2009 Spring Newsletter

TOP 5 HEALTH INITIATIVESSUPPORTING MOTHERS

WORLDWIDE AND HOW YOU CAN HELP p2

WWW.DIRECTRELIEF .ORGTHIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST

HIGH IMPACT Philanthropy p7

OUR

Mother’s

Day

Special

Report

2 WWW.DIRECTRELIEF.ORG PAID ADVERTISEMENT SPRING 2009 THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST

DIRECT RELIEF’STOP 5 HEALTH INITIATIVESSupporting Mothers Worldwide

Why we moms. Aside from the obvious—no one would exist without someone having become

a mom—mothers are the cornerstones of families, communities, economies, and societies

worldwide. That’s why it’s staggering that the World Health Organization estimates that a woman

dies each minute from complications during pregnancy and childbirth—more than 500,000 each

year worldwide. Pregnancy is often a time of joy and trepidation, but in developing countries,

pregnancy is a life-threatening condition, as pregnancy and childbirth are the second leading

cause of death among women of reproductive age.

Many of the risks for pregnant women and children in developing countries are related to

general conditions of poverty, nutrition, and severely limited health resources and access that

affect everyone. Direct Relief’s core activities have long been aimed at expanding the quality,

availability, and access to health services for all people. But a principal focus of this effort is on

maternal and child health and, more specifi cally, interventions that directly address the specifi c

threats to women during pregnancy through childbirth.

As Mother’s Day arrives, here are the fi ve high-impact initiatives Direct Relief is pursuing to

support mothers worldwide.

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MORE ON p7-8

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EXPANDING ACCESS TO CAREWhen women have adequate access to care, their chance of having a healthy pregnancy and delivery goes up exponentially. The World Health Organization reports that a woman’s lifetime risk of dying from complications in childbirth or pregnancy is about 1 in 7 in Niger and 1 in 48,000 in Ireland. Many factors limit women’s access to care. Scarcity of resources—human, financial, technological, and medical material—and limited access to education and physical proximity to care are among the many challenges. For 60 years, Direct Relief has worked to infuse essential medical resources into in-country systems so more people can receive better quality care. In recent years, these efforts have focused more intensely on expanding and enhancing health services for women and children, including prenatal care, safe delivery, care for low-birthweight babies, and access to basic medicines and supplies.

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In sub-Saharan Africa, only 40% of women are attended

by a health professional during childbirth. In building

access for essential care, Direct Relief has financed and

equipped 4 surgical theaters costing up to $50,000 each in

Malawi, Tanzania, and Zimbabwe to enable safe C-section

deliveries (which reduce the risk of HIV transmission in

childbirth) and other surgeries.

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In 2005, Direct Relief formed a strategic partnership with MARIE STOPES INTERNATIONAL (MSI), a leading reproductive health service nonprofit organization with facilities serving five million people around the world. Direct Relief now supplies MSI clinics and outreach programs in 15 countries, assisting women and children in Africa, Asia, Latin America, and the Middle East. Financial support from individuals and organizations has joined with support from corporate partners seeking to improve the health and lives of women and children. THE ABBOTT FUND and Direct Relief ’s partnership to support the ANGKOR HOSPITAL FOR CHILDREN in Cambodia, where 45 percent of children are malnourished, provides nutritional products essential for patients and also to establish an on-site garden and demonstration kitchen where families learn to grow, prepare, and eat nutritious foods to avoid preventable malnutrition. The company also has provided major support through Direct Relief for the AFGHAN INSTITUTE OF LEARNING, a dynamic, women-run organization which provides education and care for women and children at its four clinics throughout Afghanistan. In Ghana, BD has joined with Direct Relief and committed financial support, laboratory and other medical equipment and supplies, and technical assistance and training by employee volunteer teams. The collaboration has boosted the capacity and quality of services provided by the MARANATHA HEALTH SERVICES, a 30-bed facility in Kumasi, Ghana, serving 300 patients a month. The clinic offers prenatal exams, nutritional counseling for pregnant women, labor and delivery services, post-natal care, and treatment of common illnesses affecting children. The clinic also emphasizes preventive health and health education, including child-care classes for new mothers. Since 2004, Direct Relief has provided Maranatha Maternity Clinic with more than $800,000 (wholesale) in medical material aid. Sometimes small interventions make a big difference. Prenatal vitamins—which cost $13 for one year’s supply—help prevent gestational hypertension and eclampsia (caused by a lack of calcium and magnesium) and severe iron-deficiency anemia, which kills 100,000 women each year. Direct Relief provides these basic items to partner organizations and is seeking new partnerships with vitamin manufacturers to expand availability of these low-cost, high-impact supplements. More than 130 of Direct Relief ’s international partners provide a broad range of preventive and curative services for women. We hope to support them all more expansively in the years to come.

