Toughest places to be

I started off my blog with the desire to write about anything but health issues.  I wanted to write about fun things like film, fashion, books, recipes, high quality dark chocolates.  One month in, and I am struggling with that plan.  See, I like fashion, but I am not interested enough to blog about it.  I love chocolate but I am bored by the discussion of it. I don't see enough movies to have a constant stream of thoughts on them. I would probably never, ever, blog about recipes.

I am interested in health, and the social determinants of health.  What do I mean by this?  I am drawn to the intersection of education, housing, income, assets, neighborhood and community, air/water, race, sex, and policy and how they all impact our health.  So here's my plan: I will use this blog mostly to explore and highlight these issues in a non-academic, accessible, and meaningful way. This will be more or less the focus of the blog.

Of course, I still reserve the right to write about  non-health issues like Tina Fey's recent essay on juggling motherhood and career in the New Yorker (subscription needed).

Now, on to another post.

A show on the BBC called Toughest Place to Be sent an experienced midwife named Suzanne to Liberia to see how they practice midwifery in that part of the world. Suzanne was quite open to learn more about "natural birth" methods and how to improve her practice.  What she learned in Monrovia shocked her.  Women frequently suffered unbearably during the childbirth process--many babies and their mothers die of preventable causes.  One young woman, after a failed abortion using the "leaf of death," became septic, and died right before our very eyes.  She was 21 years old.  No family members were around.

Women, inpatients with various conditions shared the same ward with nothing but a curtain (in some cases) to shield them. Births occurred right next to a woman whose child may have just died minutes before, with what appeared to be a lack of sensitivity. But this--few resources, death--is a matter of fact here. Most heartbreaking of all, one Liberian woman with five living children (she had delivered a stillborn just hours before) begged Suzanne to take any of her children off her hands...she was struggling to feed them as things stood.



There are many video segments on Youtube.

Another segment of this show is of a London bus driver named Josh who was sent to Manila, Philippines to interact with his fellow bus driver, a Jeepney driver named Rogelio.  Manila is a city of about 20 million including its outskirts.  An unbelievable scene, when Josh went to visit a family in a house that measured 6 ft by 6 ft, revealed that the young woman had 13 children and a husband all living in the house. No one could quite stand up straight in this house. She described her repeated pregnancies (she's normally pregnant during the first birthday of the last child), and the difficulty it now posed as life had become impossible. As Catholics, she had long believed it was a sin to control her fertility. That decision had led her to a terrible bind-no food, no space, education for the children was not an option.  This is juxtaposed with Rogelio's wife who insisted early on birth control, and subsequent prayer for forgiveness.

In Liberia, you see standing water in most of the outdoor shots, filthy conditions outside the hospital, no medicines (no antibiotics for a septic patient) in the hospital, self medication in the most outrageous circumstances, stigma, poor training for some of the health care providers, poor transportation and no fans. In the Philippines, even in a 6 by 6 ft house, there's electricity, but lack of education, terrible infrastructure, extreme poverty. While I marveled at the shared ward in Monrovia, Liberia, there were shared beds--four women and their newborn infants--to a bed in Manila.

The common denominator: In both places, poorly educated women, arresting poverty, poor healthcare infrastructure and poor health, and family planing--in more ways than one--gone completely awry.