A New Reality for Mothers in Dar es Salaam

In February 2012, Kupona Board member Dr. Yoni Barnhard visited Amana Hospital in Dar es Salaam, and shared his experiences in a series of blog posts.

An American OBGYN, Dr. Barnhard found himself in an overcrowded, under-staffed, under-equipped delivery ward, and reported that, despite the desire to save their patients, the staff at Amana didn’t have the resources they needed to do so. The consequences were often tragic.

“Amana. Second largest district hospital in Dar es Salaam.  29,000 deliveries each year.  Do the math.  Teeming with births. Just 6 birthing beds.  Not actually birthing beds.  Metal tables with a hole at one end.  Fresh blood dripping through.  A bucket underneath.  No full-time OBGYN.  No full-time anesthesiologist.  No air conditioning.  92 degrees outside.  Hotter inside. This is where we start.”

Four years later, we’ve come a long way from where we started. Thanks to the tireless efforts of CCBRT’s Maternal and Newborn Healthcare team, in close partnership with the Government of Tanzania, Amana is unrecognizable. Kupona donors joined a committed network of supporters and partners including Vodafone Foundation, Global Affairs Canada (GAC – formerly DFATD), and CBM Australia. Today, we see expectant mothers are entering a very different hospital.

“The challenge is not practicing good obstetrics.  The challenge is practicing better obstetrics with limited resources.”

Relieving the Pressure
Dar es Salaam’s healthcare system was designed to support a city of 750,000 people; hospitals and clinics now serve a population of over 4.4 million. Severe overcrowding hampers healthcare workers’ ability to give every patient the attention and quality of care they deserve. When Dr. Barnhard visited Amana 4 years ago, the hospital conducted 2,000 deliveries a month. He counted three nurses helping 41 women in labor.

Capacity building and training at smaller pre-referral healthcare facilities across the region means that families now place their trust in a greater number of facilities, decongesting wards at district and regional hospitals and relieving the pressure on healthcare teams. Today, Amana Hospital conducts 1,000 deliveries a month, giving staff more time to focus on each patient and respond efficiently to emergencies. In 2012, the labor wards were so crowded women were delivering five to a bed, or on the floor. Today, more women deliver one to a bed, though there are still space constraints in some of the wards.

“When it comes to saving a life, one can do far more with a single unit of blood than an ultrasound machine.”

The Tools to Save Lives
In 2012, Anna¹, a 29-year-old pregnant woman, and mother of 6, arrived at Amana displaying severe preeclampsia symptoms. Her attending healthcare worker ran from room to room borrowing the medication needed to save her life. It wasn’t enough, and she died a few hours later. Anna’s death could have been prevented. Today, eclampsia and emergency kits are readily available, stocked with the medication and supplies needed to avoid preventable tragedies. Today, her 6 other children would still have a mother.

The leading cause of maternal death in Tanzania is post-partum hemorrhaging, and this is unlikely to change without addressing the severe shortages of safe blood supplies. In 2012, little was being done to overcome these challenges. In 2015, CCBRT’s Capacity Building Program began working with the Regional Health Management Team in Dar es Salaam to establish four satellite blood banks, increasing the availability of clean blood in the region. In addition, there are now two full-time OBGYNs at Amana, and training is available for surgical and medical management, giving staff the knowledge to confidently and competently save lives.

Lasting Change You Empowered
Improvements² across the board at Amana mean that staff are equipped, trained, and available to tackle emergency cases, prevent birth injuries like obstetric fistula, and identify and refer newborns with impairments like cleft lip or clubfoot. A healthy child born to a healthy mother is less likely to be caught in the cycle of poverty, and more likely to pursue education and employment later in life.

In 2012, Amana Hospital’s delivery ward was a sea of women in all stages of labor, with an overwhelmed staff fighting an uphill battle to treat and save the patients in their charge. Today, with your support, we are seeing a new reality for the women of Tanzania, and in turn, for their children. There is still room for improvement and growth, particularly in early labor wards which are still crowded. There is also an emerging need for a space where mothers can nurse their sick newborns. However, CCBRT is ready to meet these challenge, spurred on by the success you’ve supported. Four years later, the future for Tanzanian families looks much brighter.

1. Name changed to protect patient’s identity
2. Following a recent assessment, Amana achieved 78% of quality standards for Basic Emergency Obstetric Care, compared to a baseline score of 9% in 2010.

A long-standing supporter of Kupona Foundation.

Welcome, Bob Schwed

Bob was first introduced to Kupona through our Board Treasurer, Adrian Stewart. Adrian invited Bob to participate in Kupona’s Annual Golf Outing, an event that Bob has attended and supported for the last 4 years, along with his team at WilmerHale, LLP.

“The golf event is really interesting. Adrian created interest in a charity that most people aren’t familiar with, and he was able to accomplish a lot with a group of people who were very serious and very dedicated.”

A graduate of Harvard Law School, Bob practiced law for 40 years, specializing in serving private equity firms and guiding clients through corporate finance transactions and acquisitions. He is an adjunct professor at George Washington University School of Law, and a recently retired partner at WilmerHale, LLP. Bob’s interest in philanthropy, and particularly healthcare in Africa, was inspired by his family. Both his son and daughter-in-law are doctors who have worked in Africa. Bob also worked with Kupona’s Board Chair, Dr. John Brothers, before they both joined the Kupona team, to build a nonprofit serving underprivileged youth and families in his local community in Brooklyn, NY.

