63rd World Health Assembly unanimously adopts the WHO global Code of practice on the international recruitment of health personnel

Dear HIFA2015 colleagues,

Please find below a press release from the Global Health Workforce Alliance. In the words of Dr Mubashar Sheikh, GHWA Executive Director: "The world is now a significant step closer to ensuring health workers are available and accessible to all".

PRESS RELEASE: 'Sixty-third World Health Assembly unanimously adopts the WHO global Code of practice on the international recruitment of health personnel. Alliance members and partners applaud Member States. The Alliance 21/05/2010.

[Photo: WHO/Jess Hoffman. Dr Pierre François Unger, State Councillor of the Canton of Geneva, addresses delegates at the opening of the Sixty-third World Health Assembly.]

'Geneva, 21 May 2010 - In a historic move today, the Sixty-third World Health Assembly unanimously passed a resolution to adopt the voluntary WHO global Code of practice on the international recruitment of health personnel. With this step, the world's nations acknowledge the global dimension and complexities of the health workforce crisis and the interconnected nature of both the problems and the solutions.

'With this resolution, Member States commit themselves to the voluntary principles and practices for the ethical international recruitment of health personnel taking into account the responsibilities and rights of source and destination countries, other stakeholders, and those of the migrant health personnel themselves. The Code provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthen the health systems of developing countries.

'A drafting committee was established on the first day of the Assembly and after three days of negotiations, stayed up till 4:30 am on Thursday, 20 May 2010 to seek consensus on a draft resolution that retained the principles and spirit of the Code while also representing a way forward for all countries.

'The draft was unanimously accepted at the tenth session of Committee A late evening on 20 May 2010 and brought long awaited joy and celebration to the many organizations and individuals, campaigners and professionals, institutions and Member States who had been working tirelessly since the last three years to see a meaningful and equitable resolution on the Code be adopted at the World Health Assembly.

'"The process was not always easy, but there was commitment from all Member States to see a resolution adopted. This helped to keep the process moving and the results are there to see" says Alliance Board member, Bjarne Garden, Assistant Director, Global Health and AIDS Department, NORAD, a member of the Norwegian delegation.

'"This brings to fruition the pioneering work seeded by the Alliance three years ago with the creation of the Health Worker Migration Initiative bringing together the Health Worker Migration Global Policy Advisory Council and WHO led team of technical experts. It is the result of the work of multiple stakeholders who have effectively rallied around together. The world is now a significant step closer to ensuring health workers are available and accessible to all", says Dr Mubashar Sheikh, Executive Director, Global Health Workforce Alliance.

'World Health Organization (WHO) has played a key role in coordinating the process. "The Code sets out a roadmap for implementation. Within 2 years WHO will provide guidance to countries on monitoring implementation of the Code, and then report to the Assembly on the progress against implementation. The Code is voluntary, but progress on implementation will be monitored and reviewed" explained Dr Manuel Dayrit, Director, WHO department of Human Resources for Health.

'Health personnel migration has been a clearly identified priority for the Alliance since its inception. During the First Global Forum on Human Resources for Health in March 2008, the Alliance endorsed the Kampala Declaration and Agenda for Global Action, which sparked broad interest in the creation of the Code.

'Progress on the code has been achieved as a result of consultations and discussions, particularly at all six WHO Regional Committees and national consultations, involving participation by a wide range of stakeholder groups. The UN ECOSOC meeting and the G8 Summit in July 2009, and the UN General Assembly in December 2009 had strongly supported and encouraged WHO to move forward in finalizing the draft code of practice. The 126th Session of the WHO Executive Board, January 2010, had discussed a revised draft of the Code and recommended that it be submitted to the 63rd World Health Assembly.

'At this momentous milestone, the Alliance and WHO call upon Member States and all its partners to reinforce its spirit of working together as they now gear up to implementing the code. The Alliance remains committed to facilitating the process and supporting sharing of information among Member States and all stakeholders.'

