Make Motherhood Safe for Tanzanian Women

by Kupona Foundation
Play Video
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women

Project Report | Feb 16, 2012
A Slice of Dar: Part 1

By Katie Flanagan, Executive Director | & Dr. Yoni Barnhard, Norwalk Hospital

At the end of January, our hospital in Dar es Salaam, CCBRT, was extremely fortunate to host Dr. Yoni Barnhard, OBGYN Department Chairman and Director of Maternal-Child Health at Norwalk Hospital, and Associate Clinical Professor at Yale University School of Medicine.  While he was there, Dr. Barnhard worked right alongside our own OBGYN Director, Dr. Brenda D'Mello, delivering babies at one of our partner district hospitals and teaching 45 Assistant Medical Officers at CCBRT. 

While he was there, Dr. Barnhard wrote three incredibly poignant stories about his experiences.  Over the next three months, we'll be sharing them with you. We hope you find them as moving as we do - real reminders of the challenges we face, but also of the hope that our maternal health project brings to the women of Tanzania.


Day 1

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.  High maternal mortality rate.  High full-term neonatal death rate. The intent was to spend the afternoon teaching the basics of eclampsia management.  Recognizing the risk factors, eliciting a good history, making quick, simple observations, taking blood pressure, and recording pulse.  Assessing that the fetus is still alive. At Amana that means putting your ear up to the belly and listening for fetal heart tones.  An art lost several decades ago in the West.  Now we let our electronic dopplers perform this ancient exam.

The challenge is not practicing good obstetrics.  The challenge is practicing better obstetrics with limited resources.  The high technology wrongly considered essential nowadays for the modern practice of obstetrics is simply unavailable in the developing world.  When it comes to saving a life, one can do far more with a single unit of blood than an ultrasound machine.

Basics.  History and physical.  The idea is to standardize the triage process.  Ask the right questions every time.  Follow the best evidence available for detecting a problem.

Most of the serious clinical problems that besiege the health worker here are preventable.  Although disastrous complications such as rupture of the uterus, vesicovaginal fistula or malaria causing anemic heart failure in pregnancy can be treated when they occur.  Their elimination is the challenge that cannot be neglected.

Next comes management.  IV lines.  Hematocrit.  Anti-hypertensive medications.  Magnesium sulfate to prevent seizures.  We are working on creating an eclampsia kit.  A drawer that will contain these things.  A drawer that is hopefully stocked more times than not.

But the kit cannot act on its own.  Even simple things like correct doses of medications seem to be part of a lost narrative.  We will make some posters that outline the basic management steps.  Put it in a simple, 5-step checklist.  Plaster it all over the hospital.

Not so simple.  The head of the hospital told me this might create clutter.  He took great pride in telling me that Amana is doing a 5S project.  I did not have the heart to tell him that 5S is not a housekeeping tool.  It is intended to remove waste so that the essential items are available.  A poster on the wall outlining how to save a life should certainly qualify.

In the middle of all this the strangest thing happened.  I had been introduced as Professor Yoni. ”Professor” puts you on par with the angels. There was an emergency in labor and delivery.  A woman needed an urgent C/S.  The head of the hospital asked if I would please run over to the operating theater and do the C/S.

I was given a pair of surgical scrubs.  I think they once belonged to the fattest man in Tanzania.  We needed to find a piece of rope just to keep me from operating in my underwear.  And a pair of rain boots. White rain boots.  The room was incredibly hot.  Hot even before I put on what looked like a rubber butcher’s apron.  Between the boots and that apron I really felt like we should be going to a fish market.

My assistant began his training 6 months ago as a general medical officer.  This was his 3rd C/S.  I might have been concerned about the sweat dripping from my forehead into the surgical field, but I was more worried about what I would do if one of those flies landed on my nose once the sterile gloves were on.

So here I am.  Standing over a Tanzanian woman’s belly with a scalpel in my hand.  None of the usual instruments available.  No electrocautery.  No hemostatic gauze.  Blunt scissors.  A pick-up whose ends don’t quite approximate.  And suture material that looks like it was just cut and dried from a dead cat.  Much too thick. Probably gonna cause as much bleeding as it stops.

And of course there is an audience standing outside looking in through the window.  All the credibility of 25 years bet on one hand. As I made that first incision I truly wondered how I ended up here.  At Amana.  In 92 degree heat.  Wearing rain boots and a pair of surgical scrubs about to fall to the ground. Flies buzzing around.  A scalpel in my hand.  And at that moment no one else in the room who could make a difference.

Skin.  Subcutaneous fat.  Muscle.  Fascia. Peritoneum.  Uterus.

Thick meconium. My hand now inside the womb.  Gentle.  Lift the head out.  Slowly.  Now the shoulders.  Focus.  Clear away the meconium from the mouth and nose.  Concentrate.  Cut the cord. Healthy baby.  And a mom who will be able to care for this new child.

There is much to be done here.  Training.  Supervision.  Continual reinforcement. A commitment to quality care. With more than 80 deliveries each day at Amana, there is little time to look back.  Under the sweltering Tanzanian sun, we move on to the next patient.

Share on Twitter Share on Facebook

Dec 9, 2011
Kupona Foundation/CCBRT Report: Make Motherhood Safe for Tanzanian Women

By Katie Flanagan | Executive Director

About Project Reports

Project reports on GlobalGiving are posted directly to by Project Leaders as they are completed, generally every 3-4 months. To protect the integrity of these documents, GlobalGiving does not alter them; therefore you may find some language or formatting issues.

If you donate to this project or have donated to this project, you can recieve an email when this project posts a report. You can also subscribe for reports without donating.

Sign up for updates

Organization Information

Kupona Foundation

Location: Saratoga Springs, NY - USA
Facebook: Facebook Page
Twitter: @KuponaFdn
Project Leader:
Laura Wicks
Executive Director
Washington , DC - District of Columbia United States
$149,195 raised of $400,000 goal
2,186 donations
$250,805 to go
Donate Now
Donating through GlobalGiving is safe, secure, and easy with many payment options to choose from. View other ways to donate

Kupona Foundation has earned this recognition on GlobalGiving:

Help raise money!

Support this important cause by creating a personalized fundraising page.

Start a Fundraiser

Learn more about GlobalGiving

Teenage Science Students
Vetting +
Due Diligence


Woman Holding a Gift Card
Gift Cards

Young Girl with a Bicycle

Get incredible stories, promotions, and matching offers in your inbox

WARNING: Javascript is currently disabled or is not available in your browser. GlobalGiving makes extensive use of Javascript and will not function properly with Javascript disabled. Please enable Javascript and refresh this page.