You have recently seen Sierra Leone in the news due to the Ebola outbreak that to date has killed 2500 people.

Decades of poverty, illiteracy, war, lack of safe drinking water and sanitation, overcrowded housing, and little access to healthcare create the perfect storm for an epidemic. Sierra Leone is vulnerable to a disease outbreak due to poor social determinants of health and decades of structural violence.

Social determinants of health are the conditions a person is born into that affect their health. These are powerful indicators of a person’s quality and quantity of life. A child born in Japan has a chance of living 43 years longer than a child born in Sierra Leone simply because of the environment in which they live.

The poor living conditions of the Sierra Leonean people are reflected in their health statistics. Sierra Leone ranks as the least developed and poorest country in the world. Their life expectancy is 45 years old, which is the lowest in the world. They have the highest infant mortality rates globally. 45% of all children are expected to die before the age of 5, also the worst under-5 mortality rate in the world.

The Jawei Chiefdom of southeastern Sierra Leone is located on the border of Liberia. Ebola hit the Chiefdom in May and spread quickly due to the poverty and lack of health care services. Jawei was one of the first regions to experience the outbreak and one of the hardest hit areas with high death rates and almost total loss of their trained health center staff and midwives.

Even with the help of NGOS, Doctors Without Borders, and the UN, no one could stop the spread of the disease. In an effort to save their communities the tribal chiefs and National Parliamentary Representative took matters into their own hands. They went door-to-door, as respected and trusted elders of their communities, to educate each household and create protocols and by-laws on Ebola prevention, treatment, and recovery.

The Jawei Chiefdom is now Ebola free with no new cases since September while the epidemic continues to rage in much of the country where communities are waiting for outside aide. The successful recovery of Jawei is attributed to local level collaboration and leadership that used local resources and systems of governance. Their recovery is not attributed to outside aide. The strength of their empowered self-reliance literally saved their lives. Now other regions in Sierra Leone are looking to the Jawei Chiefdom as a model of local level action in an epidemic.

The 100 households affected by Ebola had to burn all of their clothing, bedding, and household possessions. Communities are also experiencing serious food insecurity due to in-country travel restrictions, inability to farm, and economic crisis. The National Parliamentary Representative of Jawei has contacted the Sukuli Project, a local group that operates in Sierra Leone, asking for assistance. Sukuli accepted their request and is now working with our American partners, and Chiefdom leaders, elders, and representatives to replace household possessions and provide food for the households affected.

OHSU’s Nursing Students Without Borders are holding a fundraising event for the Jawei Chiefdom on January 16^th at 6:30 pm in the Stevens Union Room 319. Sudy Storm, MPH, Midwife, and founder of the Sukuli Project will present ‘The Social Inequity of Ebola: How A Local Community Saved Themselves’.

Tickets to the event are on a sliding scale starting at $20.00. This includes a presentation, a ceramic bowl with soup, and raffle ticket for a hand sewn Jawei blanket.

100% of the proceeds will go directly to the Jawei Chiefdom for the families of Ebola victims and survivors.

According to the State of the World’s Midwifery 2014 Report there is a global shortage of midwives, which is tragic because high quality midwifery care could save the lives of millions of women and babies who die during and after pregnancy. Shane Carnahan posted a reflection here recently regarding the World’s Midwifery 2014 Report and how to improve birthing options for women on a global scale (25 July 2014).

The impact of midwifery is paramount. World Health Organization statistics show that births attended by midwives have lower infection rates, lower Cesarean rates, fewer complications and healthier birth outcomes than births attended by physicians in the hospital. Further evidence of the impact of midwifery is that the countries with the healthiest birth outcomes in the world have midwives as their main maternity care providers.

According to the State of Midwifery Report, there is a serious shortage of midwives in Africa, Asia and Latin America. These countries suffer 99% of the world’s maternal deaths and more than 90% of stillbirths and newborn deaths. Each year 300,000 women are estimated to die during pregnancy, childbirth or postpartum worldwide. Every day 800 women are estimated to die from pregnancy or complications related to childbirth around the world. The blog written by Shane discusses the key challenges to providing midwifery care in these areas, such as standardizing midwifery education and equipping facilities with supplies for emergency procedures.

Over three quarters of stillbirths and maternal and infant deaths could be prevented in the countries with the highest infant and maternal death rates if quality midwifery care were available to all women. Millions of lives could be saved! The return on investment from the education and organization of community-based midwives is estimated to be similar to vaccinations in terms of the cost per life saved. More importantly than the return on investment is that all women are entitled to respectful, compassionate care before, during and after pregnancy and birth. And all babies deserve to be born in a loving, nurturing environment.

I hope this blog will stimulate your interest in reading the entire report (State of the World’s Midwifery, 2014) and an excellent article in the journal Lancet (Midwifery, 2014). Please join us in appreciating love and compassion in action, expressed daily by the midwives in your town, state, nation, and our world.

Randi Powell

Global Force for Healing Intern

OHSU Senior Nursing Student

Nursing Students Without Borders

The Pemako Health Initiative, a nonprofit that is part of the Healthy Birthing Project network, functions in a small area located in a region of the Himalayan Mountains in the state of Arunachal Pradesh, India. Kathy Morrow, a nurse midwife, founded the Pemako Health Initiative after developing compassion for the indigenous people in this extremely remote region when she witnessed their suffering during her first visit in 2009. There was no access to general healthcare, obstetrical care or emergency childbirth services. Children were dying from preventable infections and mothers were dying from post-partum hemorrhage. The infant mortality rate was 77 per 1,000 births and the maternal mortality rate was 400 per 100,000 births. The estimated life expectancy was 54 years and villagers were traveling up to four days to reach a hospital.

The Pemako Health Initiative was founded on the belief that every family has the fundamental right to have access to healthcare, clean water and a clean and safe birth experience. They are providing access to the most basic healthcare services and sanitation, with their primary focus to provide clean drinking water through Biosand water filters and to build latrines. Kathy works with the community to create sustainable, renewable, long-lasting change by working within preexisting community networks to build a foundation of community education and trust.

Kathy’s work builds momentum with every trip she takes. She impacts maternal and infant health by distributing Delivery Kits for laboring women and training healthcare workers. In the future she hopes to provide access to emergency obstetrical care, trained Birth Attendants, childhood immunizations, prenatal and postpartum care, and basic reproductive health and family planning needs. Kathy is helping to alleviate their suffering by planning to provide access to healthcare in a region where access to safe, loving maternal and infant care and community health are desperately needed.

To learn more about the Pemako Health Initiative, please visit:        http://pemakohealthinitiative.org/

Randi Powell

Global Force for Healing Intern

OHSU Senior Nursing Student

Nursing Students Without Borders

Today is UN International Indigenous People’s Day. This year’s theme is “Bridging the Gap: implementing the rights of Indigenous peoples.” UN Secretary General Ban Ki-moon has called the estimated 370 million people in 90 countries “powerful agents of change” who must be included in the new development agenda. Due to historical inequities and discrimination, they make up 15% of the world’s most resource poor and 1/3 of the extremely resource-poor rural population.

Power structures and development programs must be created to eliminate obstacles to indigenous people’s rights to self-determination and ability to lead peaceful, sufficient lives. We join hands with everyone seeking meaningful outcomes from the first World Conference of Indigenous people in September 2014, and truly hope that there will be a positive impact on MotherBaby and community wellbeing for marginalized people everywhere.