The Mother and Child Health Care Association that I proposed when in Tanzania this past August has now met often enough to put together a ten-year plan of action. Soon they will apply for official recognition as a Tanzanian nongovernmental organization, submitting as part of the registration process the thirty-five-page draft for a grant proposal written by Joas Kahembe’s son, Jason. Jason’s English skills far exceed those of any of the nineteen nurses and midwives, from Dareda Kati and several surrounding villages, who dominate the membership of KAMM (acronym for the Association’s Swahili name). The membership includes only one other person, the local public health clinic doctor, Sadock Wilson Bilalama; he speaks and writes English pretty well and will serve as Secretary.
The care taken by the nurses and midwives and Dr. Wilson in laying out what they want to achieve over the next decade thrills us at Karimu since we had no idea what to expect. A handful of generalities wouldn’t have surprised us, so our Board Member Lorraine Flores, who has a lot of grant-writing experience, had said she would draft a proposal if necessary. Instead they have sent us this long proposal, impressively dense with detail. But now we face a much harder job than writing a proposal: we have to help find a donor or donors willing to fund KAMM’s work, projected to cost just over forty thousand dollars per year.
Veronika Mosha, the extremely capable midwife who, as my September 1 post reported, introduced us to the prevalence of genital cutting in her village and the larger area, chairs KAMM. It especially pleases our Board to see that the draft proposal calls for purchase of a Toyota double-cabin pickup truck. I first started considering a focus on women’s and children’s healthcare because Veronika had emphasized to Marianne and Dr. Susan Hughmanick that genitally-cut women face particular danger of bleeding to death during childbirth—above all when transportation to a hospital is difficult or impossible.
And thank goodness that women do the majority, and indeed the best, of Karimu’s work: we needed Marianne and Susan to hear about genital cutting and other vital women’s health concerns from Veronika, who would never have talked so freely to me.
One thing we’ll want to do before advising KAMM to send its grant proposal to potential funding sources is find the most current and precise data we can for maternal mortality in Tanzania. As it stands, the proposal cites research done ten years ago which “demonstrated that, in every 100,000 babies born alive in Tanzania, an average of 1500 women die during pregnancy, delivering or shortly after delivery.” This left Tanzania the “fifth most risky place in Sub-Saharan Africa for a woman to give birth, behind Sierra Leone, Niger, Malawi and Angola.”
On the other hand, a more recent study in The Lancet, based on research conducted in 2008, put Tanzania’s maternal mortality rate per one hundred thousand at “only” four hundred and forty-nine, lower than that of thirty other sub-Saharan African countries and therefore safer than average for the region. (The Lancet ranks the Central African Republic as the most dangerous of sub-Saharan Africa’s forty-one countries in which to give birth, with one thousand five hundred and seventy mothers dying out of every one hundred thousand.) The study shows Tanzania’s maternal mortality rate falling by one and seven-tenths percent annually—good news, of course.
Yet nowhere near good enough: just four Italian mothers die out of every one hundred thousand and even in the United States, the most perilous country for giving birth in what people used to call the “First World,” seventeen die (up from eleven and a half in 1990!). That makes Tanzania more than twenty-five times as dangerous as the U.S. for childbirth, so KAMM has much to do.—Don Stoll