The Draft Resolution, dated 20 May 2010, is available here:
http://www.who.int/workforcealliance/knowledge/themes/migration/wha_A63_A_Confpaper_11.pdf

Key elements of the draft code (as described in The Lancet, 15 May) are:

• Establishment of voluntary global standards for ethical international recruitment of health personnel, balancing rights and obligations of source states, destination states, and health personnel.
• Promotion of coordination of national policies and international cooperation among states and their partners in health professions and civil society.
• Recommendation that states strive to meet their domestic needs for health services with their own human resources through planning, education, and training for health workforce.
• Recommendation that states ensure that international migration should have net positive effect on developing countries through technical assistance, support for health personnel training and retention, twinning of health facilities, and specialised technology and skills transfers.
• Recommendation that states establish voluntary financial mechanisms to support efforts of developing countries to strengthen health systems.
• Recommendation that states protect rights of migrant health workers through fair labour practices. In all terms of employment and conditions of work, migrant health personnel should enjoy same legal rights and responsibilities as domestically trained health workforce, without discrimination.
• Recognition that health personnel have ethical responsibilities to cooperate with local authorities in interests of patients, health systems, and society.
• Recommendation for national data collection and information exchange on health personnel migration, including establishment of national centre for information exchange, expansion and coordination of national research, and periodic reporting to WHO.
• Promotion of compliance through periodic state reporting to WHA of measures taken to implement the code; and recommendation that WHA periodically reviews the code's implementation with input from non-governmental sources.

Allyn L Taylor & Lawrence O Gostin. International recruitment of health personnel. The Lancet, 375(9727)1673-1675, 15 May 2010
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960596-X/fulltext?_eventId=login&&version=printerFriendly
(free access after free registration)

My source: HIFA2015 with photo addition

Ensuring You Have Nursing Skills Through 2030 ...

In Computing 20 May 2010 Andrew Charlesworth (p.24-26) writes about a report from Gartner the IT industry advisory group warning of a gap in mainframe skills due to the imminent retirement of experienced IT staff. The report notes:

"Increased focus needs to be to be on the preservation of detailed and specialised expertise that goes well beyond basic knowledge."

Nursing faces its own challenges in terms of skill gaps and loss of skills due to retirement. In contrast to the mainframe IT market the skills needed is in the orchestration of basic nursing care.

This is an ironic state of affairs as there are many forces acting to deprofessionalise nursing. Demographic trends is one. This is happening amid decades of specialisation and the production of - profession establishing - models and theories of nursing (care). Some of these are, however, quite complex and removed from the rudiments and tenets of basic nursing care.

The real irony here though? Well, as the demographic wave washes over many nurses themselves, the care they may subsequently need and receive will - just like mainframe skills - be the harvest from seeds they have also cast, or are sowing right now.

Ensuring You Have Mainframe Skills Through 2020, Gartner, Mike Chuba, Research VP.

Prime Minister’s Commission on the Future of Nursing and Midwifery in England – 2010

Earlier in March The Prime Minister’s Commission on the Future of Nursing and Midwifery in England published its final report.

You can download the report in full.

Box 3.1.2 (on page 43) features key statistics on nursing and midwifery:

• In 2009 there were nearly 595,000 RNs on the register residing in England, 77% of them registered in the adult nursing branch.
• In 2009 there were over 31,000 RMs on the register residing in England.
• Nine out of 10 of RNs in England are female.
• There are disproportionate numbers of men in more senior nursing positions and certain specialties: a third of mental health nurses, for example, are male.
• Nearly all RMs in England are female. There are 131 male midwives.
• Well over half the RNs and RMs working in the NHS in England (57%) are aged between 35 and 54, with less than 3% under 25. Almost 70% of RNs and RMs on the NMC register in England are aged 40 and over.

Reporting on the Commission's report the RCN Bulletin (10 March) notes the need to encourage more men into the profession and people from black and ethnic minority groups. As the list above highlights, however - There are disproportionate numbers of men in more senior nursing positions and certain specialties: a third of mental health nurses, for example, are male.

From my early nurse education days (especially from mental health to general nursing) you had no choice, but be aware of gender and just w(h)ere you had landed. Upon my first encounter with Hodges' model, the model stood out in the list of theories and models of nursing.

It was not listed on the original nursing theory website.
(Hence, the initial website project)
The majority of models and theories were created by women and outside England.#

The future of nursing depends on successfully addressing* the numbers: totals, proportions, recruits, retirees*. ... We can use the numbers, quality, safety and I have to say - Hodges' model to help craft the creative and innovative messages needed. We really are in for a fascinating and exciting 20-30 years in nursing; here in the UK, EU and Internationally. There is much more in the Commission's report to reflect upon which will follow here. ...

http://cnm.independent.gov.uk/

* Note the use of 'addressing' not balancing - that's why this is also challenging.
# This is not a complaint, just an observation.

