breastfeeding, and their babies are frequently born underweight, perpetuating the vicious circle of malnutrition.>> ALICE GANDIWA [Concern Worldwide]: Most mothers, they work very hard in the fields, and they grown enough food, probably in the end that food may be sold and the children may not be fed enough. They suffer inwardly. They wish they could have done better for their children, but probably they don't have the means or they don't have the knowledge to do it. At times it's the feeding practices. At times it's the cultural practices. But inwardly, the mother would want a healthy child. Every mother would want a healthy child.>> BRENDAN ROGERS: There's no doubt about it, African women are very much second-class citizens. That's the fact. And while at the UN we pay lip service to equality and gender equality and gender empowerment, it's not happening underground. And there is that gap, and it's being increasingly recognized at every level of society. But if we want to improve the lives of women, if we want to improve the lives of children, if Africa wants to produce enough food to sustain itself, there has to be a refocus on agriculture and rural livelihoods. >> DR. STEVE COLLINS: Most of the hungry people are actually living on small farms. So one key way to get around it is not that the state comes and brings food to them, it's that they are enabled to produce the food themselves. And that requires big changes in the importance of agricultural policy, in government giving more support to farmers and to the rural areas so that farmers can produce and can trade. >> HOWARD DALZELL: The development of CTC has been unusual in that a private sector research organization (Valid International), an NGO (Concern), and a public sector body, such as the Irish government, work together to make it happen, and none of us could have done it by ourselves, but the public-private partnership worked.>> DR. STEVE COLLINS: In the world today, there are 300 million children with chronic malnutrition. We know that that can be prevented with just 40 grams of a high-quality food complement each day, given over a period of 18 months. So this is a problem that is treatable.>> HOWARD DALZELL: And we are convinced that the sort of principles of food signs that are in our ready-to-use foods can be used to make not just therapeutic foods, but supplementary and complementary foods that can go into the marketplace and that parents can buy for their children. It'll keep them growing, it will keep them healthy, and it will prevent malnutrition. >> DR. STEVE COLLINS: I think to date, large companies haven't really targeted the so-called bottom of the pyramid, the poorest of the poor, because I think they felt that these people just haven't got enough money to buy the kind of products they want to sell. But when you get to a really simple, low-cost nutritional supplement, the market is so big (300 million people) that if they each spend 10 dollars a year only on a quality nutritional product, that's a market of three billion dollars a year. Now that's a substantial market. If multinationals start to create properly designed nutritional products, and they price them at an affordable level, you're going to have a whole generation growing up who are capable of using their brains better, and capable of helping themselves more. So, as a foundation for development, the changes that are now happening are profound, and can have real implications in the alleviation of poverty.>> HOWARD DALZELL: It surprises companies when they hear that an NGO and a not-for-profit humanitarian company are actually following business principles. They don't expect us to want to manage costs very clearly, to want to show a surplus that then gets reinvested. They see charity and business as very different, and this whole concept of a not-for-profit company, Valid Nutrition, with a humanitarian mission following best business practices, is just unusual.>> TOM ARNOLD: We are clearly moving into a more difficult economic situation, where people have many legitimate fears about their future, about their future livelihoods. But at least so far, people in this part of the world are not at least fearful of going hungry, and long may that continue. But that is not the reality for a sixth of the world's population. And I think those of us who have escaped that fear of going hungry do need to think about that sixth of the world's population who still have that fear and that daily reality.>> VOICEOVER: The Irish government taskforce report, published in the autumn of 2008, stated clearly that there had been a collective failure at international and national levels to prioritize ending global hunger. Community-based Therapeutic Care demonstrated that when there is a genuine desire for change, solutions can and will be found. And yet, every night, one in six go to bed hungry.>> DR. STEVE COLLINS: This idea that we're doing it because we're compassionate-- that's not-- people have a right to health, a right to good nutrition, they have a right to education, they have a right to security. It's not doing good to ensure those rights are maintained and upheld. It's their rights! So it's a work, you know, you have to do it. I don't want people to do it because they're such nice people; I want people to do it because they can create change and because that's what they should do.>> HOWARD DALZELL: Child death through serious malnutrition is probably the greatest blasphemy in the world today. It simply shouldn't be allowed to happen. It's morally unacceptable. And I think what will actually stop it happening is moral indignation. Slavery was seriously tackled 180 years ago. It wasn't tackled because women in America had dishwashers, and Hoovers, and fridges, and microwaves, so that they didn't need slaves in their kitchen. It was blown out the water because people said this is wrong, our fellow human beings shouldn't be treated like this. It was a moral victory, not a technical victory. We have the technical answers to malnutrition. But to get rid of that blasphemy requires conviction and advocacy, and acceptance of everybody's right to food. It's as simple as that.>> TITLE: Tonight, almost a billion people will go to bed hungry. Most of them are women and children. We have the power to change this. Visit www.concernusa.org http://www.viewchange.org/videos/bwindis-babies Access to proper medical care can be a matter of life and death for pregnant women in rural Uganda and their babies. Elizabeth, a midwife at Bwindi Community Hospital, confronts the challenges facing pregnant women while preparing for the birth of her own child.<br /><br />CAUTION: This video contains graphic medical scenes. Tue, 22 Feb 2011 09:02:00 +0000 http://www.viewchange.org/videos/bwindis-babies Uganda, Public health, Childbirth, Pregnancy, Maternal death, Health, Africa, Marie Stopes International, Child mortality, Hospital >> TITLE: Bwindi's Babies >> VOICEOVER: Bwindi, on the Uganda/Rwanda border, is a small and remote rural community. >> ELIZABETH NABADDA [Senior Midwife]: Bwindi is a far place. It's really a far place, and of course transport is poor. Our roads are not so good, and then, hospitals are quite far apart. I mean the next hospital is about three to four hours' drive. >> VOICEOVER: For millions of poor women living in developing countries like Uganda, delays in accessing medical care can be life threatening for them and their babies. >> ELIZABETH NABADDA: We would get mothers who had been really delayed, mothers who would come with lots of problems. Obstructed labor, mothers would come with dead babies inside because they were really delayed. It's really frustrating seeing a baby dying, and it's so bad if the mother dies during the process. >> VOICEOVER: As a nurse, Elizabeth has delivered hundreds of babies. But it doesn't stop her worrying now she is pregnant herself. >> ELIZABETH NABADDA: I will be having a baby in about maybe six, seven weeks from now. And I'm excited; I'm just waiting for that time to come. Of course there is that kind of tension and wondering what may happen because you know, anything can happen during labor. But I trust everything in God and I think the doctors will do their best to me. >> VOICEOVER: For the past year, women in the Bwindi area have been using a voucher scheme. For the price of a loaf of bread, a woman can buy a voucher, which covers the otherwise high cost of ante- and post-natal care for her and her baby. >> ELIZABETH NABADDA: The rich can afford to go to any hospital. The poor may not even afford to come to Bwindi hospital. So it means everyone, even the poorest of the poor, can access the services. >> VOICEOVER: It's seven o'clock in the evening and an emergency case arrives from a hospital two hours' drive away. Melanie has been referred with complications. >> ELIZABETH NABADDA: She has leaking membranes... >> VOICEOVER: She has a voucher, so will be treated for free whatever happens next. >> JULIUS NKALUBO [Surgeon]: Our patient is 36 weeks pregnant and she has been referred in because she has leaking membranes. And this has been happening for the past three days. We found that, in addition to the leaking membranes, she has a transverse lie, and we could not get the heartbeat. If this baby is in any way compressing against the cord it will die in utero. And since it's transverse, we'll have to do a C-section to deliver the baby who is already dead. You have the head on one side of the ribs and the buttocks on the other side of the ribs, so actually when you look at labor, how it will go on, the mother's uterus fights to expel the baby. The strong part, which is the head, finds an area where it can pass, so it can rupture the uterus to go out. >> VOICE: And what happens to the mum then? >> JULIUS NKALUBO: Disaster. If she doesn't get emergency cesarean, she'll bleed and she will die. >> VOICEOVER: Within minutes, Julius and his team start operating, hoping it won't be too late to save Melanie and her baby. >> ELIZABETH NABADDA: So this is the baby that was born yesterday. The baby's name is Shabomwe. How many kilos is