A passion for saving mothers’ lives

Posted on May 23, 2013 by Kathleen Donnelly

Patience Cofie. Photo: PATH.

Three decades ago Patience Cofie decided to dedicate her career to public health—specifically, to the health of women and children in her native Ghana and surrounding countries. Her reasons for the choice were perfectly logical. She had a thirst for knowledge, a good mind for management, and a talent for teaching—traits that would help her establish everything from a national strategy to increase childhood immunization to a community-based health insurance system to help poor women and their children access care.

But personal motivation fueled her passion as well.

“I lost my niece to postpartum hemorrhage,” says Patience, referring to the excessive bleeding during and just after childbirth that is the number one cause of maternal deaths worldwide. “And I thought if there ever is the opportunity, I should try hard to stop it.”

Opportunity arrives

Opportunity arrived in the form of an innovative product called the Uniject™ injection system, combined with a drug called oxytocin.

Oxytocin injection, when administered immediately after child birth, causes the uterus to contract and is effective in reducing the risk of bleeding. It’s usually given to women by health professionals in hospitals. But for women like Patience’s niece who give birth at home or in smaller health clinics, access to both the drug and a trained provider can be intermittent at best.

The Uniject™ injection system may help. It’s a single-use syringe that comes prefilled with a dose of medicine—in this case, oxytocin. It’s easy to use, injection ready, and potentially a lifesaver—if it’s available when and where women need it.

Dianna Peter, left, received oxytocin to control excessive bleeding when she gave birth to a girl at her home in central Ghana. Hannah Abundu, trained by PATH, administered the injection. Photo: PATH/Evelyn Hockstein.

That’s where Patience, who is taking part in next week’s Women Deliver conference on the well-being of women, comes in.

Advocating for transformative innovation

Just because a potentially useful technology exists doesn’t mean it will be adopted and used. Governments and others must be convinced of its safety, effectiveness, and value. Patience’s job is to be an advocate for reducing the risk of postpartum hemorrhage in general, and specifically, for use of oxytocin in Uniject™ packaged with time-temperature indicators. (The indicators measure cumulative exposure to heat and help prevent accidental use of spoiled oxytocin.) The advocacy effort Patience leads in Ghana has four major goals:

To ensure that oxytocin in Uniject™ is registered within Ghana so that it can be purchased by the government, which provides health care.
To include it with the government’s essential drug list and safe motherhood protocols as one of the standard treatments used for postpartum hemorrhage in community settings as well as in hospitals.
To make sure it earns a place in the “cold chain” of proper transportation, refrigeration, and distribution as the product travels from manufacturer to mother.
To authorize community-based health providers to administer oxytocin in Uniject™ to women in difficult-to-reach communities.

Meeting with the health ministry

To reach those goals, Patience is harnessing the power of partnership. A working group on postpartum hemorrhage is meeting to help focus the government’s attention on reducing maternal deaths. Tactics to reach that goal include using oxytocin in Uniject™, but Patience points out the ultimate aim is much higher, and in many ways more understandable.

“When I started this work,” she says, thinking back on her niece’s death, “I put in all efforts to ensure that we manage to save lives. My passion for the work comes naturally for somebody who is interested in making sure women do not die, particularly from excessive bleeding when we are giving birth.”

More information

PATH at Women Deliver.

Our work in preventing postpartum hemorrhage.

Making childbirth safer: oxytocin in Uniject™.

Posted in Featured posts, Health technologies, Maternal and child health, PATH personalities | Leave a comment

Innovation in motion

Posted on May 21, 2013 by Steve Davis

PATH President and CEO Steve Davis. Photo: Auston James.

This morning, I strapped on a tool belt and climbed up on a stage to talk to some 800 of PATH’s most loyal supporters—including Melinda Gates, whose family foundation has so generously funded our work and who spoke so eloquently on our behalf today.

“Bill and I feel in some ways like we have grown up with PATH,” Melinda told the crowd in Seattle. “PATH was certainly here first in the Northwest. And when we started to want to get to know about global health, it was really PATH that we turned to.”

Melinda went on to describe a couple examples of the work we and our partners have engaged in recently: the development and delivery of an affordable vaccine against meningitis A, which has protected 100 million children and young adults so far, and community-based training for families in India on how to care for their babies so that they survive and thrive, which has reached more than 24 million people.

My topic? Diarrhea.

I’ll admit it doesn’t sound like the most promising premise for our annual fundraising breakfast, where our supporters unstintingly provide us with the funding that is critical to the success of our work. But I’m sure they—and perhaps that includes you—were not put off by the message. In fact, I’m betting you were inspired, as I was.

