Irish Medical News 2 June, 2009
Nick O'Donoghue
Since 2000, when the world agreed to cut maternal mortality by 75 per cent, little has changed, consultant obstetrician Dr Grace Kodindo tells Nick O’Donoghue.
Having struggled for years working in Chad, consultant obstetrician Dr Grace Kodindo is looking to highlight the plight of thousands of African women who die every year as a result of complications associated with childbirth.
Assistant clinical professor at Columbia University, New York, Dr Kodindo is also medical advisor to the University’s RAISE (Reproductive Health Access, Information and Services in Emergencies) initiative, which aims to raise awareness of the problem of maternal mortality.
Speaking to IMN prior to a screening of a BBC documentary Dead Mums Don’t Cry at the Oireachtas, Dr Kodindo said her aim was to encourage Irish politicians to take responsibility for how aid money is used overseas.
Dr Kodindo added that the World Health Organisation (WHO) and donor governments should implement “interventions” to provide education about the importance of antenatal healthcare alongside funding infrastructural improvements.
“There should be many interventions, to improve the knowledge of people… to remove all the cultural barriers. The interventions should also make communications and transport infrastructure available.
“The development should be at the level of the government. The government should put it [maternal mortality] as a priority among other priorities. There should be the political will to make this issue a priority and address it with what resources they have, instead of taking money and buying arms, like what is being done in my country.
“We are an oil-producing country, but the money is going to buy arms [not improving maternal mortality rates] or something else; you know the corruption in Africa,” she said.
“When there’s a political will and maybe even some pressure from the donor’s government saying ‘we are going to assist you, but we want to know what you’re doing’, [things may improve] but most of the time they give money but they don’t follow it. They don’t try to know what the investment is for,” Dr Kodindo added.
She accused Western governments of wasting taxpayers money by failing to ensure aid is being used to improve the livelihoods of people in developing countries.
“Once they [politicians] have given money, they feel good about themselves. They don’t even try to see what’s happening…. This is not right, because they have achieved a decline in maternal mortality in their own countries.
“The population should really put pressure on the government because they have more power to question the government than people like me, because they are going to elect them.
“This is the people’s money, this is taxpayers’ money, so they should have some power to put some pressure on these countries to make sure the money is spent properly,” she said.
The mortality rate for pregnant women in Chad is one-in-11, and one-in-seven in Niger, while it is one-in-47,000 in Ireland, Dr Kodindo noted.
Despite the Millennium Summit agreement reached in Niger in 2000, to reduce maternal mortality by 75 per cent by 2015, little has been done to improve the chances of survival for women in developing countries.
Dr Kodindo stressed the WHO has to take a more active role in directing government leaders on health policy, to ensure countries have access to drugs that can save women’s lives, like magnesium sulphate and antibiotics.
“Magnesium sulphate is a drug recommended by the WHO as the most effective against convulsions of women during eclampsia – a complication of high blood pressure during pregnancy, meaning the woman will have fits – so magnesium sulphate will cut out the fits.
“The situation in Chad is that antibiotics are not there, so if a woman comes in with complications like infection, relatives have to go and buy antibiotics, sometimes from outside the hospital in private pharmacies to bring us antibiotics to treat the infection.
“Magnesium sulphate is not there in the whole country. It was not on the list of social drugs; as you know, when a drug is not on the list of social drugs, the country can’t even order them, and this is the job of the WHO.
“The WHO has not delivered on this. They should advise countries, the Ministers of Health, about the essential drugs that should really be put on the list. This is not only in Chad, but in many sub-Saharan countries,” she said.
Dr Kodindo added that Irish doctors could play their part in reducing the levels of maternal mortality in developing countries by advising the Government on aid policy or joining an international organisation, with which they could go to countries like Chad or Niger to train hospital staff and improve future outcomes.
“They can personally volunteer [to work in developing countries], but I’m thinking about the long-term – they can go and work but also train local people, that is what’s most important,” she said.
She rejected suggestions that maternal mortality is a “typically African” problem saying, “It’s not some tropical disease. It’s haemorrhaging, it’s infection, it’s eclampsia. It is the same causes that used to kill women in Ireland and that has been resolved. It’s not some sophisticated African disease.”
While a lack of resources has limited the ability of medical staff in developing countries to save lives, Dr Kodindo warned that doctors working in these areas must be aware of the need to be empathetic towards their patients, as a woman might never go back to hospital after a bad experience.
“There is a lot of emphasis on the skills, but not enough on attitude and how to behave around the patient. This is particularly important in countries where women are reluctant to go to hospital because they are ignorant, they are illiterate and they are afraid,” she said.
In 2007, Dr Kodindo gave up her position as one of two consultant obstetrician and gynaecologists in Chad’s Hôpital Général de Référence in N’Djamena, frustrated with the lack of progress in fighting maternal deaths in her 30 years there.
“My efforts were no longer useful. It was just a drop of water for me; I was just sitting there in the hospital having women coming in and sometimes I had nothing to treat them with and I was sitting there seeing them dying.
“It really frustrated me and I thought if I had an occasion to go out and raise awareness about the situation, maybe I could be more useful,” she said.
Prior to taking up her position with RAISE, Dr Kodindo helped develop a structured plan to reduce maternal mortality in Chad, but to date she said this strategy has not been implemented, as the Government has not secured aid for the plan.