she? >> MUEZZIN MERETH [Nurse]: He is 2.0. >> ELIZABETH NABADDA: It's not bad. And now he's suckling, yeah? >> MUEZZIN MERETH: Yes now he's suckling very well. >> VOICEOVER: Baby Shabomwe is lucky. His mother made it to the hospital in time. But not every mother does. In the next cot, baby Rosetti has a different story. >> MUEZZIN MERETH: This one we received two weeks back. And it was from maternity. Unfortunately we lost the mother. We were told it was secondary postpartum hemorrhage. What we know, they are twins. Then they delivered one, and then the mother was referred in, by the time they delivered this one I think it was too late. The mother bled severely. So that was actually the cause of death according to the report we got from maternity. >> ELIZABETH NABADDA: Maternal health is a complex thing. It ranges from attitude change to real activity. We are really fighting hard and it is quite something that is not easy to achieve. >> ELIZABETH NABADDA: How are you doing? >> MELANIE: I'm OK. >> ELIZABETH NABADDA: To save mothers is to save the future. >> TITLE: A few weeks after filming, Elizabeth gave birth to a baby boy. Both mother and son are doing well. http://www.viewchange.org/videos/zainabus-decision Contraceptives are difficult to get hold off in rural Sierra Leone. As a result, many young couples end up with more children than they can take care of, a strain on both the family's budget and the mother's health. But a new program is teaching young mothers about family planning and providing free birth control. Wed, 09 Feb 2011 10:33:00 +0000 http://www.viewchange.org/videos/zainabus-decision Sierra Leone, Pregnancy, West Africa, Birth control, Maternal health, Family planning, Reproductive health, Marie Stopes International, Public health >> TITLE: Zainabu's decision>> VOICEOVER: Sierra Leone, in West Africa, is one of the poorest countries in the world. Here, pregnancy and childbirth claim the lives of thousands of women every year. In rural areas, girls get married young and traditionally have lots of children, like farmer's wife Zainabu. >> ZAINABU KARGBO: I have given birth to ten children. One died, so I am left with nine. Here, we are happy to have a lot of children. But everything is difficult, especially when you have a lot of children. It's hard but we have to be strong. We work hard to feed our children and to pay for them to go to school. It is not an easy life.>> SULLAY KARGBO: I love my children. We are a family. We play and laugh. Sometimes they help me on the farm. I'm too young to have so many, but here it earns me respect. We have too many children. They want to eat and eat, but I don't have the money. How can I be a good father to them if I can't give them everything they need? It's a problem.>> VOICEOVER: Aside from the financial costs of parenthood, in Sierra Leone one pregnancy in every eight results in the death of the mother. >> WOMAN: Did you hear about the lady from Mafullah? They said the baby was okay, but she died. And now, Bai Bai's wife is having a tough time and the baby still hasn't come.>> ZAINABU KARGBO: Oh God! It makes me think. I can't go through all that again.>> ZAINABU KARGBO: I've never used any kind of birth control, let alone gone to the hospital for it. I want to have a rest from having children, so I've decided to go and find out about family planning. >> WOMAN: If you want family planning, today is the day! Marie Stopes has brought family planning to your door.>> VOICEOVER: Zainabu's community is fortunate. Every month an outreach team comes to town to provide contraception. While Zainabu is seriously considering birth control, the men in the village are struggling with old superstitions. >> SULLAY KARGBO: What do you think about family planning? >> MAN 1: Family planning? I think it's good but I am also worried about it. My wife had a treatment and after that she became very thin. No one can tell me why.>> MAN 2: It's good that we have this service. But now my wife is fat and looking good. What if she uses this and then gets thin? People will laugh at us and say I cannot feed my wife. >> SULLAY KARGBO: When women go to family planning, they are no longer afraid to flirt. That's why some men don't like it. They think, now that they can't get pregnant, their wives will do what they like. But if my wife wants to use family planning, I guess I'll have to trust her. She told me she wants to go for it. We do have enough children. So I've said: "No problem, I agree with you." >> ZAINABU KARGBO: I've heard family planning suits some women but not others. I wonder if it will work for me. But I don't want any more children. >> WOMAN: Hello everyone. Please be quiet and pay attention. We're here to hold a family planning clinic. What is family planning? Who can tell me what is family planning? >> VOICEOVER: For Zainabu and most of the other women, this is all new. >> WOMAN: Implants. These are very popular. They are just inserted into your arm, like this. Then we have the coil. It's not metal. It's plastic. Come and touch it. You see? Can you see it? This stays in place for up to ten years. Now, Mr. Bright is going to show you how to use a condom. >> MR. BRIGHT: This condom will prevent sexually transmitted diseases. >> WOMAN: We have one more. What have we left out? The one where you don't want any more children at all! We make a cut, then take this tube and tie it. Take this tube and tie it. We use a local anaesthetic. You are not asleep. You can talk. With the anaesthetic, you won't feel any pain. After 3 or 4 days you can have sex again. You can go back to work. >> VOICEOVER: After hearing all the options and consulting with a nurse, Zainabu opts for a tubal ligation. Permanent sterilization. >> ZAINABU KARGBO: If we don't have any more children we can give the ones we have more attention. >> VOICEOVER: The operation will take 25 minutes. Zainabu has a local anaesthetic so is awake the whole time, and the team talked to her. >> ZAINABU KARGBO: I'm very happy it's done. It's over now. I didn't feel it. I'm very happy. I'm going to be fine now. http://www.viewchange.org/videos/living-proof-ethiopia-liyas-diary Most Ethiopian women deliver their babies at home without the aid of a trained birth attendant, increasing the chances of complications for both mother and child. World Health Organization Global Ambassador Liya Kebede confronts the challenges facing mothers and newborns in her home country, and discovers how new programs are helping shift the odds in their favor. Tue, 01 Feb 2011 11:10:00 +0000 http://www.viewchange.org/videos/living-proof-ethiopia-liyas-diary Ethiopia, Public health, Childbirth, Birth attendant, Pregnancy, Maternal health, Neonatology, Africa, Living Proof, ONE Campaign >> LIYA KEBEDE: It's 3am in a remote village in Ethiopia. A woman named Kumi is in labor. The nearest clinic is hours away and her only choice is to deliver the baby on the dirt floor. Even though I grew up in Ethiopia and I knew giving birth here was dangerous, nothing prepared me for seeing it firsthand. It's literally pitch black in there. The thing is, every time a woman is delivering in a place like this, her chances of survival ... I don't even know how you survive. >> TITLE: 94 percent of women here deliver at home without a trained attendant. >> LIYA KEBEDE: Not far from Kumi, a loving father named Alemu Amallo reads to his seven-year-old daughter Amarech. Just seven months ago, his wife hemorrhaged to death during childbirth. "My wife was the love of my life," he said. Alemu now has to be both father and mother to his two little girls. He says he doesn't know what he's going to do. When a woman dies in childbirth, the whole family, the whole community, feels the effect. >> TITLE: More than 300,000 women die giving birth in the developing world each year. >> LIYA KEBEDE: And then there are the newborns. One in 32 babies in the developing world dies during the first month of life. Dr. Mulualem Gessesse is a neonatologist in my hometown, Addis Ababa. She works seven days a week and sees thousands of babies a year. While giving a tour of the facility, she had to stop to resuscitate a baby girl, just 14 hours old. She was struggling to breathe. When asked the chances of the baby surviving she held up her hand and said, "Zero." >> DR. MULUALEM GESSESSE [NEONATOLOGIST]: When you lose one, you cry. In spite of everything we are doing, it's not easy just to lose a life. >> LIYA KEBEDE: But there are glimmers of hope. The Ethiopian government and global partners have recently launched new programs to provide pregnant women with prenatal care and clean and safe delivery. Because of those efforts, a trained birth attendant arrived in time to help Kumi deliver a healthy baby girl. She named her Idalee, which means "lucky day." If these efforts can grow, my hope is that, one day soon, a healthy childbirth in my country will no longer be considered a stroke of luck. >> TITLE: Living Proof: Real Lives. Real Progress. www.one.org/livingproof http://www.viewchange.org/videos/living-proof-nepal-dangerous-day The dangers of childbirth become amplified when mothers live in remote and poverty-stricken areas. In the Himalayan foothills of Nepal, far from any clinics or hospitals, a young mother struggles with the fear of complications during the birth of her daughter. This film examines how skilled birth attendants can dramatically improve the survival odds for both the mother and child. Sun, 14 Nov 2010 17:33:00 +0000 http://www.viewchange.org/videos/living-proof-nepal-dangerous-day Nepal, Childbirth, Birth attendant, Child mortality, Maternal death, South Asia, Midwifery, Himalayas, Rural area, Gender >> TITLE: Part 1, Delivery Day >> TITLE: In one of the world's poorest places, the day a woman gives birth is the most dangerous day of her life, and her child's life. Can one woman and her baby beat the odds? >> TITLE: Western Nepal >> TITLE: People scratch out a living in the Himalayan foothills, and life is hardest for women >> MAHESWORI: My name is Maheswori. I'm 19 years old. My husband went to India to work. Here there is no food, no rice, no nothing. Around