So no child perishes

In addition to Melinda and two of our unstoppable board members, Phyllis Campbell and Dean Allen, this morning I shared the stage with Dr. Alfred Ochola, who holds one of the most meaningful job titles I’ve ever seen: technical adviser for child survival and development in Kenya. Alfred leads an initiative to control diarrheal disease in the country’s Western Province. He told the story of Jane Wamalwa, who buried three of her children before PATH-trained community health workers helped her learn how to fight the diarrhea that killed them before their sixth birthdays.

Now Jane is a PATH-trained community health worker herself. Her deeply personal understanding of diarrhea’s consequences makes her a powerful ambassador for the tools and techniques that can save children’s lives.

And that brings me to the tool belt I wore this morning. Continue reading »

Posted in About PATH, Diarrheal disease, Featured posts, Maternal and child health, Meningitis, Pneumonia, Vaccines and immunization | Leave a comment

In the news: Angelina Jolie

Posted on May 17, 2013 by Claire Hudson

On Wednesday, actress Angelina Jolie wrote in The New York Times about her decision to undergo a preventive double mastectomy to lessen her chance of developing breast cancer. Jolie carries the BRCA1 gene, which sharply increases her risk for breast and ovarian cancer. Since then, her decision has been the subject of intense discussion, but few have noted her mention of testing and care for women in low-income countries, where noncommunicable diseases including cancer are a growing concern. Coincidentally, our director of noncommunicable diseases, Helen McGuire, addressed the subject on our blog on Wednesday.

At $1, this diarrhea vaccine paves way for social innovation

Forbes India, May 15, 2013

After nearly 25 years of work involving multi-institution, multicountry collaboration, India yesterday announced its first locally developed anti-diarrhea vaccine. Effective against a strain of rotavirus that causes severe diarrhea among children under five in India, this vaccine is one of the emerging examples which show how the world in general, and India in particular, needs a different model for developing new therapies. The old model of pharma companies deciding what and when to develop new drugs is crumbling.

Read the article.

Four main culprits found for serious childhood diarrhea

Nature, May 14, 2013

Just four pathogens underpin most cases of serious diarrhea in children—the second leading killer of young children worldwide—according to a study published today in The Lancet. Out of nearly 40 diarrhea-causing microbes, the researchers identified four primary culprits: rotavirus, Cryptosporidium, a toxic type of Escherichia coli, and Shigella. The winnowing of the list could allow health experts to design targeted health campaigns

Read the article.

Three women, wearing matching blue vests and nametags, link arms and smile for the camera. Photo: PATH/Tara Hayes Constant.

Peruvian health promotoras educate women about breast cancer. Photo: PATH/Tara Hayes Constant.

My medical choice

The New York Times, May 14, 2013

My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was. We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.

Read the article. Continue reading »

Posted in Cervical cancer, Diarrheal disease, Featured posts, Noncommunicable disease, Vaccines and immunization | Leave a comment

Catching noncommunicable diseases

Posted on May 15, 2013 by Kathleen Donnelly

Helen McGuire, our first director of noncommunicable diseases. Photo: PATH.

The fact that noncommunicable diseases like diabetes and cancer are a problem in low-income countries still surprises some people, says Helen McGuire. After all, work in global health has understandably been most sharply focused on the communicable side of things—HIV, malaria, diarrheal diseases, and other deadly maladies that spread from person to person.

But, says Helen, who recently joined PATH as our first director of noncommunicable diseases, epidemiological evidence has been building for years that shows noncommunicable diseases are a serious and growing problem in poorer countries, just as they are in wealthier ones. In fact, she says, the global burden of disease attributed to noncommunicable diseases is greater than that attributed to communicable diseases and injuries combined. The question now is how to address what Helen calls the “double burden of disease”: the communicable diseases we must continue to fight and the burgeoning problem of chronic diseases.

On May 29, Helen will join a panel discussion on the subject at Women Deliver, an international conference focused on improving the health and well-being of girls and women. We asked her to give us a preview.

Which noncommunicable diseases are problems in low-resource settings?

The World Health Organization (WHO) has focused on cancer, diabetes, cardiovascular disease, and chronic lung diseases. In fact, WHO hopes to confirm the action plan to monitor progress against these diseases at the World Health Assembly next week. One of the reasons they’ve focused on these four is their impact on development and their common risk factors: physical inactivity, use of alcohol, unhealthy eating, and smoking. So when we look at prevention initiatives, we can have a greater impact by grouping these four diseases together.

A woman with her arms around a young girl and an adolescent girl.

