Korean Job Discussion Forums

[Boodleheimer]

i can't seem to find a link to the article online, so i'll be typing it out.

mods, can you please leave it in its complete form? thanks!

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Prudence's Struggle Ends
Nicholas D. Kristof

YOKADOUMA, Cameroon

As Prudence Lemokouno lay on a hospital bed here, spitting blood, her breath coming in terrible rattles, it was obvious that what was killing her wasn't so much complications in pregnancy as the casual disregard for women like her across much of the developing world.

Neither Western donor countries like the United States nor poor recipients like Cameroon care much about Africans who are poor, rural and female, so half a million such women die each year around the world in pregnancy. It's not biology that kills them so much as neglect.

I began Prudence's story in my column last Monday, and for a while I thought I would have a happy ending.

Prudence, 24, was from a small village and already had three small children. As she was in labor to deliver her fourth, an untrained midwife didn't realize she had a cervical blockage and sat on Prudence's stomach to force the baby out -- but instead her uterus ruptured and the fetus died.

Prudence's family carried her to the hospital on a motorcycle, but once she was there the doctor, Pascal Pipi, demanded $100 for a Caesarian to remove the fetus.

The fetus was decomposing inside her, and an infection was raging in her abdomen -- but her family had total savings of only $20, so she lay down in the maternity ward and began to die.

I arrived the next day, interviewed Pipi about maternal mortality -- and found Prudence fading away in the next room. Pipi said she needed a blood transfusion before the operation could begin, so a Times colleague, Naka Nathaniel, and I donated blood (yes, the needles were sterile) and cash.

The transfusion helped Prudence, and she grew strong enough to reach out her hand and respond to people around her. Pipi said the operation would begin promptly, and Prudence's family was ecstatic. But as we waited in the hospital lobby, Pipi sneaked out the back door of the hospital and went home for the night.

It wasn't just the doctor who failed Prudence, but the entire system. He did operate the next morning, but by then the infection had spread further -- and the hospital had no powerful antibiotics. Prudence's breathing grew strained, as her stomach ballooned with the infection adn the bag of urine from her catheter overflowed. The nurses couldn't be bothered with a poor villager like her.

That night she began vomiting and spitting blood. She slipped into a coma, and a towel beside her head grew soggy with blood and vomit. On Tuesday afternoon, she finally passed away.

Intellectually, I knew that women in Africa had a 1-in-20 lifetime risk of dying in childbirth. But it was wrenching to see this young mother of three fade and die so needlessly.

There's no doubt that if men were dying at this rate, poor and rich countries alike would make the issue a priority, but the problem seems invisible, like the victims.

The UN Population Fund has a maternal health program in some Cameroon hospitals that might have saved Prudence's life, but it doesn't operate in this region. And it's difficult to expand, because President George W. Bush has cut U.S. funding for the population fund -- even for African programs -- because of false allegations that it supports abortions in China.

That's shameful. Two women have tried to recoup American honor by starting a group, 34 Million Friends of UNFPA, to make up the shortfall with private donations (www.34millionfriends.org).

(I discuss some of the groups active in this area at nytimes.com/ontheground, and I'll also have a link to video of Prudence.)

Neither left nor right has focused adequately on maternal health. And abortion politics have distracted all sides from what is really essential: a major aid campaign to improve midwifery, prenatal care and emergency obstetric services in poor countries. We know exactly how to save the lives of women like Prudence, partly because a few countries like Sri Lanka and Honduras have led the way in slashing maternal mortality.

Lynn Freedman, head of the Averting Maternal Death and Disability program at the Mailman School of Public Health at Columbia University (www.amdd.hs.columbia.edu), notes that the United States could provide all effective interventions for the maternal and newborn health to 95 percent of the world's population for an additional $9 billion per year.

Sure, that's a lot. But think of Prudence and women like her dying in childbirth at a rate of one a minute -- and after all, the world spends $40 billion a year on pet food.
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i guess the only thing to say is: discuss!