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The $50 kit is designed to handle 100 deliveries, with equipment that is sterilized after each use and supplies that can be restocked by Direct Relief.

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Pregnancy and childbirth are the leading causes of death and disability among women in developing countries. Having a skilled attendant present during delivery is considered the single most critical intervention for ensuring safe motherhood. Direct Relief is deeply committed to reducing maternal and infant mortality. It supports facilities and organizations that train midwives so that more women

have access to prenatal and obstetric care, and more babies are properly cared for during their critical fi rst hours and days. It also helps equip birth attendants with necessary supplies to make use of their life-saving skills.

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Midwife TrainingDirect Relief supports midwife training programs in 12 countries, including Afghanistan and India. Afghanistan has one of the highest maternal mortality rates in the world, but the AFGHAN INSTITUTE OF LEARNING (AIL) is working to reverse that statistic. Founded by Sakena Yacoobi in 1995, AIL provides healthcare services, preschool through university-level education, and training to women and girls at four sites in Afghanistan. With support from the Abbott Fund and Direct Relief, AIL has operated a successful nurse-midwife training course since 2005. To date, 46 women have completed their training, with most now employed in clinics and hospitals. An additional 25 women are currently enrolled and will graduate in August 2009, with a second group of 25 students expected to graduate in 2010.

Trainees study a comprehensive curriculum of medical subjects during the 18-month program and after graduation are able to treat an estimated 11,000 patients a year. Because it is culturally preferred that Afghan women receive health care from a female provider, highly skilled nurse-midwives represent greater access to care and are highly sought after. The Abbott Fund has funded nurse-midwife training programs since 2005; together, Direct Relief and the Abbott Fund have provided AIL with more than $7 million in cash grants and medical material assistance.

In Maharashtra State, India, PRASAD CHIKITSA provides medical care to a largely tribal population marginalized by caste and poverty. Midwifery skills traditionally have been passed down through generations, with a midwife, or dai, learning from her grandmother and mother. With Direct Relief ’s support, PRASAD Chikitsa is providing a two-year training program for dais to improve and expand their skill base. Thanks to funding from the Abbott Fund, 40 women are receiving training through the program.

In Afghanistan, where only 14% of births are attended by a skilled healthcare worker and the literacy rate is just 13% for women, Direct Relief and the Abbott Fund have teamed up for 5 years to support the critical work of the Afghan Institute of Learning in training midwives and educating women and children.


Equipped and ReadyTraining and equipping midwives saves lives and signifi cantly increases and improves the chance for safe delivery. Based on input from partners in the fi eld, Direct Relief created medical kits to equip midwives. The kits come in two versions: one for traditional birth attendants (TBAs) working at the village level and another for graduates of formal midwife training programs, or skilled birth attendants (SBAs).

The TBA kits are targeted to areas where more than 70 percent of deliveries occur at home and where providers have completed basic birth-attendant training programs. The program started in 2006, and, with support from the STEINMETZ FOUNDATION, 694 TBA kits have been provided to midwives in Sumba, Indonesia, and 13 other countries.