here, there's no work. >> TITLE: Maheswori is pregnant and past due. >> MAHESWORI: I am very, very scared. Everyone has been asking about it, and that makes me even more scared. My first child was breech born, and I might just die this time. If I will live, I will live. If I will die, I will die. >> TITLE: The nearest hospital is four hours away. >> MAHESWORI: Some said take her to the hospital, some said drive her down. Everyone had opinions. But how would you get a car without money? >> TITLE: She plans to deliver in the same place she gave birth before. >> MAHESWORI: In November my daughter was born. I had the baby in our cow shed. >> TITLE: By local custom, mother and child are quarantined as "unclean." >> MAHESWORI: For 12 days after the birth, the baby and I were kept in the cow shed. On the 13th day we were allowed out. You can't take a newborn in the house, God gets angry. You're better off in the cow shed. >> TITLE: Because of Maheswori's high-risk pregnancy, an aid worker traveling with the camera crew makes a case to village elders. They consent to having a birth attendant, and she won't give birth in the cow shed. >> MAHESWORI: I am going to die. Oh my mother! I am dying ... >> WOMAN: Get me the gloves, quickly. >> MAHESWORI: I am dying ... am dying. Please ... I can't. >> WOMAN: It's a complete breech situation. Push hard! >> INDUKA KARI [CARE Program Officer]: She was completely unaware of the fact that she would need medical care because her first child was breech born. >> TITLE: She gives birth to another daughter, Seema. >> INDUKA KARI: If she hadn't gotten proper care by a trained birth attendant, she would've died. >> MAHESWORI: I'll rest for seven days, but then it's back to work. I have to pound the rice, carry water, cut grass, and chop wood. Life is tough here. >> TITLE: Living Proof. Real Lives. Real Progress. >> TITLE: In Nepal, 80 percent of births occur at home with no skilled birth attendant like Maheswori had. But support from global partners is helping train Nepal's 45,000 female health volunteers, and they are dramatically improving Nepal's health outcomes. >> TITLE: In Part 2. Living Proof. Real Lives. Real Progress. www.one.org/livingproof http://www.viewchange.org/videos/living-proof-malawi-grandparents-shaping-safe-childbirth In Malawi, agogos (grandparents) are responsible for passing on tradition. Through the Agogo Program, they are educating future parents on proper pre- and post-natal care to help increase the odds of safe childbirth.<br /> Sun, 14 Nov 2010 11:33:00 +0000 http://www.viewchange.org/videos/living-proof-malawi-grandparents-shaping-safe-childbirth Malawi, Pregnancy, Millennium Development Goals, Maternal death, Child mortality, Living Proof, ONE Campaign, Sub-Saharan Africa, Home birth, Childbirth >> TITLE: Wacapati = Pregnancy >> TITLE: In Malawi, the word for pregnancy also means 50/50. Conventional wisdom says there is just a 50/50 chance a woman will survive childbirth. >> TITLE: Agogo = Grandparent >> TITLE: Agogos are known as the guardians of wisdom and are responsible for passing on tradition. >> TITLE: Can agogos help improve the odds of wacapati? >> TITLE: Ekwendeni, Malawi >> LYTON CHAWINGA: My name is Lyton Chawinga, and I have six grandchildren. I was born at home, in 1948. In previous days, pregnant mothers were using unsafe methods. Some would have their babies in grass huts. After giving birth, they would leave babies on the ground in the cold. We didn't know better. We had a lot of deaths. One day, hospital workers asked us to be a part of the Agogo Program. >> TITLE: The Agogo Program teaches village elders about proper natal care and helps agogos pass along those messages to their communities. >> LYTON CHAWINGA: We go to their house. We talk to both the man and the woman. We are here to chat with you about the importance of going to the hospital when you are pregnant. We show them pictures and tell them what can happen if they give birth at home. That the mother or baby can fall sick or die. >> WOMAN [Agogo]: After three months, start going for checkups. Escort each other. Many husbands refuse to escort their wives, which is not good. >> TITLE: Agogos also use traditional methods to teach modern messages. >> WOMEN: Pregnancy doesn't kill, the hospital is good, and all our children should be taken there. >> LYTON CHAWINGA: Deaths have decreased, diseases have decreased, and life has improved. I am really happy because if the student fails you are not a good teacher. I see fruits of what I teach and I am proud that I am a good teacher. >> TITLE: Living Proof: Real Lives. Real Progress. >> TITLE: With support and funding, 4,000 agogos have been trained in Malawi. >> TITLE: As a result, Ekwendeni Hospital has seen a 60 percent increase in pregnant women seeking antenatal care. >> TITLE: To accommodate them, the hospital is building a new, larger maternal ward. >> TITLE: Living Proof: Real Lives. Real Progress. www.one.org/livingproof http://www.viewchange.org/videos/living-proof-egypt-newlyweds Reaching out to Egyptian women and couples as they are about to get married, a new program educates newlyweds and women about pregnancy, labor, and newborn healthcare. This vital information is improving infant health outcomes. Sun, 14 Nov 2010 09:33:00 +0000 http://www.viewchange.org/videos/living-proof-egypt-newlyweds Egypt, Reproductive health, Community health worker, Millennium Development Goals, Child mortality, North Africa, USAID, Maternal health, Health education, Pregnancy >> TITLE: Challenge: Many Egyptian women lack proper pre- and post-natal care >> TITLE: Solution: Make weddings a time to discuss maternal and newborn health. >> TITLE: Can teaching newlyweds make healthier babies? >> TITLE: Traditional wedding celebration, Village of Gayera, Upper Egypt >> VIKKI STEIN [USAID]: Young couples in Egypt want to try to have a family or begin their family right after marriage. So, within a very short amount of time, women and men are experiencing their first pregnancy, they're experiencing their first birth, and they're raising their baby. These are all very critical health moments for a family, and women as a group when they're having their pregnancy, are seen as a high-risk group. You see women giving birth outside the medical facility. You see malnutrition, you see underweight babies, and so the newlywed initiative looks to give young families, young couples, the information they need to get off to a healthy start. >> MEDIHA ATTEYA [Newlywed]: It taught me the danger signs during pregnancy. Like, if I started bleeding, if I don't gain weight, or if I get a fever, I have to go to the doctor right away. >> VIKKI STEIN: A couple like Saad and Mediha and Kenna, participate in this program on a number of levels. They have a community health worker come and visit them and bring them information about the community health program, and also invite them to participate in community activities. >> WARDA HAMED ALY [Community Health Worker]: Don't have kids, one right after another. Space them out. We've made progress. In the past, our mothers used to have kids by the dozen, and that's why this country has so much poverty. >> HAJJA OM EZZ ABDU MAHMA [Saad's mother]: In my day, it was different. I had nine children at home: six girls and three boys, just like that. I didn't have a doctor. >> SAAD MOHD SAYED: Everyone goes to the hospital now. >> MEDIHA ATTEYA: Having a baby at home is dangerous. What if I start hemorrhaging? Nothing but the hospital will save me. >> TITLE: Newlywed Initiative women's meeting >> DOAA MEABED SAYED [Instructor]: I welcome you once again to the Arab Women Speaks. >> VIKKI STEIN: In the Arab Women Speak Out classes, women are taught about women's empowerment issues. They're taught men and women both need to be involved, and they both have an important role. >> DOAA MEABED SAYED: If a younger brother is thirsty, the mother says, "Get up, girl, and get your brother a glass of water." Is this the way to bring up our children? The most important thing I focus on is to make a happy family. We're here to modify everyone's behavior. To make happier and healthier families. >> MEN: Congratulations! >> TITLE: Living Proof: Real Lives. Real Progress. >> TITLE: Since the Newlywed Initiative began in 2004, 30 percent more pregnant women have proper prenatal care, 14 percent more mothers have medically assisted births, 27 percent fewer babies and young children are underweight. >> TITLE: Living Proof: Real Lives. Real Progress. www.one.org/livingproof http://www.viewchange.org/videos/living-proof-egypt-daily-bread Millions of Egyptians suffer from poor nutrition, including birth defects and miscarriages. Now, a food fortification program is making an edible difference. One family's newest member is living proof. Mon, 08 Nov 2010 09:14:00 +0000 http://www.viewchange.org/videos/living-proof-egypt-daily-bread Egypt, ONE Campaign, Egyptians, Living Proof, Food fortification, Luxor, North Africa, Folic acid, World Health Day, Flour >> TITLE: Challenge: Millions of Egyptians suffer the effects of poor nutrition, including preventable miscarriages and birth defects.>> TITLE: Solution: Add micronutrients to baladi bread, the staple food of poor Egyptians.>> TITLE: Can their daily bread save lives?>> TITLE: Luxor. The Nile.>> TITLE: Sombol Mohamed makes his living ferrying tourists across the Nile. He shares a home on its banks with his mother and sister and wife, Mona, who is nine months pregnant. Her first pregnancy ended badly.>> MONA: First I was pregnant with twins, but I went to the doctor and he told me: "They've been dead in your belly for 21 days." So I had to have an operation to get them out. >> OM SOMBOL [Mother]: My daughter Dalal had two miscarriages because she didn't take folic acid. Twice! Once at three months, and the other at two months, I swear.