[jinju]

I said it before. If I ever get to Cameroon Im buying a gun and puting a bullet in Pipi's head.

[dogbert]

[dogbert]

[Boodleheimer]

[Boodleheimer]

here's a response the author wrote to comments like dogbert's.... discuss!!!

____________________________________

Michael from Denver sent in a long email denouncing my columns on maternal mortality. He writes:

�Kristof�s assertions that the plight of poor African women such as Prudence is due to donor-nation complacency and a general indifference toward women in the developing world is quite off the mark. I was struck by how desperate he seemed to ascribe blame for the suffering of women in poor countries that lack modern medical infrastructure, when the cause of their suffering is the lack of development which was evident all around him in the video. It is outrageous that he assigns moral responsibility to wealthy nations such as the United States�Ridiculous! Does that figure include the amount say half which would invariably be pilfered away by corrupt officials?

�Perhaps there is a more difficult explanation, albeit one that fails to satisfy the white guilt of Kristof and his ilk: Africans themselves are still too indifferent to and complacent about their own suffering. Kristof is correct that women there face inequality with their male peers, but it the dismal state of healthcare he witnessed is not an issue of discrimination against women. What a ludicrous suggestion! Would the family of an African male in a comparable condition not have been shaken down? Would antibiotics have magically appeared? I�m sorry about Prudence�s suffering, but potholes on Denver�s highways need filling. We are responsible first and primarily to ourselves.�

Let me address a couple of these points. First (and several others raised this as well): were Prudence�s problems really the result of gender discrimination, and would men really be treated differently?

The answer is: Absolutely. Those overlooked in the public health system overwhelmingly are poor, rural and/or female. Now it�s certainly true that poor rural males don�t do well, either, but I�d say that there has been more of an effort to address gender-neutral ailments like River Blindness than gender-specific problems like maternal mortality.

Moreover, you can look at mortality rates even before the years of childbirth and easily see the public health impact of gender discrimination. For example, in India baby boys and baby girls have similar mortality rates for the first year of life, because the breast is non-discriminatory. But then from age 1 to 5, girls are 50 percent more likely to die than boys. That�s because families give better food and water to sons than to daughters, and because they are more likely to take sick sons to the clinic than sick daughters.

Another way of looking at it is to compare maternal mortality rates in countries with greater gender equality versus less gender equality. Immediately you see that the less equality, the higher the maternal mortality. Afghanistan, for example, is probably the most backward country in the world for women � and also has the highest maternal mortality rates. In India, one woman in 28 dies in childbirth in her lifetime, while in China (which has less discrimination) it�s one woman in 1200. So, sure, men die as well in poor countries, but one reason the number of maternal deaths hasn�t budged in 30 years is that the victims are not only mostly rural and poor but also female.

Now if we try to help, will all the aid be stolen by corrupt officials? It�s true, as I�ve explored at some length, that aid often isn�t terribly effective. But it�s also true that the most effective kind of aid tends to be health interventions, and many have been spectacularly effective (eradicating smallpox has saved something like 200 million lives). We also have models in countries like Sri Lanka and Honduras for how to reduce maternal mortality. So this is the kind of project that is feasible and less prone to corruption.

Finally, is this our problem or our responsibility? That�s less a factual matter than a question of values, and I doubt I can persuade Michael on this point. But it does seem odd to me that Michael should complain about the ethical shortcomings of Africans while insisting on washing his own hands of any responsibility; if the world can save hundreds of thousands of lives a year for a sum equivalent to one-third of what we spend

[ddeubel]

Yes, he finishes quite well , in his reply.....

[dogbert]

Kristof's naivete never fails to astound.

George Bush could hand-deliver money to that Cameroonian "doctor" and he would still refuse to treat the woman. It's a cultural thing, not a poverty thing and until they figure out how to live responsibly and decently, we'd be throwing money down a rathole and continuing to create moral hazards.