Additional link:

Sciences care domain: Nursing theory and models of care resources

Career and Professionalism Zone at the Health Informatics Congress 2010 (HC2010)

FROM: Sinclair, Mike (South East Coast Strategic Health Authority)

Dear all,

During the very interesting and stimulating meeting on ICT & Society run by the Faculty of Health Informatics in mid December I advertised a Careers and Professionalism Zone that we are intending to hold at this year's Health Informatics Congress (HC2010).

The aim of this zone is to increase awareness of health informatics as a career prospect for budding new students looking for career options in ICT; and to provide careers advice and guidance to those already engaged in the profession.

We are aiming to provide tables for professional organisations, and for educational establishments, as well as some one-to-one meeting facilities for individual career guidance. There will be limited space available for stands, and they will not be elaborate (to cut down on cost) as we are holding this outside the main exhibition area.

We already have further and higher education bodies coming from Sussex (who are jointly organizing the zone) and from around the Birmingham area, but would like to extend an opportunity for other educational bodies to attend (as long as it is against the purpose outlined above.)

The event is at the ICC in Birmingham and will run from Tuesday April 27th to Thursday 29th.

I attach copy of (links provided here) programme and current exhibitors booked for information.

Costs for a stand/table would be between £200 and £400 (to be firmed up at the end of this month).

If you might be interested please let me know in the first instance.
Places will be offered on a first come first served basis.

Best regards,

Mike Sinclair, Chairman
Healthcare Informatics Congress 2010 (HC2010)
BCS Health
British Computer Society
mike.sinclair at bcs.org.uk
http://www.hcshowcase.org/

'situated' in Hodges' model #1

I'm not exactly sure how many times I've cut and pasted the paragraphs that introduce Hodges' model as person-centered and situated. Quite a few!

Thanks to the HIFA-2015 list I realised last week that there is no tag for 'situated' on W2tQ. Well, this post corrects that omission, but what does situated mean in Hodges' model?

Here is a definition c/o Google:

• situated/s'ɪtʃueɪtɪd/
  Synonyms:

  • adjective: located
  • If something is situated in a particular place or position, it is in that place or position. ADJ adv ADJ v-link ADJ prep
    ...
    

Related phrases

• situate
  If you situate something such as an idea or fact in a particular context, you relate it to that context, especially in order to understand it better.
  ...

Hodges' model is based on the belief that health and social care are multicontextual. Without wishing to substitute one term for another context and situation are inter-related and bear closer examination here on W2tQ.

Hodges' model prompts the user to consider that the person (-at-the-center) of care is simultaneously residing within four primary situations or contexts (five - if we include the spiritual aspects). Veterans and new recruits appreciate from the dizzy heights of the model, how quickly we find complexity in the multiple contexts that exist in health and social care. The many perspectives and views that must be taken into account to achieve safe, integrated and holistic care. Together with the above there are other definitions of relevance to scholars, champions and users of Hodges' model:

located: situated in a particular spot or position; "valuable centrally located urban land"; "strategically placed artillery"; "a house set on a ...
wordnetweb.princeton.edu/perl/webwn

In artificial intelligence and cognitive science, the term situated refers to an agent which is embedded in an environment. ...
en.wikipedia.org/wiki/Situated

Located in a specific place; Supplied with money or means
en.wiktionary.org/wiki/situated

The first definition about location is important as Hodges' model puts the person at the center. It is from there that the care domains are considered in turn and revisited as required. Hodges' model provides a locus around which care activities can be placed. Usually we view self-centeredness in a pejorative way. When you think about it though this is precisely what is needed to achieve person-centered care. In this case we need something that constantly re-centers - reorientates the subject(s) and agent(s) of care.

The second definition which looks to A.I. for inspiration is relevant as the concept of embodiment, embeddedness already has academic form* as a means to explore self-centeredness. Not only is the individual embedded in a (the) situation, but the carer (formal - informal) must also reside there and share to an extent the experience, if empathy, rapport and communication are to arise.