The Women Deliver conference focuses on the well-being of women and girls. There, PATH’s Helen McGuire will discuss integrating noncommunicable diseases into existing health care for women. Photo: PATH/David Jacobs.

Can you use the same kind of interventions to prevent or manage these diseases?

Prevention and management are two different things. Certainly for prevention, by addressing physical inactivity, alcohol use, unhealthy eating, and smoking, you potentially will have impact on those four noncommunicable diseases. But when we get to long-term disease management, because we have limited funding, we need to be especially creative. We need to think about how we can use the great work that’s been done in areas like HIV, tuberculosis, and maternal and child health, and ask ourselves: how can we leverage those care platforms to advance available and accessible care for people with noncommunicable diseases? Continue reading »

Posted in Featured posts, Maternal and child health, Noncommunicable disease | Leave a comment

Dr. Alfred Ochola: so no child perishes

Posted on May 13, 2013 by Lesley Reed

Dr. Alfred Ochola will speak about his work to save children’s lives in Kenya at PATH’s Breakfast for Global Health on May 21. The Breakfast is an annual event in our headquarters city of Seattle, Washington, that raises funds for some of our most innovative work.

Smiling man dances while surrounded by a line of dancing men and women.

Dr. Alfred Ochola will speak at PATH’s annual Breakfast for Global Health. Photo: PATH/Eric Becker.

“Hello? Are we together?” Dr. Alfred Ochola, PATH’s technical advisor for child survival and development in Kenya, stands in the center of a circle of public officials, health workers, and community members gathered in a grassy field. In hearty call-and-response form, the crowd answers him: “Yes!”

Alfred, who leads our work in Kenya to control diarrheal disease, malaria, and other childhood illnesses, has been talking about one of the country’s most stubborn killers. He’s so passionate about the topic that he is often introduced as “Dr. Stop Diarrhea.”

It’s hard to imagine that he almost missed his life’s calling.

Finding a life’s mission

As a college student in Nakuru, Kenya, Alfred was a standout athlete who played basketball, soccer, and volleyball. Military officials recruited him after watching him at several sporting matches. Alfred had already begun his studies in medicine, but he accepted, impressed by all the army was willing to offer him.

During the second week of boot camp, Alfred’s father paid him a visit. “I have other sons who should join the army, but not you,” his father told him. “Your heart is with the patients and that is where you belong.” Continue reading »

Posted in Diarrheal disease, Featured posts, Malaria, Maternal and child health, PATH personalities, Water | Leave a comment

In the news: a vaccine pioneer

Posted on May 10, 2013 by Claire Hudson

Fifty years ago this spring, five-year-old Jeryl Lynn Hilleman woke up with the mumps. Her father, a scientist at a pharmaceutical company, took a sample from the back of her throat that eventually led to the development of a vaccine that makes mumps a disease of the past among the immunized. In The New York Times this week, Richard Conniff remembers Maurice R. Hilleman, who during a long career devised or improved some 25 vaccines and thus, other researchers say, saved more lives than any other scientist of the 20th century.

A health worker prepares for vaccination using the measles, mumps, rubella vaccine. Photo: PATH.

At a defining moment in the fight to end malaria

Huffington Post, May 3, 2013

Last week, as the world commemorated the sixth annual World Malaria Day, I was struck by the tremendous progress we have made against this disease—progress that, at the outset, many would have thought impossible. Malaria mortality rates in Africa have decreased by one-third, and more than one million lives have been saved over the last decade. Amazingly, we are now in a place few of us could have imagined: eliminating malaria in Africa is a real possibility.

Read the article.

Measuring to improve vs. improving measurement

Stanford Social Innovation Review, May 7, 2013

Measurement was once again a hot topic at this year’s Skoll Forum; with seven measurement-related sessions over three days, it eclipsed other perennially popular topics like funding and innovation. And yet there was a marked difference in the discourse this year, with many speakers and attendees questioning whether social-sector organizations are thinking too narrowly about the whole paradigm of measurement. Put another way, there seemed a real tension between whether the greatest bang for the buck in measurement will come from organizations measuring for their own improvement, or from the social sector improving on the measurement tools and techniques available to organizations in the first place.

Read the article.

A forgotten pioneer of vaccines

The New York Times, May 6, 2013

The name Maurice Hilleman may not ring a bell. But today 95 percent of American children receive the MMR—the vaccine for measles, mumps and rubella that Dr. Hilleman invented, starting with the mumps strain he collected…from his daughter. It was by no means his only contribution. At Dr. Hilleman’s death in 2005, other researchers credited him with having saved more lives than any other scientist in the 20th century. Over his career, he devised or substantially improved more than 25 vaccines, including 9 of the 14 now routinely recommended for children.

