Last week, RCFC member Dr Larry Kieft reminded us of the state of Women’s Health in the Global Community. He began with 3 vignettes (with photos) that gave the data to follow a very personal focus.
First was Blessings Story about a young woman Larry met (in Jos, Nigeria) at her seamstress shop. This young woman’s story illustrates the potential effects of a male-dominated culture - rape, adolescent pregnancy, shame, abandonment and AIDS. Next, we heard the stories of 4 neonates (pictured) abandoned at a local hospital illustrating the results of poverty (the fathers were farmers and the social status of mothers) and the lack of modern maternal care (each mother died of eclampsia or complications of triplet delivery). The third story was described by 3 photographs - a young woman is seen standing outside a schoolroom door while inside younger students attend class. (1. Women are less likely to get an education and 2. Schools require uniforms and a tuition fee meaning many cannot afford their children an education).
But why address women’s health as a separate issue? Being born female is dangerous to your health because of societal discrimination and prescribed roles of women in many developing countries. The results can be premature death, excess morbidity and disability leading to enormous economic and social consequences for these countries. The WHO has defined the crisis as a social and political one rather than primarily medical or technical. On the medical side there are those disorders that affect women worldwide complicated by the issues of cost, accessibility, AIDS and preventable gynecologic cancers (think early screening and HPV vaccination).
Looking more closely at the social/cultural norms we see prenatal sex selection, preferential feeding practices (males eat first) and restricted access to education and health care. What follows for women is STD’s (generally more damaging to women than men), high maternal mortality and morbidity, violence, sexual abuse and unsafe abortions too often leading to death or disability.
Maternal mortality is easy to quantify - every day 1,000 girls and women die in pregnancy or childbirth. Maternal deaths are the greatest health inequity of the 21st century. Skilled health care during pregnancy and at the time of delivery as well as modern contraception methods can dramatically reduce this number.
Next, we saw maps that illustrated this inequity worldwide - sub-Saharan Africa has the highest maternal mortality in the world. Living “rural” has a different meaning in Africa as roads in and out of the cities are often barely passable, critical for those who need urgent or emergent maternal care.
Next, we visited ongoing efforts to improve care - basic training for “health attendants” (midwifes) and simple medical kits for use in home delivery. We saw photos of Larry visiting classes and teaching medical staff about the management of high-risk pregnancies including C-section.
Better screening for, and the treatment of, precancerous lesions of cervical cancer has been a focus of Larry’s efforts. Cervical cancer accounts for 275,000 deaths each year worldwide. The training of nurses, midwives, physicians, and P.A.s to diagnose and treat early lesions is vital. This became a focus of Larry’s volunteer work in Africa. As infectious diseases are treated, we see the emergence of chronic disease that affect women worldwide such as diabetes, heart disease and cancer.
As we look at future challenges to women’s health it is good to restate “women are not dying because of disease we cannot treat… they are dying because societies have yet to make the decision that their lives are worth saving”-Mahmoud Fathalla.
During the brief Q & A we were reminded that in our own country women’s health has only recently received the focus it deserves. And our maternal mortality ranks only 8-9th in the world. This was compared with Canada’s better outcomes at a lower cost and universal healthcare access.
Dr Larry Kieft has been practicing “service above self” long before he joined our club. We thank him for his dedication and focus as well as today’s presentation to RCFC.