That final definition can be utilised due to the inclusion of means. People have skills, strengths and coping strategies and this sense of situated rings very true at present, with the emphasis on recovery, staying well, relapse prevention and adjusting to what may be permanent change. People also need knowledge as a means to maximise their health and well-being, which takes me back where I started with Health Information for All by 2015.

So, amid all the complexity, over-arching infrastructures, policies,
debate (and definitions!) it is refreshing that as I revel in the
scope of Hodges' model - two axes, four domains,
its holistic bandwidth... I can find the
word 'situated' planted
firmly
at the model's
center.

* Ref:
Paley, J. (2004) Clinical cognition and embodiment, International Journal of Nursing Studies, Volume 41, Issue 1, Pages 1-13.

Image source - with thanks: Ariel Bravy - http://www.arielbravy.com/photoblog/
http://www.arielbravy.com/photoblog/images/20060719214447_glenn%20x%20millenium%20park.jpg

Nurses as modellers and informaticians: surely not!

Nursing is still trying to escape and evade the sexual 'Carry On' stereotypes that have plagued the profession in the popular imagination. For the majority of people talk of nursing and models more readily conjures up visions of catwalks than an academic pursuit.

You can still see and hear the response of bright-eyed girls and boys (aged 9-10...) to the age-old question: "What do you want to be when you grow up?" The answer: "I want to be a nurse and help people get better!" Even though youngsters are more sophisticated these days (the reference to girls and boys is not just me being politically correct), they are still most likely primarily motivated by humanistic leanings as opposed to wanting to pursue the necessary studies in the sciences.

Despite efforts worldwide practicing nurses do not all see themselves as data modellers enthralled by IcT. IT isn't usually why they came to nursing, although many mature students may have started their career in the IT sector. Chapter 1 of Programming the Semantic Web highlights how a basic table is a model (p.6-7). So of course gifted with natural language we are all data modellers. Hodges model then is the ubiquitous high-level data model - a two-by-two table and a whole lot more.

An invitation to mine data, gather information and deliver nuggets of knowledge.

Ref:
Programming the Semantic Web: Build Flexible Applications with Graph Data
By Toby Segaran, Colin Evans, Jamie Taylor
Publisher: O'Reilly Media
Released: July 2009

Hodges' model: the puzzle of holistic care

Like many day-to-day 'customer' facing businesses, it is very difficult to get health and social care just right (for a kick-off 'just' is not good enough).


If you are faffing about with clothes and belongings when an emergency ensues you have just become an adornment yourself: one that is in the way. In the SCIENCES domain fail to assess mobility and balance and who is going to catch them when they fall? Not you: health and safety! It's a problem for the mental health team is it? Could this gentleman be constipated? Nice place is it? OK, crease your eyes up and tell me where the door is and hand-rail?

Are you ready to crowd surf?

That's good because there is an abundance of outstretched hands ready in the SOCIOLOGICAL domain. If, however, you do not attend to the patient's instructions regards information sharing - even if it was a relative you spoke to - just where are you going to hide?

(Ouch - that's gotta hurt! Sounds like they dropped you.)

Fail to assess mood and motivation comprehensively in the INTERPERSONAL domain and will you be able to say how Mrs Green really feels, behind that Mona Lisa smile? Will you know how to observe her, will you and your colleagues know just what you are looking for?

Did you miss that opportunity with the patient, carer - family in the POLITICAL domain to resolve the (ongoing Sunday afternoon) issue? You know the one about mum's medication, agitation, the appropriateness of the care environment and the outstanding referral to the community mental health team? Well yes, you might wonder what that buzz is. It's a complaint just passing you by(e).

Basic, holistic, integrated, person-centered care and much more. Now that's the real puzzle.
A puzzle worth spending a whole career trying to find the pieces - never mind the solution ....

Smiley career choices

It is nice to use smileys in e-mails and something now we take for granted. It made me smile placing this one on the page...

It is quite something else though when your job involves helping to put real smiles back on real faces, or more importantly helping people find contentment in their heart. ...


Additional links:

Mental Health Nursing

60+ Social Workers

Social Work careers

Intellect UK - Women in IT Scorecard: Ada Lovelace Day II

A definitive up-to-date evidence base for data and commentary on women in IT employment and education

Women in IT Scorecard (PDF 1MB) Published: March 2009
Type: Scorecard
Area: Transformational Business

Summary

Technology is central to the success of the UK economy and is becoming even more important the current economic situation. It is important to understand the trends in employment, education and any issues that could impact the future of the industry especially in such turbulent times.

