PHM-Exch> In War and Isolation, a Fighter for Afghan Women

[Kamayani Bali Mahabal]

http://www.nytimes.com/2009/07/28/health/28midw.html

Everybody wants Pashtoon Azfar. Her government, American aid groups and her
own colleagues, the
midwives<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/midwives/index.html?inline=nyt-classifier>of
Afghanistan, all want her to work for them, lead them, help them
rebuild
a health system from the rubble of war.
 <http://www.nytimes.com/2009/07/28/health/28midw.html#secondParagraph>

Pashtoon Azfar, president of the Afghan Midwives Association.

Ms. Azfar, 51, is trying to oblige. By day she directs Afghanistan’s
Institute of Health Sciences, by night she works for a nonprofit group
from Johns
Hopkins University<http://topics.nytimes.com/top/reference/timestopics/organizations/j/johns_hopkins_university/index.html?inline=nyt-org>that
focuses on women and children’s health, and somehow she also manages
to
serve as president of the Afghan Midwives Association.

Visiting from Kabul recently, she was the star at a Capitol Hill briefing
titled “Maternal Health in Afghanistan: How Can We Save Women’s Lives?” Her
audience included members of the Congressional caucus for women’s issues.

Afghanistan has the world’s second-highest death rate in women during
pregnancy<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/pregnancy/index.html?inline=nyt-classifier>and
childbirth (only Sierra Leone’s is worse). For every 100,000 births,
1,600 mothers die; in wealthy countries the rates range from 1 to 12. In one
remote northeastern province, Badakhshan, 6,507 mothers die for every
100,000 births, according to a 2005 report in the medical journal Lancet. In
all, 26,000 Afghan women a year die while pregnant or giving birth.

The main causes of these deaths are hemorrhage and obstructed labor, which
can be fatal if a woman cannot obtain a Caesarean
section<http://health.nytimes.com/health/guides/surgery/c-section/overview.html?inline=nyt-classifier>.
Even if the mother survives, obstructed labor without a Caesarean usually
kills the baby. Most of the maternal deaths — 78 percent, according to the
Lancet report — could be prevented. Against this bleak history, Ms. Azfar
told her Washington audience, “I would like to share some successes with
you.”

An intense woman with short, graying hair, Ms. Azfar rarely smiles. She ran
through statistics showing notable increases recently in the country’s
number of midwives, their education and the percentage of women who give
birth with the help of a “skilled attendant,” usually a midwife. The United
States, the World
Bank<http://topics.nytimes.com/top/reference/timestopics/organizations/w/world_bank/index.html?inline=nyt-org>,
the European Commission<http://topics.nytimes.com/top/reference/timestopics/organizations/e/european_commission/index.html?inline=nyt-org>,
Unicef<http://topics.nytimes.com/top/reference/timestopics/organizations/u/united_nations_childrens_fund/index.html?inline=nyt-org>,
the Hopkins group (known as Jhpiego) and other donors have all helped
Afghanistan’s Ministry of Public Health to make improvements.

But there is a long way to go. Most women in Afghanistan, as many as 80
percent, still give birth without skilled help, and only a third receive any
medical care at all during pregnancy.

Afghanistan’s problems mirror those of many other poor countries: shortages
of personnel, supplies and transportation to clinics or
hospitals<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier>,
especially in remote regions and mountainous areas that are snowbound half
the year. The deeper problems are cultural, rooted in the low status of
women and the misperception that deaths in childbirth are inevitable — part
of the natural order, women’s lot in life.

During her talk in Washington Ms. Azfar quoted Dr. Mahmoud Fathalla, an
Egyptian physician and advocate for women’s health: “Women are not dying of
diseases we can’t treat. ...They are dying because societies have yet to
make the decision that their lives are worth saving.”

Ms. Azfar works 12 hours a day, seven days a week. She has irked relatives
by missing weddings and other family events because of work.

“My children are not happy,” she said in an interview after her speech.

Ms. Azfar grew up in a village about an hour from Kabul.

“Everywhere then, girls went to school,” she said. “Women’s rights before
the Taliban<http://topics.nytimes.com/top/reference/timestopics/organizations/t/taliban/index.html?inline=nyt-org>were
the same as in Western countries. Women had the right to vote.”

Her mother had 10 children, 2 of whom died. She always gave birth alone,
behind a closed door. When Ms. Azfar was 9, she began to help, by waiting
outside the door to receive the newborn baby and wash and swaddle it, while
her mother then delivered her own placenta.

