It was a pre-dawn morning in 2007 and I was on the back of a doctor's motorbike with no headlight, tearing down a dark, Rwandan dirt road toward the hospital. I was medical student volunteering at a district hospital in rural Rwanda. The doctor had fetched me to assist him in a cesarean section for a woman suffering from obstructed labor. I had not observed many cesareans in my training but I understood the basic principles. At that dust-choked moment however, what I did not understand was how these basic principles would be applied in a setting with so few resources.
It is clear to me that a woman’s rights begin at birth and must be defended throughout her life cycle – her rights to adequate nutrition, education, work opportunities, and decisions free of coercion about her sexuality, her marriage and childbearing, and about her quality of life at an old age.
As the obstetrician skillfully and rapidly delivered the baby, I kept convincing myself that the lack of familiar, and as far as I could tell required, equipment would not be a problem. A nagging fear tugged at me. Would this woman really survive? Would her child? The baby weakly gasped for his first breaths and we reached for the suction. Only, half of the suction parts were not there. Making do, the obstetrician cleared the infant boy's airway and finally his strong cries echoed against the tile walls.
The contrast with the birth of my own son in the United States five years later could not have been greater. At any even slight indication of stress to him, health professionals ran into the room to help. Throughout my long labor, I found it somehow impossible not to remember that Rwandan mother (or the countless others around the world who I have encountered since). I was swirling in a sense of overwhelming appreciation of my privilege and also anguish. I could not stop thinking about our dichotomous experiences. My commitment to providing universal access to reproductive health care had always been strong, but it became painfully urgent ever since.
Growing up in a house of public service, I learned as a child that with privilege comes responsibility. While my father's work is better known, both my parents instilled this commitment. My mother, Julia Thorne, spoke out fearlessly against the stigma around depression at a time when not many acknowledged its isolation and destructive ways. She was as vocal as my father on the importance of being an independent spirit and active against alleviating the sufferings of others. I have tried to carry on that family tradition.
In all of my travels, I have seen that two standards of care exist in too many places. The poor often subsist more on distant hope than on actual help, and medical facilities are often so scarce and so under-resourced that they have become places where one only goes to die. I launched Seed Global Health in 2011 to help address this problem. My non-profit organization partners with the U.S. Peace Corps and PEPFAR to support training for local nurses and doctors in places like Rwanda, because improving maternal and infant health in underserved regions is a long-term effort that cannot continue to rely on imported medical personnel.
Worldwide, 800 women and 9,000 newborns die every day due to complications of pregnancy and childbirth. The vast majority of these deaths of mothers and their babies occur in resource-limited settings around the world. The risk to a woman's health has additional effects on a household and community. Research shows that children who lose their mother are more likely to die before the age of two than those don't, and if they do survive, they are more likely to be socially and economically disadvantaged for the rest of their lives. Some 220 million women now lack access to safe and effective family planning that would let them determine the timing, number and spacing of their children, giving them options that many have never experienced. And amid all this need, study after study documents a huge and growing shortage of trained medical personnel in resource-limited settings around the world.
Trained health professional volunteers who embed as educators for longer-term commitments are empowering to a health system. As hands-on educators, they can both perform, but more importantly, teach cesareans and other emergency care, neonatal resuscitation, temperature support, assisted ventilation and other essential skills. They also become profound advocates to promote comprehensive health care policies. The ripple effect from each nurse or physician educator we send abroad can be enormous: if each one teaches 200 trainees, those 200 are not only more skilled, but also become teachers and advocates themselves for the next generation of local health professionals. These same volunteers are more likely to invest in needs of the U.S., their home country as well, working in underserved areas and underserved specialties after their service.
Propelling this idea, Seed Global Health partnered with the Peace Corps in 2012 to create the Global Health Services Partnership (GHSP), which sends qualified doctors and nurses to resource-limited countries as Peace Corps volunteers to teach and work. The first group of nearly 30 volunteers are now working at 11 sites in Tanzania, Malawi and Uganda, providing technical and medical expertise and advocating for reproductive and other health care in national and local health systems. The GHSP obstetricians, gynecologists and midwives perform and teach essential procedures such as emergency cesareans, hysterectomies, or vaginal fistula repair to save lives. These GHSP volunteers demonstrate to the next generation of providers that maternal survival in pregnancy and childbirth is more than just possible, it should be expected. We hope to expand the program in future years with more sites, countries and health professions.
It is clear to me that a woman's rights begin at birth and must be defended throughout her life. These include her rights to adequate nutrition, education, work opportunities, and to decisions free of coercion about her sexuality, her marriage, her childbearing, and her quality of life at an old age. Building an adequate supply of well-educated health professionals and comprehensive health services, including modern family planning – and ensuring access to them for everyone – is essential to achieving these solutions. It is also essential to creating a uniform standard of quality health care for all people and all genders in every country around the world.
Dr. Vanessa Bradford Kerry is the CEO and co-founder of the non-profit Seed Global Health, the Associate Director for Partnerships and Global Initiatives at the Center for Global Health at Massachusetts General Hospital, and the director of the program in Global Public Policy and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School.