British Computer Society (BCS), e-skills UK and Intellect., with support from Department for Business Enterprise and Regulatory Reform (BERR), have worked in partnership to produce a ‘Women in IT scorecard’ to understand and demonstrate the trends in our industry by gender from secondary education through into the IT workforce. The purpose of this document is to provide a robust evidence base for the facts behind the trends, to demonstrate differences in the participation rates between the genders and to present an analysis of these trends and the current situation to inform policy debate and future action by the partners and their communities.

The concern
While females represent 45% of the UK working population, they only make up 21% of the IT Industry workforce. For a profession that a few years ago was beginning to edge towards a ‘critical mass’ of 30% women - reaching 23% - we now find an alarming situation. In 2008 the make-up of the profession has changed:

* Males outnumber females in the IT industry by nearly 4:1.
* In the IT workforce, the number of males has fallen by 23,000 while the number of females has fallen by 63,000 since 2001.
* In IT occupations the number of males has increased by 77,000 while the number of females has fallen by 28,000 since 2001.
* Females account for around one in every five IT professionals.
* In Higher Education females account for 25% of all lecturers and 12% of professors in Computer Science / IT related subjects.
* In 2008 there were 17,455 male and just 1,581 female chartered IT professionals – 8% female.

Download
Women in IT Scorecard (PDF 1MB).

For more information contact:
Carrie Hartnell
Head of Industry Strategy
carrie.hartnell at intellectuk.org

See also - Ada Lovelace Day: Enid Mumford - Socio-technical perfume down the mine

Ada Lovelace Day: Enid Mumford - Socio-technical perfume down the mine

I had to enter a pledge and join the call today to post in response to Ada Lovelace Day - an international day of blogging to draw attention to women excelling in technology.

Women’s contributions often go unacknowledged, their innovations seldom mentioned, their faces rarely recognised. We want you to tell the world about these unsung heroines. Entrepreneurs, innovators, sysadmins, programmers, designers, games developers, hardware experts, tech journalists, tech consultants. The list of tech-related careers is endless.

Recent research by psychologist Penelope Lockwood discovered that women need to see female role models more than men need to see male ones. That’s a relatively simple problem to begin to address. If women need female role models, let’s come together to highlight the women in technology that we look up to. Let’s create new role models and make sure that whenever the question “Who are the leading women in tech?” is asked, that we all have a list of candidates on the tips of our tongues.

read more from Ada Lovelace Day

It was soon after this blog first appeared that I learned of the news of Enid Mumford's death. I never had the pleasure of meeting Prof. Mumford, but came across her work whilst doing my own studies and a degree at Bolton. We have something in common in being raised in Merseyside. In the NW of England there is also a tradition of mining...

Studying geology at school we went on a field trip down the pit at Golborne Colliery. Strange to be told after an underground train ride we where under the East Lancashire A580. Enid Mumford's early work took her underground, but her impact extended far beyond her perfume bottle:

'A woman down the mines?" Enid Mumford's classic sociological research for the National Coal Board had a strong impact on unbelieving miners. Later, as an active advocate for women's rights, Enid, who has died aged 82, enjoyed recounting her early experiences: "They were terribly nice to me whenever I turned up, but they were awfully embarrassed at what I might catch them doing." Enid would "drench herself with perfume", so that the ventilation system would give the miners a chance to prepare themselves for her arrival at the coalface. In such ways, Enid began her contributions to social theory, with its challenges to action researchers like herself.
The Guardian obituary

As posted previously this year sees a chapter published on Hodges' model and socio-technical structures in nursing informatics. I really latched on to Enid Mumford's approach and needless to say Professor Mumford's invaluable work figures in my overview:

Background: Existing socio-technical structures and methods

This section scratches the pages of the socio-technical literature by introducing two seminal contributions and briefly references other sources. The two authors discussed are Mumford (1983) in the socio-technical sense and Giddens (1984) who is more generic socially and organisational oriented. Enid Mumford created ETHICS, a systems design methodology: Effective Technical and Human Implementation of Computer-based Systems. The need for ETHICS is to help manage change with three objectives.