SBA kits contain the same contents as TBA kits but include higher-level equipment such as stethoscopes, blood pressure cuffs, and instruments appropriate for either births at home or in a health or maternity center. MILTEX, INC., a division of Integra LifeSciences Corporation, provided critical elements to complete the kits. A total of 30 SBA kits were produced and sent to partners in 2008. Kits targeted to partners’ needs have helped increase capacity for safe delivery in several regions around the world:

AFRICA – Cameroon, Ethiopia, Ghana, Uganda ASIA – Afghanistan, China (Tibet), India, Indonesia, Laos, Philippines LATIN AMERICA AND THE CARIBBEAN – El Salvador, Haiti, Honduras PACIFIC – Fiji

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ADDRESSING COMPLICATIONSEMERGENCY OBSTETRIC CARE

Every year, more than half a million women die because of largely preventable complications of pregnancy and childbirth. This tragedy is most

significant in the poorest countries where the risk of death is many hundred times greater than it is in the developed world. For every woman who dies in labor, many more will suffer serious injury if proper obstetrics care is not available in time. Obstetric fistula is most commonly caused by a prolonged labor that obstructs the birth canal and renders the woman incontinent. Because of the obstruction, obstetric fistula almost always results in stillbirth. Worldwide, more than 2 million women are living with obstetric fistula, 80 percent of whom live in sub-Saharan Africa. An estimated 50,000 new cases are reported each year, though the number is likely much higher. Obstetric fistula is preventable. When women have access to quality emergency obstetric care, the incidence of maternal death and disability drops significantly. Obstetric fistula repair surgery is a relatively simple one, and the success rate of repair on the first attempt can be as high as 90 percent. Direct Relief supports several obstetric fistula repair and prevention programs in Africa, from Ethiopia to Liberia.

Since inception in 1974, the Addis Ababa Fistula Hospital has treated 30,000 Ethiopian women for fistula repair.

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RESTORING HEALTH & HOPE OBSTETRIC FISTULA PREVENTION & CARE

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In Ethiopia, Direct Relief provides support to the ADDIS ABABA FISTULA HOSPITAL, the only medical center in the world dedicated exclusively to fistula repair. The hospital is the model institution for obstetric fistula repair and training in Africa. The Addis Ababa Fistula Hospital provides free repair services for approximately 2,200 women every year and long-term care for 35 women whose obstetric fistula cannot be repaired. In Somaliland, EDNA ADAN MATERNITY AND TEACHING HOSPITAL is the region’s main referral center for obstetric emergencies. The traditional practice of female genital mutilation, common in Somaliland, can lead to complications in childbirth and increase the likelihood of maternal injury or death. Edna Adan Maternity and Teaching Hospital places a high priority on training nurses, midwives, and community health workers to

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PRINCESS DIANA HEALTH CENTER is one of several health facilities in Uganda’s large district of Soroti—population 1.6 million. Princess Diana, a primary health center for residents of Soroti town, is the EMOC center for the district and a referral center for surrounding areas. High-risk patients are sent to Princess Diana in advance of delivery so they can receive surgical intervention immediately if an emergency arises during labor. Nearby, SOROTI DISTRICT HOSPITAL handles all surgical referrals, from road accidents to C-sections. Several hundred EMOC interventions are performed there each month, but

women must travel long distances and wait for long periods before surgery. Delayed EMOC is often fatal for unborn babies and their mothers.

EMOC is part of a care continuum. Adequate prenatal care supporting the mother and her unborn baby is paired with careful

monitoring before and throughout delivery. At minimum, a midwife is present during delivery. Proper training enables a midwife to provide interventions when complications arise, or to know when to refer a woman on to an EMOC facility. AMREF trains midwives and clinical officers, and Direct Relief sees that these health professionals have the tools they need to support such critical decision making.