>> DR. AZZA GOHAR [Egypt National Nutrition Institute]: Iron is one of the vital elements that a mother needs during her pregnancy. So, if she's iron deficient or folic acid deficient, that's a problem. It compromises her health and her child's. The baladi bread program is a national program. We add iron and folic acid to the baladi bread flour. The population is 80 million and they depend on the bread. Even if somebody cannot afford anything else, he can afford to buy bread. >> TITLE: El Etihad Flour Mill, Luxor>> MOHAMED ABDOBASHA [Mill Manager]: We began the iron fortification program last year, meaning 2008. We mix the iron and folic acid in the machine, and the computer regulates how much nutrient is released into the flour.>> TITLE: Every day the Luxor mill ships 125 tons of fortified flour. Most of it goes to neighborhood bakeries, where it is transformed overnight into baladi bread for the people.>> NOUBY ABDELHAMEED [Bakery Owner]: My share is seven sacks of flour a day. We come in to mix the yeast around 11 at night. Half a pack of yeast and half a sack of flour. We mix them in the kneading machine, and we leave them till morning. Around seven o'clock in the morning, the bakers come in to make the dough and bake the bread.>> TITLE: Citizens can buy 20 loaves for one Egyptian pound. There are always more customers than loaves.>> TITLE: Twenty million Egyptians now have the benefit of iron and folic acid in their daily diets, including pregnant and soon-to-be pregnant women.>> DR. AHMED ABDEL MONTELB [Obstetrician]: With folic acid we're protecting coming generations; we're protecting an entire generation, a new generation with fewer birth defects and miscarriages. >> TITLE: Two weeks later, Sombol's wife, Mona, gave birth to a healthy baby boy.>> SOMBOL MOHAMED: I'm so happy with my son, my first, which is a special love. Hopefully, God will give me many more.>> OM SOMBOL: This is my first grandchild and I'm so happy with him. I'll get him gold tokens that ward off the evil eye, and I'll make him so happy.>> TITLE: Living Proof: Real Lives. Real Progress.>> TITLE: Food fortification is one of the world's most cost-effective public health tools. Global partners support food fortification in over 25 countries, aiming ultimately to reach 1 billion people>> TITLE: Living Proof: Real Lives. Real Progress. www.one.org/livingproof http://www.viewchange.org/videos/the-art-of-activism-martha-ryan The founder of San Francisco's Homeless Prenatal Program talks about how her experiences of volunteering in the developing world gave her the inspiration to help people in need closer to home. Thu, 04 Nov 2010 08:25:00 +0000 http://www.viewchange.org/videos/the-art-of-activism-martha-ryan San Francisco, Homeless Prenatal Program, Martha Ryan, Redford Center, Prenatal care, Pregnancy, Homelessness, Poverty, Health, Gender >> TITLE: Redford Center: The Art of Activism. Let's listen, let's talk, let's act>> MARTHA RYAN [Founder, Homeless Prenatal Program]: My plan had been all along to go back to Africa or to the developing world to set up maternal and child health programs. And, while I was volunteering in this shelter, I realized that there was a developing world right here in San Francisco. I knew I couldn't volunteer the rest of my life; I had a lot of loans to pay back. I wrote a grant, [my] first class project. I decided I would submit it to the San Francisco Foundation. I was a nurse who had never managed a program, but they liked the idea. In 1989 they gave me a grant for USD$52,000 and that started the Homeless Prenatal Program. >> MARTHA RYAN: Poverty is an accident of birth. Children don't get to choose which families they're born into and people who are born into poverty or are raised in poverty have fewer opportunities than those that are born into a family of means. I remember seeing one of my clients being interviewed, and the reporter asked her, "Are you worried about the baby you're about to have?" She said, "No, I worry about the ones I already have." And so I realized that the state of pregnancy was a wonderful window of opportunity for a woman to turn her life around. They needed more than just prenatal care: they needed housing, they needed help with addiction, some needed to get away from a batterer. They had lived their lives in poverty and they needed help in learning how to overcome these barriers.>> MARTHA RYAN: I describe the Homeless Prenatal Program as a place of hope, a place where people can find opportunities that they don't normally have. It's a place where people can turn their lives around. I modeled some of the program here after work I did in Eastern Africa. I worked in refugee camps. What we did there was we trained women everything we knew about the prevalent diseases. In those six months we had four epidemics, and we were able to control those epidemics, not because of western medicine, but because of women who we trained to be our health workers. So one of the first women I ever hired was addicted to crack, and she was in recovery, early in recovery; she said to me, she said, "I can't believe you'd hire an addict." And I thought, "Perfect person to hire as far as I'm concerned." Because they would be able to help people who were addicted to turn their lives around. They would understand them, they would understand the pathophysiology of addiction. And that's exactly what happens.>> MARTHA RYAN: Today, we serve over 3,600 families, we do this with a staff of 62, more than half of whom came to us initially as clients. We have a computer lab and we have a financial literacy program. We also do classes in English. And we try to help them get what they need to exit poverty. I've always been a volunteer throughout my life. I used to volunteer at St. Anthony's, [at] the same time I was working in the ICU at San Francisco General. And I used to wonder why I would go to St. Anthony's on my day off. But I always left the clinic inches off the ground. When people volunteer and give, they feel so much better. It's so easy to cast judgment on someone that you don't know, and if we could just not do that, and accept people for who they are, and be nice and kind and give a helping hand, we'd feel better about life, and so would everybody else.>> TITLE: Activism takes many forms: perhaps the most radical is kindness>> TITLE: [end credits]>> TITLE: www.RedfordCenter.org http://www.viewchange.org/videos/women-empowered-vigilantes-de-la-vida Sometimes improving healthcare isn't simply a matter of building new hospitals or training more doctors. Filmmaker Phil Borges travels to the southern Peru, to learn about how local people are working with medical professionals to make pregnancy and childbirth safer for everyone. Mon, 25 Oct 2010 07:16:00 +0000 http://www.viewchange.org/videos/women-empowered-vigilantes-de-la-vida Peru, Childbirth, Quechua, Midwifery, South America, Latin America, Prenatal care, Maternal death, Phil Borges, International Women's Day >> TITLE: Tococori, Peru. September 2008>> PHIL BORGES [Documentary Filmmaker and Photographer]: Lorenzo told me his wife didn't stop bleeding after she gave birth. >> TITLE: Lorenzo Quispe, Farmer>> PHIL BORGES: He left her and the baby with his mother-in-law and set out on his bicycle to get help. Peddling in the dark for 10 miles in the pouring rain, he barely made it to town. He finally found a doctor but, by the time they got back to the house, three hours had passed. Lorenzo's wife died just as they entered the room. Adolfo is now a year old, survived by being breastfed by his aunt. Lorenzo's son Juan dropped out of school to help take care of his brothers and sisters. And Lorenzo's health has worsened since his wife's death. The family is struggling just to survive. >> TITLE: Somewhere in the world, every 52 seconds, a woman dies in childbirth. >> TITLE: Most of these deaths are preventable. >> PHIL BORGES: For Gladys, the emergency was different, but it could have been just as deadly. >> TITLE: Gladys Huamani, Ayacucho, Peru >> PHIL BORGES: The fetus was in a dangerous breech position. A well-trained team performed the emergency C-section. Because Gladys had regular prenatal care, and a trained midwife that knew when to refer her to the hospital, she and her baby avoided a potential tragedy. >> TITLE: Vigilantes de la Vida>> PHIL BORGES: Maternal mortality was all too common in the Southern Highlands of Peru. Fortunately, in the past five years, the number of maternal deaths has fallen dramatically. I came to Peru to see what had made such a difference. In Ayacucho, I met Bacilia Vivanco, a midwife who had helped spearhead the change. >> BACILIA VIVANCO [Midwife]: Ayacucho was averaging 35 maternal deaths a year. In 2004, we gathered the midwives, doctors, leaders from the regional hospital, and began to formulate a set of guidelines for obstetric emergencies. We brought in all the people from the rural health posts. Over 200 people worked on it. CARE facilitated the process. We are so proud. The 2004 guide is now famous and is being implemented all over Peru. >> PHIL BORGES: These guidelines were a crucial step in addressing the problem of maternal mortality. The next hurdle was to get them implemented. Eugenia raises llamas and sheep in the high plains of Southern Peru. Like most Quechua woman, she gave birth to her three children at home. She just didn't see any benefit in going to the local health post. Three years ago, she began training with CARE to become a citizen monitor, or what they call a "vigilante." One day a week, she rides six miles to the health post to volunteer her services. Her presence builds the trust between the healthcare providers and their clients. That trust is the key to the extraordinary improvement that has taken place in Peru's maternal health program. >> EUGENIA ITME [Citizen Monitor (Vigilante)]: At first the women did not trust the health post. The doctors did not speak our language, or honor our traditional methods of birthing. I asked the women, "Do you trust the treatment you are getting? Does the doctor speak Quechua? Do they treat you with respect?" >> PHIL BORGES: The suggestions and complaints that Eugenia and other vigilantes gather help create the understanding of the Quechua views and traditions. Their findings are then sent to Peru's health ministry to be addressed. >> EUGENIA ITME: For me, it was very important to learn about my rights in the trainings. It meant that women didn't have to limit ourselves to the home. We could go out and have responsibilities with groups. We could go and speak with authorities about what we need and want. This has given me strength!