Read the article.

Posted in Malaria, Vaccines and immunization | Leave a comment

Technologies to keep mothers safe

Posted on May 8, 2013 by Kathleen Donnelly

This Sunday—Mother’s Day in the United States—will be a day of light hearts and laughter for many. At PATH, we’re dedicated to developing simple, affordable technology to make sure becoming a mother is a time of joy the world over.

Two smiling women pose for the camera, one wearing a bright pink headscarf.

Elizabeth Abu-Haydar, right, with a mother in a prenatal clinic in Rajasthan, India. Photo: PATH/Noah Perin.

In some parts of the world—notably sub-Saharan Africa—childbirth remains an extremely dangerous time in a woman’s life. Some 300,000 women worldwide die each year just before or after delivery. Excessive obstetric bleeding—postpartum hemorrhage—causes 1 in 4 of these deaths. And mothers who survive aren’t out of danger. Those who live through severe postpartum hemorrhage are significantly more likely than other mothers to die within a year’s time, leaving their babies and families alone.

Elizabeth Abu-Haydar, a public health specialist with our Technology Solutions program, looks for ways technology can make childbirth safer. On May 28, she’ll be presenting her work at Women Deliver, an international conference focused on improving the health and well-being of girls and women. To celebrate Mother’s Day, we asked Elizabeth about some of the technologies that hold promise for making childbirth safer.

What will you talk about at Women Deliver?

I’m going to highlight some of the technologies we’re working on to fill a gap that occurs when women experience severe postpartum hemorrhage. There’s a clear protocol that’s followed when a woman starts bleeding after delivery: She’s given medication and her abdomen is massaged, and in 62 percent of the cases, that works to stop the bleeding. But in those other roughly 40 percent of cases, the woman could potentially continue bleeding—and if she’s bleeding severely, even a healthy woman can die within two hours. Most of these women are not as healthy as they could be, and the biggest problem is that many of them are anemic.

Click to enlarge images.

Why does anemia make the problem worse?

These women have low iron stores, and the body during pregnancy requires more iron. If a woman starts bleeding and she doesn’t have iron stores, she’s likely to go into heart failure and shock much more rapidly than a woman who is healthy. In sub-Saharan Africa, where 40 to 50 percent of the women are anemic, that’s a huge problem.

What can we do about it?

We’ve been testing a device that makes it very easy to assess whether a woman is iron deficient or not. We call it a noninvasive anemia screening device. The device measures iron levels using a clip that attaches to the woman’s finger. Ideally, you would use it every time she comes in for her prenatal visit. If there’s a problem, you can start treatment and monitoring. The screening doesn’t require blood, it gives a reading in less than a minute, it doesn’t hurt, and it’s visual, so that it becomes a way to talk about iron with the woman. Plus, there are no sharps and no waste and no resupply issues either, which is a big, big deal. Continue reading »

Posted in Featured posts, Health technologies, Maternal and child health | Leave a comment

In the news: defining poverty

Posted on May 3, 2013 by Claire Hudson

At what level of daily income are people no longer living in poverty? Charles Kenny, a fellow at the Center for Global Development and the New America Foundation, took on that question this week in Businessweek. Right now, extreme poverty is defined as living on $1.25 a day or less, while poverty logs in at $2 a day or less. Both are too low, Kenny argues. You can find a link to his piece below.

Two doses of HPV vaccine may be as good as three

NBC News, April 30, 2013

Girl looks at camera while a needle is inserted into her arm.

A girl receives HPV vaccine in Uganda. Photo: PATH/Robin Biellik.

Two doses of the vaccine against human papilloma virus (HPV) may work just as well as the recommended three doses in protecting against infection, a new study from Canada suggests.

In the study, girls who received two doses of the HPV vaccine had just as good of an immune response to the vaccine as women who received three doses, even three years after vaccination. In studies of women, the HPV vaccine reduces the risk of developing early signs of cervical cancer and genital warts. At this time, women and girls should still get the recommended three doses over six months, because it’s too early to know the long-term results of getting only two, experts say.

Read the article.

“Cured of AIDS”? Not yet

The New York Times, April 29, 2013

What to make of all the recent “cured of AIDS” headlines? An American in Berlin, a baby in Mississippi, and 14 patients in France are all alive without treatment. Is a cure at hand?

No. But in unusual cases, some people seem able, with temporary help from antiretroviral drugs, to kill the virus before it can sink into reservoirs deep in their bodies—or to at least force it to stand at the doorways of their cells, unable to get in.