First, ETHICS stresses that the future users of computer systems, whether directly or indirectly involved should play a major part in designing these systems. User involvement is closely related to subsequent job satisfaction and efficiency gains and hence the realization of benefits. The users of systems are credited as experts; if this knowledge and experience is recognized and utilized then job satisfaction gains are likely as the users are active agents in the change process and not passive. There is an interesting correspondence here with the continuing emphasis on patients and carers being acknowledged as experts in their care assessment, management and evaluation.

The second objective focuses on the human – behavioural response to change. It is important that specific job satisfaction objectives are factored into the design from the outset and not left to chance, lost amid technical specifications and objectives. In this way potential negative change impacting the quality of work life can be anticipated and avoided or at least ameliorated. Technology has frequently been associated with de-skilling and of course the loss of traditional jobs. The prospect of technical, management led change can cause consternation in the user community. If alienated employees may be absent, seek alternate employment, and overall be less productive.

ETHICS is not restricted to the computer system; the third objective highlights the need for a new computer system to be ‘surrounded by a compatible, well functioning organizational system’ (Mumford, 1983). Design must be viewed globally as a whole. The technical design is just one part of a very complex design process that must also incorporate the details of human-machine interaction; what would be called gap analysis, the differences in existing processes and proposed new processes and procedures. In addition, as per objectives one and two, individual jobs and workgroup activities must be reviewed; how are existing roles and relationships altered and newly defined? What new management arrangements are needed, since (middle) management is rarely untouched?

<>

I wish I could spend more time on Hodges' model, socio-technical thought and its application. Women in ICT? This is not a new call.

Women must have role in IT - not just to ensure the social in SOCIO-technical.

Not just to ensure that the 'c' in ICT happens.

Whether in programming, instructional technology, internet infrastructure, semantic web, the games industry and a whole host of other areas - Ada Lovelace, Enid Mumford - and of course others past and present must not be lone pioneers. ...

Additional links:

Intellect Technology Association: Women in IT Scorecard maps gender imbalance in IT workforce

BCS Women

Binary Girl

Daphne Jackson Trust

Girl Geeks

Information Age (2008) Women flee IT industry

The Register (2008) Women IT EU Job Shortage

UK Resource Centre for Women in Science, Engineering and Technology

WITI - Women in Technology International

Women in Technology

Dedicated 2 Beth

Help for NHS.jobs and job hunters with standard file names

NHS.jobs is a marvellous web resource. Once you have entered your personal and career details you can save time and focus on what matters....

One thing I've noticed is that should you download assorted 'job descriptions', 'person specifications' and other essential guidance the files become meaningless when listed.

Browsers and operating systems do behave differently, but on my PC extra characters are appended to differentiate one 'jobdescription.doc (or pdf)' file from another.

There must be a way to define a standard across the NHS (and dare we suggest the social care sector)? Then prospective job-hunters can see from the file name the organisation, the job title, closing date or other combination of details? Given the redundancy in our language(s), the need for equality (in access) it would not take much to achieve this?

There are some points of note: what's the shelf (directory!) life of these files? "If you have not heard from us within four weeks of the closing date then please assume your application has been unsuccessful on this occasion."... Plus, the semantic web and an intelligent file system may overtake this problem and perceived requirement, but until then...?

Even if only gifted a recommended convention, then perhaps this could quickly emerge as a standard, because it makes a difference, affords an early advantage in the 'market place' and assists everyone.


As the demographic squeeze tightens its grip this might even help HR departments, students, returnees, and the middle-aged-mid-career-crises-smitten.

Until then NHS.jobs and job hunters can only handle the files they 'receive'.

NHS.jobs does very well in helping to open doors... in the meantime I'll keep knocking ... and anyway what date did I save that person spec?

Image source: http://www.ectomo.com/index.php/2007/08/24/hand-door-handles-by-naomi-thellier/

Death in Birth By Vivienne Walt/Freetown Thursday, Sep. 18, 2008

An excerpt from an article in TIME magazine is posted below by Patti Abbott, Co-Director of the PAHO/WHO Collaborating Center for Nursing Knowledge, Information Management and Sharing (KIMS), Johns Hopkins University School of Nursing.

