The passing of our most recent Mother's Day, along with my work in poor villages in Haiti and the Dominican Republic, have made me take a fresh view of the enormous sacrifices that women make for the sake of our children, present and future. In our country, flowers, cards, dinners out and a special day mark motherhood, childbirth, a life experience which is accepted as hard work, but which has a fruitful outcome almost guaranteed. Here, with an experienced physician or midwife in charge, along with a small platoon of supporting personnel, a woman labors knowing with near certainty that her life as well as that of her unborn child is not in jeopardy.
Not so with a young woman of the same age and health who had the misfortune to be born in a country where there are few resources, and where the choice of where to deliver may determine her living or dying or forever being damaged by the result. Never mind that her decision will also determine the survival of her unborn child.
You see, in most villages in the poorest of countries, there are no health facilities of any kind. A female, nonmedical elder will supervise the labor of the patient in a small dirt-floor room or outside under the tropical sky. There may be a village shaman or voodoo doctor who is consulted when things are not progressing well, and whose answer, while not medical, carries the full weight of authority of her village. The result is then left to the whim of Mother Nature whether the mother will survive this most natural, but very difficult, female endeavor.
Or, the woman might try to walk to the nearest hospital. On a recent trip to a remote village on a mountainside in Haiti, I took a four-wheel-drive vehicle over the same roads that a woman must walk to reach the nearest health facility. It is an eight-hour walk over rocky, unpopulated roads where streams and rivers must also be forded to reach any kind of maternity care. Imagine the fear and the hope that tussle in that young woman's mind as she walks, hour after hour, in labor, often in the dark and in bad weather, to reach the land of Oz, where she and her baby will be safe.
I have also seen the destination and, sadly, it is not Oz. The hospital in that larger town has only one obstetrician for 400,000 people. The first problem the woman will encounter when she arrives at the hospital is whether or not an experienced OB provider is available. The next hurdle is whether the generator there has any fuel. If it doesn’t, the operating room cannot run, and the patient is turned away, while her labor continues with no fetal or maternal monitoring of any kind. And if there is fuel, is there an anesthesiologist who can help with the pain relief needed for a caesarean section? They are as rare as obstetricians.
And what is particularly troubling is that the choice made by the young woman, whether to stay in her village or to take to the road to try and reach Oz, is not a choice at all. Behind each door of choice is a tiger, not salvation.
Globally, a young woman dies of labor complications at the rate of one a minute. That adds up to six to seven football stadiums of lost young mothers and potentially their newborns every year. What horrible images.
As an experienced obstetrician, as well as a medical director of our hospital mission program, never mind also being a father, grandfather and brother, I am appalled at this daily loss of life. I have witnessed it firsthand and it has left me forever changed. I had not lost a young mother in my long years of practice at St. Francis Hospital and Medical Center, but suffered that most terrible of tragedies on the very first night of my first mission trip six years ago.
On a happier note, we can save these young women if we are serving there when they go into labor.
The sad part is that we can help so few. We must do much more for these young women who are the future of their next generation: in monies to support the extension of OB facilities to outlying areas, and in training more United States obstetrical personnel to make a difference by donating their skills to international mission trips.
I am proud to represent St. Francis Hospital and Medical Center when I join the many selfless men and women from St. Francis who donate their time and skills – and who pay their own way – to make such a difference to these neglected women. The hospital’s administration and many of its departments fully support the hospital’s growing mission program.
If you are moved by what you have read here, please go to our Web site, www.saintfrancisimm.org, and consider a tax-deductible donation to our cause. We are excited to announce that we hope to break ground in the fall on a St. Francis Hospital Mission House in Dame Marie, Haiti. This will be a joint effort which involves our mission team and which will try to create a sustainable ongoing program to improve care in the largely undeveloped western third of Haiti. One hundred percent of any donated dollars goes to defray mission supplies and support.
Michael Bourque is a senior obstetrician who has practiced at St. Francis for the last 32 years. He is one of two medical directors of St. Francis Medical Missions, and a founding member of that organization.