As part of the pilot program, AMREF is improving training and capacity at all facilities in Soroti district to ensure adequate local maternity services. Direct Relief supports AMREF by supplying materials, pharmaceuticals, and equipment. A large consignment of supplies and equipment—including an anesthetic machine, oxygen concentrators, and an ultrasound machine—will enable the trained staff at Princess Diana to inaugurate EMOC service in the new health center. Direct Relief has also donated nine motorcycles and several computers to AMREF in Soroti to assist in service delivery and evaluation of the project.

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In about 15 percent of deliveries worldwide, an unpredictable complication occurs. That’s when emergency obstetric care (EMOC), such as a cesarean section, becomes necessary. But for women in developing countries, access to EMOC is very limited, and without access, a woman who experiences complications during delivery will likely suffer debilitating injuries like obstetric fistula or even death. The disability or loss of a mother reduces the survival rates of her other children and affects not just her family but the community at large. In partnership with African Medical Research and Education Foundation (AMREF), Direct Relief has started a pilot program in Uganda to fight maternal mortality by equipping health facilities and providers so they can offer quality EMOC services.

4 WWW.DIRECTRELIEF.ORG PAID ADVERTISEMENT SPRING 2009 THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST WWW.DIRECTRELIEF.ORG PAID ADVERTISEMENT SPRING 2009 THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST 5

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The Abbott-donated Determine® test is quick—results take 15 minutes—and requires no electricity or water, making it ideal for areas that may lack steady access to either resource. If a pregnant woman tests positive for HIV, the healthcare provider can take the necessary steps to help prevent the baby from being infected with the virus. Between 2002 and 2008, Abbott donated more than 11.2 million rapid HIV tests to prevention programs throughout the developing world. Through 2007, over 7.7 million pregnant women have been tested and 855,000 of those women tested positive for HIV. Two million spouses and children of the pregnant women tested were also screened. In many developing countries, Direct Relief works closely with ministries of health and other major healthcare networks running prevention of mother-to-child transmission (PMTCT) programs to distribute the test kits. The RWANDAN MINISTRY OF HEALTH, one of the fi rst to subscribe to the program, has already tested 750,000 pregnant women. In Kenya, where UNAIDS estimates 8.3 percent of adult females are HIV positive and 117,000 children under the age of 14 are infected, Direct Relief partner ELIZABETH GLASER PEDIATRIC AIDS FOUNDATION has tested 117,000 expectant mothers, 8,600 of whom were HIV-positive.

Prevention of Mother to Child Transmission of HIV

Every 48 seconds, a child is infected with HIV, the virus that causes AIDS. This is a profound human tragedy, the primary

cause of which is preventable. Without medical intervention, the chance that a mother will pass along the virus to her child during birth is as high as 30 percent, but with proper testing and therapy, this chance can be nearly eliminated. In 2007, Direct Relief began distributing free, HIV rapid test kits. Sixty-nine developing countries are eligible for the program, including all countries in Africa, where the burden of HIV is heaviest. Direct Relief is working to eliminate the barriers to the testing of pregnant women for HIV in countries where mothers and their children face the greatest threat.

prevent maternal death and disabilities like obstetric fi stula. To promote quality obstetric surgery in Somaliland, Direct Relief has helped equip the hospital’s operating room with all the components required for a fully functional surgical theater. The JFK MEDICAL CENTRE in Monrovia, Liberia, has a ward and operating theater dedicated to fi stula repair. The center’s multifaceted program focuses on prevention, repair, and rehabilitation/reintegration for fi stula patients. The project was launched in 2007, and in the fi rst year and a half, more than 330 women received fi stula repair surgeries. Nurses and midwives have been trained to provide quality emergency obstetric care, including safe delivery, and doctors have been trained in management of common obstetric emergency techniques, including cesarean section.

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This program, along with Direct Relief’s antiretroviral therapy drug program which began last year, represents a huge leap forward in helping local health providers identify and combat HIV across the globe.