>> PHIL BORGES: What a brilliant strategy: an army of volunteer women, women empowered just by learning their rights and getting a forum to share their insights. They're now bridging the cultural divide that had kept women from seeking and obtaining the healthcare that they were entitled to. >> PHIL BORGES: Like most Quechua women her age, 20-year-old Tarcila was born at home. >> TITLE: Tarcila Sulca, Vilcashuaman, Peru>> PHIL BORGES: However, two years ago, because of the recent improvements, Tarcila's mother decided to give birth to her last child at the health center. Following her mother's example, Tarcila and her husband Jorge came to the local health post to deliver their baby. Bacilia assisted. Just hours after giving birth, Tarcila left the hospital with her baby. Bacilia and I followed as she, Jorge, and her mother, took a taxi to the base of a steep, rugged trail. At 12,000 feet, it was all we could do just to keep up as she made the hour-long climb up to her home with her baby strapped to her back. Tarcila and Jorge's days are filled with hard work and few comforts, but as I watched Bacilia instruct Jorge on how to attend to his wife, I had a feeling that Tarcila has what she needs to keep her and her baby healthy. As I walked back down the mountain, I thought to myself, healthcare for the poor can't be solved simply by building more hospitals. What matters is what happens in those hospitals. CARE brought the right people together to create a system that respects local culture and improves the quality of healthcare. The result is women's lives and the families that depend on them, are being saved. >> TITLE: CARE's goal is to make pregnancy and delivery safe for 30 million women in 10 countries by 2015. http://www.viewchange.org/videos/sierra-leone-where-every-pregnancy-is-a-gamble After a decade-long conflict, Sierra Leone has many challenges ahead including improving child and maternal health. In 2009, one in eight women died during pregnancy. Fatimata Konte, an expectant mother, fears giving birth after already losing five of her children. She hopes the new policy to bring free healthcare to all pregnant women will save her next child and make giving birth safe for all women. Fri, 17 Sep 2010 08:16:00 +0000 http://www.viewchange.org/videos/sierra-leone-where-every-pregnancy-is-a-gamble Sierra Leone, Maternal death, Physician, Princess Christian Maternity Hospital, Kroo Bay, Pregnancy, Healthcare, Freetown, Childbirth, World Health Day >> VOICEOVER: After a brutal decade-long conflict, Sierra Leone has the highest child and maternal mortality rates in the world. >> FATIMATA KONTE [Expectant mother, Kroo Bay]: My name is Fatimata Konte. I'm 36 years old. We women suffer too much. Women in Sierra Leone suffer too much! I've lived in Kroo Bay for four years. When I wake up at 5am I get out of bed, and the kind of pain that I feel is from my waist bone down to the bottom of my belly. I cough and I'm very sick. I'm really sick but it's like this for all women. From the day a child is born, she must work. Every day I must go to the market. There I have to bargain for fruits. It's a strain to go to the market. I must sell the fruit to have money to buy food to sell for the next day. It's all I can do to survive. I work for my daughter so she can go to school. She is in class four. I want her to learn. Let her learn. I want her to be somebody. >> DR. TAGIE GBAWRU-MANSARAY [Doctor, Princess Christian Maternity Hospital]: When a woman is educated she can take care of herself, she can take care of the children, she can take care of her husband, her home. It benefits the population, the family, and it will help Sierra Leone in the long run. I'm a medical doctor, house officer here at the Princess Christian Maternity Hospital. When you're in school and you're studying to become a doctor, you read about all the fanciful techniques, all the wonderful drugs, the magic pills that you give to patients, all the different things that you can do as a doctor. When you come into the real world and you see that even basic things we don't have here -- the basic drugs, simple equipment -- and you are limited. At times you see a particular case and you think to yourself, if only I had this, if only I had that, I would have been able to save a patient's life. >> VOICEOVER: One in five children die before their first birthday, and one in eight women die during pregnancy. >> FATIMATA KONTE: I have two children and I've lost five, so this is the eighth pregnancy. So right now, I am remembering the past. I am worried this one can die too. My biggest fear is that this child will die. >> VOICEOVER: The one referral hospital in the capital of Freetown services a population of over 400,000 people. >> DR. IBRAHAM THORLIE [Doctor, Princess Christian Maternity Hospital]: Hello, good afternoon. My name is Dr. Ibraham Thorlie. In this hospital we have four gynecologists. One doctor can serve over 100,000 people. >> VOICEOVER: Though the hospital is severely understaffed, it is not the only reason so many people are dying. >> DR. IBRAHAM THORLIE: The delay starts from home. If a woman is pregnant, she wants to give birth, and the husband is not around, she cannot be taken anywhere without the husband coming, because he gives the money. If you come too late, we cannot help you. >> VOICEOVER: And, often, those patients who come too late are very close to death. >> DR. IBRAHAM THORLIE: It's a big dilemma. If the patient can pay you, then it's good. But when they cannot pay you, you need to help them. >> VOICEOVER: Rather than watching their patients die, many doctors and nurses like Rebecca pay for the worst cases from their own small salaries. >> REBECCA MASSAQUEI [Nurse, Princess Christian Maternity Hospital]: I'm a poor nurse. I don't have money to take care of this baby. But the baby should have died, because there was nobody to take care of the baby. So that's why I decided to take the baby. He will live to tell this story. So he's the victory child. That why I call his name Victor. >> VOICEOVER: Victor is one of the few lucky survivors in a place where so many die. However, the government has just launched a program providing free healthcare for pregnant women and children under five. >> DR. IBRAHAM THORLIE: Now things are picking up with the pronouncement of the free healthcare system. It's a big incentive and we hope that will surely bring a difference. But to sustain it is not an easy thing. >> FATIMATA KONTE: We women are all very happy that women will finally get treated. >> TITLE: On April 16, 2010 Fatimata Konte gave birth to a healthy baby boy. >> TITLE: [end credits] http://www.viewchange.org/videos/parteras <p>Midwives in Chiapas, Mexico's poorest state, represent the front line in a nationwide battle to improve the lives of women. They are helping to reduce domestic violence and improve education, while also working hard to maintain a maternal mortality rate of close to zero.</p> Thu, 09 Sep 2010 17:52:00 +0000 http://www.viewchange.org/videos/parteras Developing country, Midwifery, Maternal death, Domestic violence, Women's rights, Pregnancy, Chiapas, Mexico, Health, Millennium Development Goals >> TITLE: Nearly 60 women die for every 100,000 live births in Mexico. >> TITLE: The UN Millennium Development Goals aim to reduce maternal deaths to 22 by 2015. >> TITLE: In Chiapas, Mexico's poorest state, the maternal death toll exceeds 100. >> TITLE: In this highland community, the rate is close to zero. >> MANUELA LOPEZ LOPEZ [Midwife]: We're here in Carmen Zacatal. This is my hometown. Well, I work here. My name is Manuela Lopez Lopez. I work as a midwife. >> WOMAN 1 [Midwife]: Here, we are nine midwives. Of the nine midwives, we each have our own patients. Right now, I have 12 patients. >> WOMAN 2 [Midwife]: If there weren't midwives in every community, the majority of pregnant women would die, because there wouldn't be anyone to care for them, to see them, or to give them checkups. >> WOMAN 3 [Anthropologist]: Midwives have an ancestral knowledge, from generation to generation. We saw in earlier studies that the highest rates of maternal mortality were in the northern zone of Chiapas, but we began to see that in the places where the midwives have been given training, the rate is going down. We think this is the result of midwives and health workers having better tools but also that there is a better understanding among the community and a stronger coordination with health institutions. The idea is that, when the community makes a joint effort, the women will not die. >> WOMAN 2: We as midwives are organized, and we team up with a group of young men who work as volunteer health workers. We have a social network of health workers, midwives, and rural assistants. We all work together. We give talks to the local women. We tell them to defend themselves [from domestic abuse] and to not have more kids -- that, with two or three children, a small family lives better. >> WOMAN 2: I am looking for the baby's head. We'll see if the baby is well and positioned normally. I am also adjusting the baby so that it moves, or better said, I am waking it up. It's fine. >> WOMAN 4 [Mother]: This will be my last baby before I have an operation. What happened is that my first baby has a bad heart, so I have a lot of expenses. >> WOMAN 1: We feel very alone, and we are a marginalized community. We don't have materials to work with. Our community has no ambulance or a car for the drive to the hospital. Sometimes, we can't save women in time, and it is our weakness. But together we can take a sick woman out. We also partner with neighbors and local authorities. We can do it, and we give each other a hand, and now, thanks to God, there is hardly any maternal mortality here. >> WOMAN 2: Before, there was a lot of domestic abuse, but it is decreasing because of the talks and the workshops that we give, and that is what we're focusing on now. Now is not the time to be abused. Now is the time that we defend ourselves as women. >> WOMAN 5 [Midwife]: We save lives. We save two lives. >> TITLE: Midwives are the lifeline for impoverished women in these rural towns. >> TITLE: They are the first line of defense against maternal mortality. >> TITLE: A film by Captured Life Productions http://www.viewchange.org/videos/brendas-battle <p>Brenda is a health care worker in South Africa who is educating young women about sexual and reproductive health, particularly the dangers of illegal abortions. But she faces many challenges, including corrupt doctors and powerful cultural taboos.