by Harry Strulovici

Created on: May 26, 2010   Last Updated: June 21, 2010

Recent editorials to address maternal/neonatal/infant health are crucial to increase awareness of the ongoing tragedy taking place in Uganda and throughout the developing world. The problem is multifactorial and involves not only the social determinants of health, including women's empowerment, poverty, gender inequality and gender-based violence, but also other factors like culture and education. Lastly, reducing the number of deaths will require political will and good governance. Unfortunately, taking the first few steps has had minimal impact, therefore, only a holistic approach will deliver the massive reduction of maternity mortality called for by Millennium Goal # 5. (75% reduction of maternal deaths by 2015.)

            Uganda has one of the highest fertility rates in the world with almost 7 births during reproductive age. Ninety percent of the population is rural and services are almost non-existent. Each time a woman becomes pregnant, her life is at risk of developing obstetric fistula, post-partum hemorrhage, or other life-threatening complications. These women are not merely numbers; these are women and children who had dreams and hopes for themselves and their families.
           In 2007, as a Johnson & Johnson/Yale Career Scholar in International Health, I was sent to Kampala, Uganda, to help repair women with obstetric fistulae. I was lucky to be present when Dr. Tom Raassen, a Dutch general surgeon based in Nairobi, was in Kampala to train physicians to repair these women. During that week, the team repaired almost 50 women from ages 16 to 60. Some had been raped and became HIV positive, and most were poor, illiterate farmers who had been ostracized by their community and family. Many became severely depressed and even suicidal. We worked in marginal conditions, with intermittent electricity; materials were scarce. As a surgeon who exclusively specialized in this repair, Dr. Raassen explained that "the longer you wait for the operation, the more chance that the woman will be divorced or ostracized and become an outcast. Because their husband may throw 50-60% of women out of their homes, early treatment is necessary to eliminate this calamity. Around 15% of all cases can be solved without surgery if caught in time."
          During my time in Uganda, I witnessed the three classic delays that

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