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Maternal ANDChild Health

AT HOME


Why we moms. Aside from the obvious—no one would exist without someone having become a

mom—mothers are the cornerstones of families, communities, economies, and societies worldwide. That’s

why it’s staggering that the World Health Organization estimates that a woman dies each minute from

complications during pregnancy and childbirth—more than 500,000 each year worldwide. Pregnancy is

often a time of joy and trepidation, but in developing countries, pregnancy is a life-threatening condition,

as pregnancy and childbirth are the second leading cause of death among women of reproductive age.

Many of the risks for pregnant women and children in developing countries are related to general

conditions of poverty, nutrition, and severely limited health resources and access that affect everyone.

Direct Relief ’s core activities have long been aimed at expanding the quality, availability, and access to

health services for all people. But a principal focus of this effort is on maternal and child health and, more

specifically, interventions that directly address the specific threats to women during pregnancy through

childbirth.

As Mothers Day arrives, here are the five high-impact initiatives Direct Relief is pursuing to support

mothers worldwide.

RESTORING HEALTH & HOPE OBSTETRIC FISTULA PREVENTION & CARE

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$20,000$6,000

$300$250$50$25

A one-year supply of prenatal supplements for two women

A basic midwife kit for a Traditional Birth Attendant to serve at 100 births

One supplemental midwife kit for a Skilled Birth Attendant

Obstetric fi stula surgery for one woman

An obstetric ultrasound machine, including printer and extra paper

Funding for the Afghan Institute of Learning’s new Maladon clinic in Afghanistan for a year


Maternal ANDChild Health

AT HOME


Why we moms. Aside from the obvious—no one would exist without someone having become a

mom—mothers are the cornerstones of families, communities, economies, and societies worldwide. That’s

why it’s staggering that the World Health Organization estimates that a woman dies each minute from

complications during pregnancy and childbirth—more than 500,000 each year worldwide. Pregnancy is

often a time of joy and trepidation, but in developing countries, pregnancy is a life-threatening condition,

as pregnancy and childbirth are the second leading cause of death among women of reproductive age.

Many of the risks for pregnant women and children in developing countries are related to general

conditions of poverty, nutrition, and severely limited health resources and access that affect everyone.

Direct Relief ’s core activities have long been aimed at expanding the quality, availability, and access to

health services for all people. But a principal focus of this effort is on maternal and child health and, more

specifically, interventions that directly address the specific threats to women during pregnancy through

childbirth.

As Mothers Day arrives, here are the five high-impact initiatives Direct Relief is pursuing to support

mothers worldwide.

USA

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ST. CHARLES COMMUNITY HEALTH CENTER (SCCHC) in Kenner and Luling, Louisiana, has provided quality, accessible primary healthcare services to the uninsured and underinsured since 2002. In the aftermath of Hurricanes Katrina and Rita, SCCHC provided urgent medical care to more than 20,000 evacuees. In addition to supplying emergency and ongoing medical material support, Direct Relief provided a cash grant of $75,000 to help the center initiate a Maternal and Child Health Services program in 2007.

Prenatal care for the uninsured and underinsured population in the greater New Orleans area has become extremely diffi cult to access due to the post-Katrina reduction in capacity and closings of previously available providers. Latino women are in particular need of care, as many are ineligible for government-sponsored health programs, and have diffi culty accessing care due to language and cultural barriers. To address this need, SCCHC has implemented the Centering Pregnancy

Program at the Kenner facility, which has strengthened the provision of maternal and child health services in the New Orleans area. Today, women can rely on SCCHC for complete obstetric and gynecologic care, including family planning services. Nutrition counseling, pap smears, breast exams, and prenatal and postnatal care, including treatment for postpartum depression, are all provided by SCCHC. Pediatric care—vision and hearing tests, allergy and asthma treatment, dental services, sick-child visits, routine check-ups, and immunizations—is available at little to no cost. Maria Rivas was one of the fi rst patients to go through St. Charles Community Health Center’s Pregnancy Program. She and her daughter turn to SCCHC for their primary care, and Rivas advocates on behalf of SCCHC among the area’s growing Hispanic community.