</p> Thu, 09 Sep 2010 07:20:00 +0000 http://www.viewchange.org/videos/brendas-battle Sub-Saharan Africa, Reproductive health, Abortion, Marie Stopes International, Reproductive rights, Birth control, Unintended pregnancy, Pregnancy, Health, Education >> VOICEOVER: Across the world, unsafe abortion is the cause of 13 percent of maternal deaths, with millions more women left injured, disabled, or infertile. In South Africa, abortion is legal up to 20 weeks, and can be accessed for free at government clinics. But cultural taboos mean that women still risk their lives with secret but unsafe abortions. >> BRENDA [Worker, Marie Stopes Clinic]: Good Day. I'm Brenda from the Marie Stopes Clinic. >> VOICEOVER: Brenda works in the community, educating people about sexual and reproductive health. >> BRENDA: I feel passion about it because it's my mission to help women to educate themselves, to know their rights. So I want women to be independent, to have a say. >> VOICEOVER: A big part of her mission is putting a stop to the practice of unsafe abortion. >> BRENDA: It's not easy really to talk about abortion. Because our culture, we don't talk about our sexuality, our private parts. It's very sensitive issues. So I find out that most women, they don't know about all the contraceptives. They don't know much about termination. They don't know who to talk to. >> VOICEOVER: With no one to talk to, pregnant girls can end up making risky decisions, like getting an illegal abortion. Brenda decides to pose as a girl who's passed the legal date for abortion and calls up an illegal provider. >> DR. LESEGO: Hello. >> BRENDA: Hello doctor. Good day. >> DR. LESEGO: Good day. >> BRENDA: I'm pregnant. I want to have an abortion. >> DR. LESEGO: For how many months? >> BRENDA: I'm 6 months pregnant. What are you going to do to me? >> DR. LESEGO: Some pills. >> BRENDA: Some pills. I'm going to drink the pills? >> DR. LESEGO: Yes. The one, you're going to drink it. The other one is going to go in your private parts. So you must squeeze it there and it comes out as a piece of blood. It's going to come in the pieces of blood. >> BRENDA: Oh, in the pieces of blood. >> DR. LESEGO: Yes. >> BRENDA: Six months pregnant! A pill? I don't think so. He doesn't even ask about the medical history or something. You can't do that as a qualified doctor. >> VOICEOVER: Determined to make young people aware of this problem, Brenda visits a local college with 19-year-old volunteer Pinky, whose friend fell prey to one of the con men. >> PINKY: I've got a friend, she went for an abortion. When we got there, it was, like, there were steps and rooms, lots of them. >> BRENDA: Little passages? >> PINKY: It was really dark in there. This is the room we have to go in. On the other side there was a slum. We got in the room. The guy didn't ask us ... >> BRENDA: How far you are? >> PINKY: Nothing! No! So, she did it. She went inserted pills under the vagina. When she got home there were all these pains and the little baby came out. She went to school, bleeding. That's when the parents knew, that's when the boyfriend knew that she did the abortion. She went back, and they wanted more money. She didn't have money, so she got sick. >> GIRL: Maybe that unsafe abortion, it can damage something inside, unlike safe abortions. >> BRENDA: Sometimes, the pills are mixed with, um, donkey dung, and, yes, they put it inside the vagina. So, just imagine these things are going to end up causing an infection inside. You understand? Sometimes, the abortion doesn't even happen. You are still pregnant, and now you have an infection. Thank you guys. The only thing we would like to see you do is to educate the youth about these issues. Be a role model. Thank you guys! >> VOICEOVER: Brenda will continue to educate women about their reproductive rights. Modern contraception is vital, but unintended pregnancies will happen and women must be educated and empowered to avoid unsafe abortions. >> BRENDA: This is not safe. For women, it's not safe. They're the only ones who terminate. So, as a woman, as a mother, this is not right for your health. >> INTERVIEWER: So you're not going to stop? >> BRENDA: No, I'm not going to stop. I think I've just started. >> TITLE: Make Women Matter. Made in partnership with Marie Stopes International, European Union. http://www.viewchange.org/videos/colombia-justice-in-the-region-of-death <p>The Mid-Magdalena region of Colombia is one of the most macho parts of Latin America, a place where violence against women is a casual part of everyday life. But change is coming. One of the "change-makers" is Judge Esperanza Gonzalez, a woman in her late 40s who is seeking to bring justice for females both inside her courtroom and out.&nbsp;</p> Thu, 08 Jul 2010 19:39:00 +0000 http://www.viewchange.org/videos/colombia-justice-in-the-region-of-death Colombia, Esperanza Gonzalez, Latin America, Domestic violence, Sexual abuse, South America, Women on the Front Line, United Nations, Teenage pregnancy, Sexual violence >> ANNIE LENNOX: It threatens the lives of more young women than cancer. It affects one in three women worldwide. It leaves women mentally scarred for life. "It" is violence against women and girls. According to the UN, this brutality is on the rise. Our series comes from the frontline of the hidden war on women and girls. The field of conflict is just as likely to be the home as the brothel. This time on Women on the Front Line we are in Colombia, to find out if there is hope for an end to violence against the women of this country where a culture of fear, conflict, and machismo still prevails. >> ESPERANZA GONZALEZ [Municipal Judge, Bolivar, Colombia]: There are many cases of sexual violence, acts of sexual abuse, child abuse, and sexual offences in general. As a judge, I have had to try such offenders. >> VOICEOVER: It's London May 2008, and Judge Esperanza González from Bolivar -- a small town in Colombia -- has come to Europe for the first time. She is sharing a platform with another judge, Cherie Blair, the wife of Britain's former Prime Minister. >> CHERIE BLAIR: Thank you. I'm very humbled to be here tonight and to share a platform with two very strong, very competent women judges. >> VOICEOVER: They're here to mark the publication of an international report on the plight of girls and women in conflict. For the Colombian municipal judge this is a universe away from her small town in the middle of one of the country's most violent regions. This is Bolivar, Judge Esperanza's town. It looks peaceful enough, but it hasn't always been this way. Colombia is home to the world's longest-running civil war, a conflict in which illegal drugs are the fuel. And women are not spared, with one woman a day dying because of the violence. The murder rate in Bolivar and the surrounding region peaked in the 1990s, but has fallen away dramatically with the drive to end the fighting. >> CARLOS IGNACIO CUERVO [Vice Minister, Social Protection]: We used to have an annual rate of 350 murders per hundred thousand; today we have rates of 27 murders per hundred thousand. >> VOICEOVER: But that is still five times higher than in nearby Costa Rica. The people in the Mid-Magdalena region live with the legacy of a time when they had the highest homicide rate in the world. Civil conflict everywhere retards the development of civil society, and the status of women. Colombia is no place to be a girl. If you are a girl, you have a less than 50 percent chance of receiving a secondary education, and run a one in five chance of becoming pregnant while still a teenager. Mid-Magdalena is Colombia's machismo wild west, but there's a stirring of change in the municipality of Bolivar, and that's why Women on the Front Line has come here. We were to find that everyone agrees it's Judge Esperanza who is spearheading the change. >> TITLE: Justice in the Region of Death >> VOICEOVER: Our Woman on the Front Line is 48-year-old mother of two Esperanza González. In her twenties she was made a judge in Bolivar. In this program we follow her on what she says is her personal mission to bring justice for young women and girls, in and out of her courtroom. >> ESPERANZA GONZALEZ: I brought new things to the town and I spoke to women about them, about respecting their rights, about making people respect them in their work and in their homes. Previously you couldn't speak about such things; everything was hidden, everything was a sin. >> VOICEOVER: Judge González is determined to confront what she describes as Colombia's "conspiracy of silence" that surrounds the issues of sexual abuse, domestic violence, and teenage pregnancy. >> ESPERANZA GONZALEZ: Young girls in the rural areas were sexually abused by their fathers, by their uncles, by their brothers and neighbors. But because all of this was kept quiet there were no charges made and therefore no statistics at the courthouse. >> VOICEOVER: The judge hears all kinds of cases in her courtroom. Today, she is hearing a case where a father is accusing a farmhand of sexually abusing his two daughters, aged 8 and 13. Judge Esperanza moved to Bolivar 20 years ago with her biology teacher husband, now headmaster of the town's main high school. In 1986, the judge's husband -- whose masters degree was in sexual and reproductive health -- persuaded her to attend a sexual health workshop with other local experts. It was to be a turning point