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Sub-Saharan Africa has one of the highest maternal mortality ratios in the world, with a substantial portion of maternal death occurring along the rural coast of Lake Victoria, a substantial portion of which lies along Western Tanzania. There are currently multiple initiatives that were started prior to the United Nation’s Millennium Development Summit that set various goals (including reducing maternal and neonatal deaths) throughout the developing world. However, a majority of these programs have focused on equipping facilities in urban and metropolitan areas to meet basic standards for obstetric care. Doctor Daniel Gragert, currently the Chief Medical Officer of MakeSafe International, and his wife Kamilla Gazieva, started an initiative with a specific focus on transportation for laboring mothers and obstetrical emergencies in this region. This includes training an all woman team of emergency care providers to be self-sufficient first responders; as part of this initiative, they are running a multi-site study on the use of misoprostol as a preventive measure for post-partum hemorrhage, using the first-responders as a means to deliver the medication. 

We brought our car seat to Africa. We brought it Tanzania, to be more specific. All 15 kilograms of plastic, fabric, and security straps, mixed in with cases of prophylactic antibiotics, diapers, and medical equipment. We were committed to showing that humanitarian aid could be a family activity – a safe family activity. It took about 15 seconds after setting foot on our new home-base to realize that this giant hunk of western engineering had no use in a land with motorcycle taxis careening over rock trails, and overzealous drivers in beat up 90’s era Toyota Corollas speeding past. However, we were still far safer than a large percentage of families that called the region home. 

We came from a country where medical help means not having to worry that pregnancy is a death sentence. It is estimated that close to 10,000 women in the region will die every year from complications related to childbirth. The large majority of these deaths was and will be caused by postpartum hemorrhage, a pathology that is almost entirely preventable. Despite organized efforts, Tanzania, the World Health Organization, and the United Nations (among many others), has made little headway in bringing down the maternal mortality rate. The highest rate of maternal and neonatal death is in the rural region along the long coast of Lake Victoria, a beautiful and diverse region that includes exotic flora, pineapple, mango, coffee beans, and Mt. Kilimanjaro; A region rich with diverse culture, friendly and welcoming faces, and systemic poverty. The Gross National Income, per capita, is currently less than $1,000 USD (the GNI, per capita is $55,980 in the United States). The rural region’s population has hit near exponential growth, partly due to the relative political stability, but as also as refuge for those who fled the Rwandan genocide in the 1990s. This has taxed a medical network that was already systematically deficient. There are often no roads and no way to provide emergency services. 

"It is estimated that close to 10,000 women in the region will die every year from complications related to childbirth".

Nearby healthcare facilities may be a half-day walk and often provide only the most basic obstetrical care, little more than a bed in a one-room clinic.

My family has the wonderful opportunity to work with local NGOs such as the Tanzania Rural Health Movement, Bugando Medical Center (the largest tertiary facility in the region), and the Tanzania Ministry of Health to help train community healthcare workers to provide basic emergency obstetrical care and emergency transport. This means recruiting, training, and supplying teams of providers from local communities to empower themselves to find the care they need for their laboring mothers. The initiative will be part of the current Beacon System currently operating in the region. This is an SMS-based emergency dispatch system; it is currently used to help dispatch volunteer motorcycle taxi drivers to provide emergency medical care on site. We will be helping to expand this service to laboring mothers to get them emergency care and transport throughout the Lake Zone of Tanzania. It is a small effort but big task amongst a massive problem. From building our own labor ambulances, to training community health workers, our aim is to provide what assistance we can and gain a lot of adventures for our family (and especially our own little monkey).

This article and narrative is the first in a five part series of articles that highlight the needs of pregnant mothers in rural East Africa, and the day to day realities of starting and running a team focused on providing medical care in remote areas. This includes highlights from the women and family impacted by the lack of care, practical issues with providing care and dispatching in under developed areas, and stories of those who are impacted by the care they receive. 

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