"Birth of a Surgeon"

Sub-Saharan Africa is the most dangerous place on earth to give birth. PBS's Wide Angle did an episode on an amazing group of midwives in Mozambique who are being trained in obstetric surgical techniques. Definitely worth a viewing.

It's stories like these that make me want to pack up and move back to Africa.

(In Angola, my doctor friends told me that several nurses performed surgical procedures. In fact, there was not a single anesthesiologist in Lobito, Angola's second largest city- it was all done by nurses. I always wondered what those nurses would think if they knew that anesthesiology was one of the most high-paid specialities in the US.)

Habits and Behavior Change

Here is an interesting article from the New York Times on the use of advertising techniques to encourage positive behavior change in developing countries, specifically Ghana.

Nowadays, behavior change modification is the key to most successful international public health campaigns. For example, Uganda has seen one of the most successful HIV prevalence declines worldwide due to policies that focuses on behavior change- faithfulness and partner reduction.

Of course, the key is to figure out what appraoch to use to bring about the change desired. My father went to a lecture where an engineer spoke about the installation of a water pump in a village somewhere in Africa (can't remember the country). In spite of having good equipment and training the community, the water pump fell into disrepair and was useless. In this situation, something was missing, a spark to make the community incorporate postivie behavior into their daily routines.

The article talks about Ghana and one campaign to get people to use soap after the using the bathroom. It turns out that most Ghanians wash their hands after using the bathroom- just not with soap. Like so many places in the developing world, diarrhea and other illness transmitted this way are seens as just a part of life. So how to convince people to use soap as part of their after-bathroom routine? Interesting, the team conducting the study found that people used soap when they felt dirty- after cooking, working with the land, etc. The answer was to transmit the idea that using the bathroom was just as dirty. The campaign was successful- subsequent studies found that 41% more people reported handwashing with soap after using the bathroom as part of their hygiene routine.

The techniques used to encourage this change came directly from the advertising world. The approach has been criticized because it uses commerical avenues to promote a common good. But if the end result is healthier people, then there's not much that I can complain about.

As if being mother ain't hard enough...

Save the Children has recently released its 2008 Report on the World's Mothers. Things don't look good for the mães angolanas:

Bottom 10:
(Rank/Country)
137/Ethiopia
138/Mali
139/Djibouti
140/Eritrea
141/Guinea-Bissau
142/Angola
143/Sierra Leone
144/Yemen
145/Chad
146/Niger

See the report for indicators.

Just a story to show how hard it is to give birth in Angola. I'm friends with a Cuban couple in Lobito, the husband being a doctor in the better clinics and hospitals in town. His lovely wife was pregnant and went into labor the first week of March. I was in Luanda and on the road back to Lobito when I got a frantic phone call from my friend Anne. "Where are you and what is your blood type?!"

It turns out that the wife had a fine labor but then in recovery started to bleed profusely and needed a transfusion. Unfortunately, there was no blood to be had in Angola's 2nd largest city. Luckily, with a few phone calls, they were able to track down a few donors and she got her transfusion.

Now, keep in mind that my friend was married to one of the best doctors in town and had all of Lobito's resources at her disposal (no matter how pawltry they were). Now replace my friend with a poor woman from Canata, one of Lobito's worst neighborhood, and replace the private clinic with the state hospital, and imagine what would have happened.

By the stream of the Catumbela market

On Saturday, my friends I went to the market in Catumbela which is about 20 mintues from Lobito. It has a better selection of fruits and vegetables and in general is much calmer and tranqüilo than the markets in Lobito. You don’t want to look too closely at things, though. My friend Deborah almost bought a cow hoof for soup until she saw that the butcher would chop it on a tarpaulin sheet placed directly on the muddy floor. I was buying some veggies and looked up behind the woman and saw this lovely green stream covered in flies. Not sure the emerald green colors comes across well enough in this picture, but it was truly unlike anything I’ve seen. If it weren’t so hazardous to the health of myself and the entire population of Catumbela, I’d even say it was pretty.

In the background you can see the charcoal section of the market. The production of charcoal as a livelihood was a new thing to me when I came to Angola. Basically, people set trees on fire so that they can harvest the remains as charcoal. A lot of Angolans can’t afford electricity (assuming it’s even available where they live, which is a big assumption) or even gas canisters to fuel gas stoves, so they must rely on charcoal for cooking. It’s cheap, but as you can imagine, not produced by the most environmentally friendly methods. A little over a year ago, when I was doing the Listening Project conversations, the people living in the most miserable of conditions all had one thing in common: charcoal. It provided practically nothing, but it was all they had. As a result of those conversations, I’ve always thought of charcoal as the work of the very poor and marginal of society. I guess their location next to the stream of emerald green water confirms this.

Happy Anniversary

Me, one year later, with Bernice of the Sheenan tropa.

As of 4:30 am this morning I have been in Angola exactly one year. It’s been an eventful year, to say the least- one of the most challenging I’ve had.

And how did I celebrate this milestone? I think I broke my toe! I wish I could say it was doing something exciting, but I was just cleaning and jammed my foot into my chair.

UPDATE: Sergey, the former EMT informs me it is not a break, but a bad sprain. Still limping and getting an awesome bruise, though.

Some tidbits on the health of Angolans

Job training?

CNN reports that TEN people have been stricken with polio in 2007. Don't go around thinking polio has been eradicated from the earth, like I did before coming to Angola.

I wish this article was in English! Basically, it talks about how Angolan women make a living carrying things on their head. In the article, one woman states that she carries bags of cement on her head for between 300 - 500 Kwanzas (between US$4 - $6.67). That can't be good for your spine. A lot of people justify the presence of Chinese workers in Angola saying that Angolans would not do the same work the Chinese do. I've never bought that argument, given cases like this one. Carrying heavy things on your head is not an easy way to make a buck, that's for sure.