for Judge González. She was given a list of options and was asked which she would choose if she discovered one of her sons was being taught by a homosexual. >> ESPERANZA GONZALEZ: I added one more suggestion saying, "fire him." I had never felt so bad, I had never felt so small, because here were all these specialized doctors and they asked me how a municipal judge, a lawyer with additional training and all the trimmings, how could I think like this? So they gave me a tough time, they put me through the mill. I felt really bad and I changed. It didn't happen overnight, but I started to change that day. >> VOICEOVER: Part of her personal journey was finding out via her husband, Luis Antonio Figueroa, that teenage pregnancies had reached very high levels in his school of 600 pupils. In Colombia, access to contraception is limited and abortion allowed only in extreme circumstances. >> LUIS ANTONIO FIGUEROA [Headmaster, Judge Esperanza's husband]: I think that one of the major problems here regarding our region is the unity of the family. The fathers and the mothers don't show much affection toward their children and there is also too much violence within the family environment. There is also a huge lack of support from the parents towards their children, due to the fact that they lack sexual education themselves. >> VOICEOVER: Another legacy of the conflict that increases the risks to girls, is the scattering of families. Incredibly, according to the UN High Commissioner for Refugees, there are more displaced people in Colombia than any other country in the world apart from Rwanda. >> CARLOS IGNACIO CUERVO: Conflict and displacement are risk factors. Two out of three adolescent women become pregnant when they are displaced. >> VOICEOVER: Esperanza González believes that the decades of violence have helped keep regions such as Mid-Magdalena in ignorance about sex and all the dangers it poses to young girls. It is still paradoxically a prudish society, as they were to find out one parents evening during the screening of an educational video on adolescent behaviour. >> ESPERANZA GONZALEZ: When the parents heard the word "sex" they did this, they covered their faces with their hands and lifted a finger to watch the video. When we left the meeting, my husband and I were accused of corrupting the community. >> VOICEOVER: Neither Esperanza González or her husband have been put off by such charges. They have taken on the task of helping girls to stay on in education. And this is a huge challenge: 22 percent of Colombian women between 12 and 17 do not attend school, according to the 2005 population census. Judge González is visiting Carolina Mogollón. She is a similar age to the judge's son and they were at school together. They were equal academically. But Juan Luis, the judge's son, will be going to university with a professional life beckoning. His schoolfriend will not be so fortunate. Despite her abilities, Carolina's education is effectively over. The reason is her two-month-old baby. >> ESPERANZA GONZALEZ: Doña Leonor what do you think about this situation? Because you were keen on her continuing her studies, weren't you? >> LEONOR DE MOGOLLON [Carolina's mother]: Yes, she wanted to study further but ... >> ESPERANZA GONZALEZ: But what? >> LEONOR DE MOGOLLON: There is nothing that can be done now. >> ESPERANZA GONZALEZ: So what you have to do is help her. Because she has a lot of goals in life. Or not? Have you given up on them? >> CAROLINA MOGOLLON: No, not at all. It was very difficult for my family because they expected something different for me. They expected me to study. They had different dreams for me other than having a baby. I did not have and still don't have my father's support. >> ESPERANZA GONZALEZ: The family's reaction was awful and the reaction of the community was awful. She was a student representative, and helped out in the church. >> VOICEOVER: Carolina's parents divorced a few years ago and her father has shunned the family since he found out his 17-year-old daughter was pregnant. >> LEONOR DE MOGOLLON: We wanted her to go onto further education. Whatever she wanted, that's what we wanted for her. Then when Carolina's father heard that she was pregnant it all turned. He hasn't spoken to her since, he hasn't given her money to finish off her studies. Yes, I told her not to go over there ... >> INTERVIEWER: And her father? What does he think of it all? >> LEONOR DE MOGOLLON: Nothing, he doesn't even speak to us. >> VOICEOVER: It is 10 months since Carolina has spoken to her father and their shared dream of a higher education for her has vanished. Carolina is now living alone with her mother, brother, and the baby. Her boyfriend Edgar is traveling, trying to earn a living as a musician. Carolina does her best to keep in touch with him through the local internet café. Judge González has tried -- but so far failed -- to achieve reconciliation with the father and get his daughter's education back on track. Carolina's experience is fairly typical. But the judge does not give up. And we see a much darker side to life in Bolivar. >> VOICEOVER: Esperanza González also finds time to head the Bolivar Committee on Women's Health. While we were filming, Judge González brought to our attention an altogether more serious case for which judicial proceedings are just starting. A 14-year-old girl was brought to the hospital by her mother, complaining of a severe stomach ache. To protect her identity we have called her Maria. >> DR. MONICA ROJAS [Bolivar Public Hospital]: The girl came here with her mother, with a physical problem. But, when the girl was asked to sign a form, instead of signing her name she just wrote "help me." >> VOICEOVER: Dr. Rojas suspected that Maria might be a victim of sexual abuse. The first person Dr. Rojas called was not the police but Judge Esperanza, who came immediately to the hospital to talk to the girl. >> DR. MONICA ROJAS: I told her there were several factors that made us suspicious of a possible case of sexual abuse. Firstly, she changed her behaviour. Secondly, her desire to take a shower. A person who has been abused always feels dirty. There is a need to be clean. >> ESPERANZA GONZALEZ [Municipal Judge, Bolivar, Colombia]: When she saw me, she took my hand and said, "Help me, help me," and "Bathe me, bathe me. I am dirty." "My father is bad." She told us things that affect you. I am not only a judge, I am also a mother. >> DR. MONICA ROJAS: What surprised us was the reaction of the mother, there was in fact no reaction. She said, "My husband is very good. He works and I never leave the girl alone." It was not the reaction of a woman that just finds out that her daughter is being sexually abused. >> VOICEOVER: While our film crew was recording this story, Maria's father, Angel María Franco, was arrested and brought to court for a preliminary hearing. Judge González told us that her extra-courtroom role meant that she might be called as a witness in the case. So another judge was appointed to preside over the hearing. The town prosecutor lays out the charges. >> ARTURO RASCON: The crime which you are charged with today is that of rape. That means that you committed sexual acts of a violent and psychologically damaging nature that caused trauma to a minor. >> JUDGE: The accused man wants to add something? >> ANGEL MARIA FRANCO [father of "Maria"]: You are saying that I abused my daughter. That is not true. >> JUDGE: Señor Angel Maria Franco you have the right to remain silent. When the police arrested you, did you suffer any injury? How did they treat you? >> ANGEL MARIA FRANCO: Fine. >> JUDGE: Did they read your rights? >> ANGEL MARIA FRANCO: Yes sir. >> JUDGE: Did they say you had the right to have a lawyer? >> ANGEL MARIA FRANCO: Yes sir. >> JUDGE: That you had the right to remain silent? >> ANGEL MARIA FRANCO: Yes sir. >> VOICEOVER: The court has appointed a defense lawyer for the accused man. >> YORELY TELLEZ [defense lawyer for Angel María Franco]: Thank you sir, could you tell my client, the accused, the possible jail time he is facing? >> JUDGE: The maximum sentence allowed, 33 years. >> VOICEOVER: Angel María Franco applied for bail but was refused. >> YORELY TELLEZ: This type of sexual offense takes place in every sphere of society, whether they are rich, poor, social strata one, two, or five. What is happening now is that the government has carried out campaigns, particularly on the television. Consequently there are more accusations. People are more aware. Children are approaching family welfare to make accusations. >> VOICEOVER: After the hearing our crew manages to talk briefly to the accused man. >> INTERVIEWER: Why do you think your daughter is saying you raped her? >> ANGEL MARIA FRANCO: When the mother brought her to the hospital she wasn't in her right mind. That's how things are. She was with her mother the whole time. I want you to help me and find a good doctor for my daughter to find out what's wrong with her. She has made me suffer because of what she's said. >> VOICEOVER: At the time of going to air, Angel Franco is in prison awaiting trial on the charge of "incest and rape of a minor." His wife still maintains she knows nothing about the abuse. No date for his trial has been set. If found guilty, Angel Franco faces more than three decades in prison. In 2007, the Colombian Congress passed new, tougher laws for crimes involving the sexual abuse of children. It is now impossible to get a reduction of sentence for a crime of this nature. >> VOICEOVER: Judge Esperanza has also been working with the Catholic Church, a traditionally conservative institution. It has now joined in on her personal campaign to help the girls of Bolivar. She even has her own show on the local radio. >> ESPERANZA GONZALEZ: In the very beginning it was very difficult to change certain mindsets in people. The first time I asked the priest to join the sexual and reproductive health team, the priest refused. He said that he didn't want to learn anything about sex. So I asked him to accompany me to a workshop on self-esteem, and from then on the priest