“[Kupona] is dedicated to doing the right things for the right reasons.”

Following his retirement, Bob was eager to apply his professional experience to a good cause, and to be more than just a donor. His prior relationships with our Board members, and his history with Kupona make him an excellent addition to our dedicated team. 

“I didn’t solely join Kupona’s Board to write checks. I’m looking forward to the challenge of helping however I can, and really getting involved.” – Bob Schwed

“We’re delighted to welcome Bob to the Kupona team. His experience serving on the board for a publicly owned company and advising start-up companies and new ventures across sectors make him a strong addition to Kupona’s Board of Directors. We are energized by his enthusiasm to understand our mission, and his eagerness to get involved wherever he can. He is looking forward to visiting our sister organization, CCBRT, in the near future, to support the work we are doing on the ground in Tanzania. We look forward to working closely with him to build a brighter future for the people of Tanzania.” – Abbey Kocan, Executive Director, Kupona Foundation

Girls’ Globe Hangout: Dr. Brenda D’mello & Abbey Kocan

Yesterday, our Executive Director, Abbey Kocan, joined Dr. Brenda D’Mello, manager of CCBRT’s maternal and newborn healthcare capacity building program, on our first Google Hangout with our friends at Girls’ Globe. The discussion highlighted the contrasting expectations and birth experiences of mothers in the U.S. and Tanzania, the challenges facing Tanzanian mothers, and the work we are doing to change this reality for thousands of women ever year. Here are just some of the highlights.

Worlds apart, in more ways than one

Expectant moms often talk about preparing a ‘hospital bag’, a bag of clothes, toiletries, and books for when the time comes to go to the hospital. As Dr. Brenda prepared to deliver her first child in Tanzania 18 years ago, her ‘hospital bag’ looked very different. For months, she stocked up on sterile supplies, and donated 2 units of her own blood to the hospital, just in case. She arrived at the facility with a checklist for the medical team, to guide them in case she lost consciousness and was unable to give instructions. She even refused pain medication because she wanted to be alert enough to supervise her own delivery. As a doctor in the middle of her residency she knew to prepare for the worst. Thankfully, her child was safely delivered.

In contrast, Abbey delivered her first child in New York 3 months ago. She had a healthy pregnancy, and expectations of a safe, respectful delivery, but says, “The work we do was in my mind through my entire birth experience.” When there were complications during delivery, Abbey was attended by a doctor and two supporting nurses for hours. When the decision was made to perform an emergency C-section, it took minutes to assemble the supplies and safely deliver her healthy son. Abbey never doubted the medical team, and had every confidence that they were equipped and ready to save her baby. If this had happened in Tanzania, Abbey’s son would have almost certainly been stillborn.

Facing the challenges

The greatest challenge facing Tanzanian healthcare teams, according to Dr Brenda, is a shortage of skilled human resources. There simply aren’t enough trained hands on the ground. Tanzania only has around two thirds of the human resources they need to meet demand, with approximately 4-7 health professionals for every 10,000 people.

CCBRT works closely with the Government of Tanzania, directly supporting 22 healthcare facilities in Dar es Salaam, and training thousands of medical workers in high quality antenatal care, safe delivery, anesthesia, facility management, and safe surgery as outlined by the WHO. “We cover a whole host of interventions,” says Dr. Brenda. “We invest in equipment and supplies, whatever is needed to provide the services to save lives.”

Dr. Brenda provides technical training at one of the 22 health facilities CCBRT supports

Kupona enables CCBRT’s life saving program by fundraising, raising awareness, and connecting CCBRT with technical experts to train teams on the ground. Recently, Kupona seconded a Harvard-trained OBGYN to CCBRT to teach safe surgical techniques to medical teams and serve as a technical advisor. Dr. Brenda reported, “I’m hearing from the field that the techniques are still being used. This [advisor’s] legacy is saving lives.”

As Dr. Brenda shared the story of a 15-year old patient who benefited from the improving maternal healthcare standards in Dar es Salaam, she said, ”Five years ago this would have been a tragedy. It’s so wonderful to see that one-by-one we will win life for all our women.”

Together, we’re shaping the future for Tanzanian mothers

Dr. Brenda’s vision for the women of Tanzania is simple: “That they have clean, compassionate care at the time of birth, delivered by a compassionate care provider.” This may seem like the expected bare minimum in the U.S., but for the women of Tanzania who have come to expect so little it means the difference between life and death. Abbey’s vision mirrors Dr. Brenda’s, “I want to see high quality integrated care for all mothers and babies in Tanzania, with higher expectations for respectful care.”

How can you help us accomplish this?

• Donate: A donation of $65 funds 1 hour of medical coaching and technical advisement for a Tanzanian healthcare provider. A donation of $500 funds a clean, respectful birth for a Tanzanian woman.
• Spread the word: Share this blog post, and the Google+ Hangout link with everyone you know.
• Get involved: Sign up for our mailing list, follow us on social media, and reach out if you would like to attend one of the fundraising events we host in the US.

Together, we can win life and respectful, maternal healthcare for the women of Tanzania.