Ms. Azfar never actually saw a birth until she began studying midwifery at
age 16, and only then, she said, did she realize how brave her mother had
been. She finished the rigorous three-year program at the top of her class
in 1976.

“It was a very well-respected profession in my country,” she said.

But decades of war destroyed midwifery and much of health care, she said.
Professionals fled the country, and many never went back.

“One day, 100 rockets came into Kabul,” she said. She and her husband, a
physician, took their four children and moved to Pakistan, living there from
1992 to 2003. She had a fifth child there.

By the time she returned to Afghanistan, she said, midwifery was in a
shambles. Spots in professional schools of all kinds were being filled by
people with political connections instead of those with good grades. The
midwives who had stayed behind had not received any continuing education.
Their skills were outdated, and their attitudes were even worse.

“A culture of war was going on,” Ms. Azfar said. “If a mother came for
delivery they didn’t treat her as she deserved or needed to be treated.
There was no emotional support.”

Attitude counts in midwifery: if midwives and other health workers seem
indifferent or disrespectful, women start to avoid the clinics, and they
miss out on the help they urgently need.

Ms. Azfar acknowledged that it was hard to change attitudes, but she
insisted that it could be done, by making “interpersonal skills” part of the
training and the tests that students must pass to be allowed to practice. In
Afghanistan, these things became part of the midwifery curriculum in 2004.

“Does she greet the mother properly?” she asked. “Offer her a chair? A drink
of water? Introduce herself? Let the mother ask questions? They are trained.
They have to do it.”

She has seen signs of progress, of hope.

“Just five years ago we started the reconstruction of this profession,” Ms.
Azfar said. “These midwives, they are champions. Oh, I love them. They are
my heart.”
 Next Article in Health (9 of 49)
»<http://www.nytimes.com/2009/07/28/us/politics/28baucus.html> A
version of this article appeared in print on July 28, 2009, on page D5 of
the New York edition.


On Wed, Jul 29, 2009 at 6:29 AM, Claudio Schuftan
<cschuftan at phmovement.org>wrote:

> From: Vern Weitzel <vern.weitzel at gmail.com>
> crosposted from: "[health-vn discussion group]" <health-vn at anu.edu.au>
> From:   AIDS ASIA<AIDS_ASIA at yahoogroups.com>
> The Treatment Timebomb   (excerpt)
>
> Political activism needed for patent pools for HIV drugs.
>
> Editorial. The Lancet, Volume 374, Issue 9686, Page 266, 25 July 2009.
>
> "Political activism is needed once more to ensure that the next
> generation of drugs is available to the world's poorest", according to a
> report from the UK All-Parliamentary Group on AIDS published last week.
> The Treatment Timebomb describes itself as an important wake-up call to
> those who think that successful delivery on the promise of universal
> access to HIV treatment can be achieved in the long term by just doing
> more of the same.
>
> One of the report's recommendations, supported by International
> Development Minister Mike Foster, is the implementation of a patent pool
> for HIV drugs. Pharmaceutical companies insist that patents are an
> important incentive for research and development into HIV medicines but,
> perversely, patents can also hinder such research.
>
> Patent pools could create a win-win situation. Under this system, patent
> holders would still be rewarded—the originator drug company would
> receive a proportion of the royalties—while enabling the generic
> production of newer HIV drugs and the development of new fixed-dose
> combinations.
>
> The concept of patent pools is not new. The Intergovernmental Working
> Group on Public Health, Innovation and Intellectual Property
> (IGWG)—established at the World Health Assembly in 2006 to find
> innovative solutions to fund research and development in neglected
> diseases—has repeatedly called for a patent pool which would be managed
> by UNITAID.
>
> Drug companies have dismissed these calls preferring the status quo, so
> it is unsurprising that the UK drug firm GlaxoSmithKline has stated that
> it does not see the need for the patent pool proposed by the
> All-Parliamentary Group.
>
>
> The Treatment Timebomb
>
> Report of the Inquiry of The All Party Parliamentary Group on AIDS into
> long-term access to HIV medicines in the developing world
>
> http://www.aidsportal.org/repos/APPGTimebomb091.pdf
>
> _______________________________________________
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>


-- 
Adv  Kamayani Bali Mahabal
Mobile-00919820749204
skype:lawyercumactivist

www.binayaksen.net
www.phm-india.org

I carry a torch in one hand
And a bucket of water in the other:
With these things I am going to set fire to Heaven
And put out the flames of Hell
So that voyagers to God can rip the veils
And see the real goal.......
Rabia (Rabi'a Al-'Adawiyya)
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