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---- 100% OF

CONTRIBUTIONS ARE DEVOTED

TO OUR PROGRAMS. All overhead (non-program) expenses are covered by

a generous bequest.

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According to August 2008 U.S. Census data, nearly 46 million Americans lack health insurance. The uninsured have few options to receive quality, affordable health care. Nonprofi t clinics and community health centers bridge this gap by providing a broad range of healthcare services for millions of people. Direct Relief USA supports more than 1,200 of these valuable clinic resources for the medically underserved in all 50 states. Direct Relief USA has provided nonprofi t clinics across the country with more than six million prescriptions, plus other medicines and supplies valued at $150 million (wholesale), and $5 million in cash grants. While these providers often cover a comprehensive set of primary care services, a key focus of care is maternal and child health.

...YOUR

SUPPORT...

HELPS PROVIDE A RANGE OF ITEMS CRITICAL TO THE HEALTH OF

MOTHERS AND BABIES AROUND THE WORLD.

FOR EXAMPLE…

IN MEMORIAM

Gordon Allen1924-2009

We note with sadness the loss of Gordon Allen, former Direct Relief director and longtime supporter whose generosity, kindness, and

energy will be greatly missed.


MAY IS FOR MOMS!

27 S. LA PATERA LANESANTA BARBARA, CA 93117TEL: 805.964.4767 TOLL FREE: 800.676.1638 FAX: 805.681.4838www.DirectRelief.org

BOARD OF DIRECTORS

CHAIRMAN Stanley C. HatchVICE CHAIRMAN Dorothy F. Largay, Ph.D.SECRETARY Ayesha Shaikh, M.D.TREASURER James A. Shattuck

Bruce N. Anticouni • Frederick Beckett • Frederick P. Burrows • Jon E. ClarkKenneth J. Coates • Thomas J. Cusack • Killick Datta • Ernest H. Drew, Ph.D. Gary Finefrock • Richard Godfrey • Bert Green, M.D. • Raye Haskell Priscilla Higgins, Ph.D. • Brett Hodges • Tara Holbrook Ellen K. Johnson • Donald J. Lewis • Alixe G. MattinglyRobert C. Nakasone • Natalie Orfalea • Carmen Elena Palomo • John RomoJames H. Selbert • Ashley Parker Snider • Richard Steckel, M.D. Gary R. Tobey • Paul H. Turpin • Sherry Villanueva

INTERNATIONAL ADVISORY BOARDCHAIRMAN Frank N. Magid

Lawrence R. Glenn • E. Carmack Holmes, M.D.S. Roger Horchow • Stanley S. Hubbard • Jon B. Lovelace Hon. John D. Macomber • Donald E. Petersen • Richard L. Schall John W. Sweetland

PRESIDENT & CEO Thomas Tighe

HONORARY BOARDPRESIDENT EMERITUS Sylvia KarczagCHAIR EMERITUS Jean HayDIRECTOR EMERITUS Dorothy Adams

NONPROFIT ORGANIZATIONU.S. POSTAGE PAID

SANTA BARBARA, CAPERMIT #756

For a suggested $25 donation, Direct Relief will send a beautiful card to A WOMAN YOU WANT TO HONOR THIS MOTHER’S DAY. Call (805) 964-4767 or visit DIRECTRELIEF.ORG

MAY IS FORTHIS MOTHER’S DAY, honor the moms in your life with a personal tribute page. You’ll support Direct Relief’s programs that help women around the world have safer pregnancies and deliveries––and help children thrive.

Find out more at dri.convio.net/MothersDayTributes

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2009 Spring Newsletter

Health & Medicine

Transcript of 2009 Spring Newsletter