became part of the sexual health team. >> FATHER OLIVERIO MURCIA [Priest]: It worries us because we see, with great anguish, that such young girls are not ready to take up the responsibilities of motherhood. >> VOICEOVER: If Judge González can change the mind of a Catholic priest in Bolivar, then surely Carolina's father should prove no obstacle. >> JORGE MOGOLLON [Carolina's father]: Since she left she has not come back here because I scolded her. I said, "Why didn't you tell me it was simply dating? And that there were no commitments at all, and now you are pregnant." She left, and she hasn't talked to me since. She hasn't come back here either. >> VOICEOVER: Judge González is doing her best to reconcile father and daughter. >> ESPERANZA GONZALEZ [teenage mother]: Your dad is hurt because of that. I think you should talk to your dad and if he won't see you today you should go back tomorrow. And if he does not see you tomorrow go back the day after and say to him, "I'm here to show you my daughter, your grand-daughter. I made a mistake and I need your support." Is it too much for you? >> CAROLINA MOGOLLON: No it's not too much, but I am scared that again he ... >> ESPERANZA GONZALEZ: If you do not knock on the door you'll never get in. >> VOICEOVER: In a country undergoing rapid social change, with family breakdown and teenage pregnancy at epidemic levels, Judge González is convinced that her working as a counselor and health worker together with the United Nation's Population Fund is vital to the health and future happiness of the women of Bolivar. >> ESPERANZA GONZALEZ: So it started as a personal change because one has to, as they say, "modernize." You have to learn, not just to look good in front of the community but to be at peace with yourself. >> JAVIER MARTINEZ [Development and Peace Programme, Middle Magdalena]: Judge Esperanza, she is a wonderful person. She understands this subject as a health issue. An issue which encompasses many agencies; it becomes more integrated. >> ESPERANZA GONZALEZ: There are still incidents, but I think that now we can avoid many things because we are talking openly. Today, fortunately or unfortunately, depending on your perspective, if there is a domestic violence situation or any kind of problem with a couple, people will say: "If you carry on like that I will report you to Judge Esperanza!" >> TITLE: [end credits] http://www.viewchange.org/videos/unicef-modern-birthing-practices-make-kyrgyzstan-baby-friendly Investments in new equipment and modern birthing techniques are helping Kyrgyzstan adopt more child-friendly standards in its hospitals and tackle the country&rsquo;s high maternal mortality rate. Wed, 09 Jun 2010 20:47:00 +0000 http://www.viewchange.org/videos/unicef-modern-birthing-practices-make-kyrgyzstan-baby-friendly Kyrgyzstan, Health, Childbirth, Bishkek, Maternal health, Infant, Breastfeeding, Central Asia, Gender, Pregnancy >> VOICEOVER: Nargiza is in labor at Kyrgyzstan’s National Maternal and Child Health Center in Bishkek. Her sister Jibek is assisting and Nargiza can choose any position for delivery. Partner-assisted and free position deliveries are both recently introduced birth practices in Kyrgyzstan. Meanwhile, Aizat has just given birth to a boy, her second child. Better neonatal hygiene as well skin-to-skin contact after birth and exclusive breast-feeding are now becoming standard practice in Kyrgyzstan. These are just some of the ways hospitals and clinics certified by UNICEF as “baby friendly” are providing a continuum of care for mothers and newborns. >> AIZAT: This delivery was different. The doctor put my son directly on my chest after birth. Within half an hour he was seeking my breast to feed. But the first time I gave birth, the nurse immediately took my child away to a different ward. >> VOICEOVER: Most mothers in Kyrgyzstan deliver their children at a hospital or clinic, however maternal mortality rates remain high. Poor nutrition is a leading cause of birth complications. More than 50 percent of pregnant mothers in Kyrgyzstan suffer from anemia. UNICEF is working with health authorities to introduce cost-effective ways to reduce both maternal and infant mortality. >> TIM SCHAFFTER [UNICEF Representative, Kyrgyzstan]: For children, when they're born, simple techniques to improve sanitation and hygiene to prevent infection, simple techniques such as promoting breast feeding with children has an amazing reduction in child illness and death. >> VOICEOVER: Only 55 percent of Kyrgyzstan’s hospitals and clinics are certified as "baby friendly." The death of a newborn or a mother that could be prevented is a tragedy in every Kyrgyz community. However, new equipment and training is beginning to make a difference. >> GULDAN DUISHENBAEVA [Head of Maternal Health, National Maternal and Child Health Center, Bishkek]: We make it a priority to train all our doctors and midwives and health professionals so they can advocate and teach our patients. If the doctors themselves don’t know the issues surrounding, for example, breastfeeding, then they can't very well explain them to parents. >> VOICEOVER: New health policies now enable pregnant women to receive free medical care throughout their pregnancy and for their children up to the age of five. Gradually, Kyrgyzstan’s health system is developing the capacity to provide a more holistic approach to maternal and infant care. In Bishkek, Kyrgyzstan, this is Guy Degen reporting for UNICEF Television. Unite for children. http://www.viewchange.org/videos/ecuador-provides-birth-choices-to-save-lives <p>Among indigenous people in remote parts of Ecuador, expectant mothers are often reluctant to give birth away from home, leading to possible complications during labor. But local hospitals are beginning to realize that a little cultural sensitivity can go a long way toward changing their minds.</p> Fri, 07 May 2010 00:15:50 +0000 http://www.viewchange.org/videos/ecuador-provides-birth-choices-to-save-lives Childbirth, Ecuador, Pregnancy, United Nations Population Fund, United Nations, Home birth, Amazon Rainforest, Huaorani, Napo River, South American indigenous people >> VOICEOVER: Ecuador's Amazon jungle: According to a myth of the Huaorani people, pregnant women died giving birth because the only way for their babies to be born was for their husbands to cut open their bellies. But one day, the myth goes, a mouse appeared and told a pregnant woman to throw a rope over a beam in the ceiling, get down on her knees, tap her body with a palm stick, and push the baby out. This is called vertical birth. Today, indigenous women continue to follow this traditional practice at home. But home birth can be life threatening. Ecuador has 13 million people, and nearly one million are indigenous. Many live in remote areas where women face high risks of dying from complications in childbirth simply because they receive medical help too late. Alba Peralta and a group of community health promoters are on a campaign to encourage rural women to switch from home birth to hospital delivery. >> ALBA PERALTA: Life experiences have taught me that it's my obligation to tell women they should go to a health center because not only are their lives in danger, but their babies' as well. >> VOICEOVER: Today, they are travelling 60 miles up the Napo River to Palma Roja, one of the 500 tiny hamlets accessible only by boat. In 1998, the government passed a law providing free maternal health care to every woman, but few in rural communities know about it. In 2004, a network of health promoters known as the Users Committee was created. Supported by the UN Population Fund, or UNFPA, they are to inform and encourage women to claim their rights and benefits. Alba and her team are visiting 18-year-old Mariela Grefa to persuade her to go to the hospital. Pregnant with her first baby, Mariela is learning from her mother the traditional way of childbirth. But, despite the offer of free services, she still prefers giving birth at home. >> MARIELA GREFA: I am scared to go to hospital, because I know that sometimes when women cannot give birth the normal way, doctors open you up. >> VOICEOVER: For indigenous peoples, giving birth is a private and intimate family ritual. Midwives and family members are always there to give support and comfort. Modern medicine is not only unfamiliar but also frightening. >> LILY RODRIGUEZ: When women arrive in hospitals, they have to go through a practice that is completely different from their culture. >> VOICEOVER: Lily Rodriguez is the deputy representative of UNFPA in Ecuador. >> LILY RODRIGUEZ: They are in an unfamiliar environment, and in a language they do not understand, and that's why they resist going to the hospital. >> DR. ALFREDO AMORES: I asked a young mother: "Why don't you go to the hospital?" And she said, "Because we are violated." >> VOICEOVER: Dr. Alfredo Amores, director of the Orellana Provincial Health Department, says women are wary of Western medical doctors. >> DR. ALFREDO AMORES: If they open your legs and put their hands inside you without asking, what do you make of that? For an indigenous woman, this is tremendously offensive. >> VOICEOVER: Years of campaigning by the Users Committees for more culturally sensitive services have led to a new initiative. Otavalo City, high in the Andes, where half of its 10,000 residents are indigenous, recently opened a vertical delivery room in its hospital. It's the first public health institution in the country to provide vertical birth delivery. This Otavalo model is now being replicated in other health facilities. >> LILY RODRIGUEZ: What's being done is the recognition of the Declaration on the Rights of the Indigenous Peoples which says that they have the right to be taken care of according to their culture and worldview. >> VOICEOVER: To inform women of their rights and birth choices is a critical role played by Alba and the Users Committees. Since they began their work, the number of pregnancy-related deaths has started to decline in Ecuador. >> VOICEOVER: This report was prepared by Patricia Chan for the United Nations.