<a href="http://www.nytimes.com/2009/07/28/health/28midw.html">http://www.nytimes.com/2009/07/28/health/28midw.html</a><br><br>
<p>Everybody wants Pashtoon Azfar. Her government, American aid groups and her own colleagues, the <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/midwives/index.html?inline=nyt-classifier" title="Recent and archival health news about midwives.">midwives</a> of Afghanistan, all want her to work for them, lead them, help them rebuild a health system from the rubble of war. </p>
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Pashtoon Azfar, president of the Afghan Midwives Association.
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<p>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 <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/j/johns_hopkins_university/index.html?inline=nyt-org" title="More articles about Johns Hopkins University">Johns Hopkins University</a>
that focuses on women and children’s health, and somehow she also
manages to serve as president of the Afghan Midwives Association. </p><p>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.</p><p>Afghanistan has the world’s second-highest death rate in women during <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/pregnancy/index.html?inline=nyt-classifier" title="Recent and archival health news about pregnancy.">pregnancy</a>
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. </p><p>The main causes of these deaths are hemorrhage and obstructed labor, which can be fatal if a woman cannot obtain a <a href="http://health.nytimes.com/health/guides/surgery/c-section/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Caesarean Section.">Caesarean section</a>.
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.”</p><p>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 <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/w/world_bank/index.html?inline=nyt-org" title="More articles about World Bank">World Bank</a>, the <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/e/european_commission/index.html?inline=nyt-org" title="More articles about European Commission">European Commission</a>, <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/u/united_nations_childrens_fund/index.html?inline=nyt-org" title="More articles about United Nations Children's Fund">Unicef</a>,
the Hopkins group (known as Jhpiego) and other donors have all helped
Afghanistan’s Ministry of Public Health to make improvements. </p><p>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. </p><p>Afghanistan’s
problems mirror those of many other poor countries: shortages of
personnel, supplies and transportation to clinics or <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier" title="Recent and archival health news about hospitals.">hospitals</a>,
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. </p><p>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.” </p><p>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.</p><p>“My children are not happy,” she said in an interview after her speech. </p><p>Ms. Azfar grew up in a village about an hour from Kabul. </p><p>“Everywhere then, girls went to school,” she said. “Women’s rights before the <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/t/taliban/index.html?inline=nyt-org" title="More articles about the Taliban.">Taliban</a> were the same as in Western countries. Women had the right to vote.”</p>
<p>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. </p><p>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. </p><p>“It was a very well-respected profession in my country,” she said. </p><p>But
decades of war destroyed midwifery and much of health care, she said.
Professionals fled the country, and many never went back. </p><p>“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. </p><p>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. </p><p>“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.” </p><p>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. </p><p>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. </p><p>“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.” </p><p>She has seen signs of progress, of hope. </p><p>“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.”</p>
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<span>A version of this article appeared in print on July 28, 2009, on page D5 of the New York edition.</span>
</div><br><br><div class="gmail_quote">On Wed, Jul 29, 2009 at 6:29 AM, Claudio Schuftan <span dir="ltr"><<a href="mailto:cschuftan@phmovement.org">cschuftan@phmovement.org</a>></span> wrote:<br><blockquote class="gmail_quote" style="border-left: 1px solid rgb(204, 204, 204); margin: 0pt 0pt 0pt 0.8ex; padding-left: 1ex;">
<div class="gmail_quote">From: <b class="gmail_sendername">Vern Weitzel</b> <span dir="ltr"><<a href="mailto:vern.weitzel@gmail.com" target="_blank">vern.weitzel@gmail.com</a>></span><br>crosposted from: "[health-vn discussion group]" <<a href="mailto:health-vn@anu.edu.au" target="_blank">health-vn@anu.edu.au</a>><br>
From: AIDS ASIA<<a href="mailto:AIDS_ASIA@yahoogroups.com" target="_blank">AIDS_ASIA@yahoogroups.com</a>><br></div>
<div class="gmail_quote">The Treatment Timebomb (excerpt)<br><br>Political activism needed for patent pools for HIV drugs.<br><br>Editorial. The Lancet, Volume 374, Issue 9686, Page 266, 25 July 2009.<br><br>"Political activism is needed once more to ensure that the next<br>
generation of drugs is available to the world's poorest", according to a<br>report from the UK All-Parliamentary Group on AIDS published last week.<br>The Treatment Timebomb describes itself as an important wake-up call to<br>
those who think that successful delivery on the promise of universal<br>access to HIV treatment can be achieved in the long term by just doing<br>more of the same.<br><br>One of the report's recommendations, supported by International<br>
Development Minister Mike Foster, is the implementation of a patent pool<br>for HIV drugs. Pharmaceutical companies insist that patents are an<br>important incentive for research and development into HIV medicines but,<br>
perversely, patents can also hinder such research.<br><br>Patent pools could create a win-win situation. Under this system, patent<br>holders would still be rewarded—the originator drug company would<br>receive a proportion of the royalties—while enabling the generic<br>
production of newer HIV drugs and the development of new fixed-dose<br>combinations.<br><br>The concept of patent pools is not new. The Intergovernmental Working<br>Group on Public Health, Innovation and Intellectual Property<br>
(IGWG)—established at the World Health Assembly in 2006 to find<br>innovative solutions to fund research and development in neglected<br>diseases—has repeatedly called for a patent pool which would be managed<br>by UNITAID.<br>
<br>Drug companies have dismissed these calls preferring the status quo, so<br>it is unsurprising that the UK drug firm GlaxoSmithKline has stated that<br>it does not see the need for the patent pool proposed by the<br>All-Parliamentary Group.<br>
<br><br>The Treatment Timebomb<br><br>Report of the Inquiry of The All Party Parliamentary Group on AIDS into<br>long-term access to HIV medicines in the developing world<br><br><a href="http://www.aidsportal.org/repos/APPGTimebomb091.pdf" target="_blank">http://www.aidsportal.org/repos/APPGTimebomb091.pdf</a><br>
</div>
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<br></blockquote></div><br><br clear="all"><br>-- <br>Adv Kamayani Bali Mahabal<br>Mobile-00919820749204<br>skype:lawyercumactivist<br><br><a href="http://www.binayaksen.net">www.binayaksen.net</a><br><a href="http://www.phm-india.org">www.phm-india.org</a><br>
<br>I carry a torch in one hand<br>And a bucket of water in the other:<br>With these things I am going to set fire to Heaven<br>And put out the flames of Hell<br>So that voyagers to God can rip the veils<br>And see the real goal.......<br>
Rabia (Rabi'a Al-'Adawiyya)<br><br>