Read the article.

Why ending extreme poverty isn’t good enough

Businessweek, April 28, 2013

At this year’s spring meetings of the World Bank and IMF [International Monetary Fund], the world’s global finance ministers signed up to an ambitious target for progress against poverty. “We believe that we have a historic opportunity to end extreme poverty within a generation,” they declared, pledging to reduce the percentage of people living on less than $1.25 a day worldwide to 3 percent by 2030.

That would be a huge achievement. After all, for most of history, most of humanity has lived on less than $1.25 a day. As recently as 1990, more than two-fifths of the population of the developing world lived in extreme poverty, and even today, the proportion remains close to one-fifth. Yet even lifting all the world’s poor above the $1.25-a-day line would hardly constitute victory in the war against extreme poverty. If anything, we need to get a lot more ambitious.

Read the article.

A new life for a deadly disease

The New Yorker, April 25, 2013

You can hear it before you see it. Most of the time, it starts with a wracking cough. Damage to the lungs advances; if infection enters the bloodstream, it may spread throughout the body. Then the patient grows weak, and as the infection advances, the body seems to melt away. When the end comes, as it does for more than a million each year, death arrives like a train wreck of blood and phlegm and spit. It used to be called “consumption,” or “the White Death.” Don’t think of Camille, lounging in soft focus whilst romantically fading away. Tuberculosis is a ferocious killer.

Read the article.

Posted in Cervical cancer, HIV/AIDS, Tuberculosis, Vaccines and immunization | Leave a comment

How to manage menstruation

Posted on April 30, 2013 by Kathleen Donnelly

For women the world over, it’s a monthly fact of life as common as a quarter moon. And yet for many, it’s incredibly difficult to discuss.

“Because menstruation is a taboo subject in most cultures, women’s menstrual management needs are often overlooked by health programs and policies,” explains Nancy Muller, who works with our Technology Solutions Global Program. “We simply don’t have enough information on how women and girls in developing countries manage their menstruation to know how to accommodate their needs.”

Cameras break the silence

Muller and her team have been working with women in three South African communities to remedy that situation. They’re gathering information that could help women manage their menstrual periods more effectively while also improving the sanitation systems they use. To encourage the women to open up about a deeply personal subject, the team used the Photovoice research method, giving women disposable cameras and asking them to photograph how they manage their periods.

After using their cameras, the women spoke with the researchers about the images they captured—and about how they manage menstruation. You can see a selection of their photographs, accompanied by some of their comments, below.

Click to enlarge images.

A private matter in a public place

Menstruation must come out from behind closed doors in part due to urban women’s increased access to disposable sanitary pads. While convenient and comfortable, the pads can contribute to waste management problems and cause blockages in sanitation systems. But in order to design systems that meet women’s needs better, it’s important to know how women are using the systems and menstrual hygiene supplies they’ve got now. Continue reading »

Posted in Featured posts, Maternal and child health, Water | Leave a comment

In the news: World Malaria Day

Posted on April 26, 2013 by Claire Hudson

Small girl in white dress and sandals drags a blue, rectangular package along the ground.

A young girl drags a packaged bednet, one tool against malaria. Photo: PATH/Gena Morgan.

To mark World Malaria Day yesterday, Dr. David Kaslow, director of the PATH Malaria Vaccine Initiative, posed an optimistic question: what’s the role of malaria vaccines in the ongoing effort to eliminate the disease? Optimistic, because until recently, the answer was depressingly simple: none. Now, David argues in an article for The Guardian’s malaria and infectious diseases hub, malaria vaccines have progressed far enough that we should consider their future place among other tools to end malaria. Here’s a link to his thoughts, and other items in a week packed with global health news.

Malaria vaccine development: no longer a pipe dream?

The Guardian, April 24, 2013

Saturday, last week, marked the beginning of World Immunization Week, and Thursday is World Malaria Day. It seems a fitting time to consider these two occasions by posing a seemingly simple, but in fact quite complex, question: what is the role for malaria vaccines in the ongoing effort to turn the tide against malaria, an ancient scourge, and ultimately to eradicate this wily parasite?

Read the article.

The bird flu has spread beyond China and it’s “one of the most lethal” ever

The Atlantic, April 24, 2013

The new strain of bird flu infecting and killing people in China is on the move. All of the reported cases had been contained to a relative few hotspots, but the first reported case of a human infection outside mainland China arrived Wednesday, and that’s got the world’s top scientists pretty worried about this H7N9 strain—even if it’s not being transmitted from person to person.

Read the article.

Posted in Influenza, Malaria, Maternal and child health | Leave a comment