The entire article can be found at: http://www.time.com/time/magazine/article/0,9171,1842278,00.html

“In a hospital ward in Freetown, the capital of Sierra Leone, Fatmata Conteh, 26, lay on a bed, having just given birth to her second child. She had started bleeding from a tear in her cervix, the blood forming a pool on the floor below. Two doctors ran in and stitched her up, relatives found blood supplies, and nurses struggled to connect a generator to the oxygen tank. One nurse jammed an intravenous needle into Conteh's arm, while another hooked a bag of blood to a rusted stand, and a third slapped an oxygen mask over her face. In the corner of the room, a tiny baby--3 hours old--lay on a bed, wailing, swaddled in bright-colored African fabric. "Listen! You must feel happy to hear your baby cry," said a nurse, pleading with Conteh to find strength. Three visiting members of a neighborhood church began chanting over Conteh: "Jesus, put blood into this woman! Thank you, Lord!" But as their chants grew louder, the nurses stepped back from the bed. Conteh was dead.

Some version of that scene is repeated around the world about once a minute. Death in childbirth is not just something you find in a Victorian novel. Every year, about 536,000 women die giving birth. In some poor nations, dying in childbirth is so common that almost everyone has known a victim. Take Sierra Leone, a West African nation with just 6.3 million people: women there have a 1 in 8 chance of dying in childbirth during their lifetime. The same miserable odds apply in Afghanistan. In the U.S., by contrast, the lifetime chance that a woman will die in childbirth is about 1 in 4,800; in Britain, 1 in 8,200; and in Sweden, 1 in 17,400. Deaths are heavily weighted to the poorest and most isolated in each country, which means that many politicians remain largely ignorant of the scale of the tragedy. "Often the people in the cities do not know what is happening in their own rural areas," says Sarah Brown, wife of British Prime Minister Gordon Brown and patron of the White Ribbon Alliance, a global advocacy organization that works with governments to lower maternal mortality rates. Brown--who lost a baby 10 days after giving birth in 2001--says that when she tells heads of state and their spouses how many women die in childbirth, "they are aghast."

The Gains Not Made
They have reason to be. For here is the truly ghastly reality of maternal mortality: in 20 years--two decades that have seen spectacular medical breakthroughs--the ratio of maternal deaths to babies born has barely budged in poor countries. To be sure, maternal health has seen advances, with new drugs to treat deadly postpartum bleeding and pregnancy-related anemia. But in many places, such gains are dwarfed by a multitude of problems: scattershot care, low pay for health workers and a scarcity of midwives and doctors. In Mozambique, where women have a 1 in 45 lifetime chance of dying in childbirth, there are just 3 doctors per 100,000 people; in all of Sierra Leone, there are 64 government doctors, only five of whom are gynecologists. Millions of families have never seen a doctor or nurse and give birth at home with traditional birthing helpers, while those who make it to a clinic--some being carried on bicycles or in hammocks--often find patchy electricity, dirty water and few drugs or nurses. Explaining the task of reducing maternal deaths, Sierra Leone's Minister of Health, Saccoh Alex Kabia, who returned home last year after decades of working as a surgeon in Atlanta, says, "The whole health sector is in a shambles."

The article goes on to say:

“When world leaders gather in New York City this month to take stock of the MDGS, their speeches are likely to tout the many achievements since 2000: millions more African children now attend school and sleep under mosquito nets; thousands of new water wells have been dug. Yet though maternal health care underpins many other development goals (healthy mothers are more likely to ensure that their children are well fed and educated), the total number of women dying in childbirth has remained virtually unchanged in eight years. Why? Health officials are clear in their answers. Aside from lack of money and political will, they also face entrenched traditions and fatalistic attitudes to maternal mortality, especially in very poor communities. "People think that dying in childbirth is not preventable," says Nadira Hayat, Afghanistan's Deputy Minister of Health. "They say it is up to God."

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I think they need knowledge, a nurse, a midwife.

Patti
Patricia A. Abbott, PhD, RN, FAAN
Co-Director of the PAHO/WHO Collaborating Center for Nursing Knowledge, Information Management and Sharing (KIMS), Johns Hopkins University School of Nursing
___________________
Visit web site:
http://my.ibpinitiative.org/GANM/NMmakingpregnancysafer/

My source: posted by Jody Lori: [Nursing and Midwifery for Making Pregnancy Safer: Discussion] link to article in Time Magazine.

Additional links:

http://www.unicef.org/infobycountry/sierraleone.html

http://www.unicef.org/infobycountry/sierraleone_statistics.html