I departed the US on October 3 and up until that date, was repeatedly required to explain the location and importance of Niger to anyone I could engage about my mission. Forty-eight hours later, when I arrived in Agadez, Niger had catapulted into American consciousness with the tragic loss of US special forces agents and Nigerien military, ambushed during routine reconnaissance maneuvers. Many questions about that mission remain unanswered. However, the success of our medical mission and its bright future are clear.
We set out with the goals of restocking our medical clinic while supporting our nurse, Rabi and training and resupplying our steadfast matrones. We were hoping to see some new faces among the matrones and were delighted to welcome four new participants.
Rabi staffs our general medical clinic and has steadily increased the number of patients she sees during her two years of employment. Tamesna clinic is private and therefore not reliant on the government for medications or supplies (an unpredictable and sometimes untrustworthy source). Patients are asked to make a donation for their care but no one is ever denied treatment due to a payment issue. Rabi was delighted to replenish her supply of US medications – their strength and purity is assured. We brought several suitcases of antibiotics, blood pressure medications, and various remedies donated by Direct Relief and Amani Hishme, an Ojai pharmacist. In addition, Pat and I had purchased a few medications we thought might be useful. The need always exceeds the supply but without our clinic, most nomads would have no care at all.
Matrone training was carried out over four days and was both fun and immensely productive. Given the language barrier, Pat and I try to depend more on simulations with facial expressions and vocalizations than long narratives. While we surely are amazing actresses, the nomads so outdid us! With each topic, we engaged matrones to work with each other, demonstrating for the group how they would handle various situations and they were superstars. Given that none of them reads or writes, they must commit all of the information we provide to memory, including identification of medications, their use and dosage. Each was quizzed individually and demonstrated a full understanding of her supplies. In the coming years, we plan to turn more of the basic training over to the experienced matrones while holding master classes to continue to expand the knowledge base of the senior women.
Our mission included a visit to the Centre de Sante Mere & enfant in Agadez, the hospital where nomads are transferred when they are critically ill or need cesarean delivery. The mortality rate for our transfers is extremely high and it was helpful to discuss this with the hospital staff. The time required to arrange transport is the single biggest barrier to better outcomes.
To decrease maternal and infant mortality among the nomads, our objectives remain the same: encourage prenatal care with treatment of anemia and prevention of malaria, give matrones the tools to prevent and treat post-partum hemorrhage, and help matrones identify preeclampsia to permit timely transfer to a hospital. At present, our statistics for post-partum hemorrhage are excellent – there have been no deaths due to post-partum hemorrhage since the matrone project’s inception. The most common killers are malaria and eclampsia. We are working hard to prevent malaria and help matrones identify preeclampsia in sufficient time for transfer to prevent eclampsia.
Upcoming projects include consideration of cataract surgery at our clinic and the expansion of the matrone training to a different region, Iferouane. In addition, we plan to move beyond the basics with our senior matrones educating them on the finer points of emergency response and giving them the tools to be successful teachers. The future of maternal health among Niger’s nomads is looking brighter and depends on these brave and wise women.
I am grateful to the many donors who have made my Nomad Foundation work possible, in particular, Ventura Global Health who provided travel support and my many friends and relations who support the matrone project in various ways from funding for medications, supplies, and vitamins to securing timely transport.
I believe every woman deserves the chance to have a safe, joyful childbirth with respectful care.
Building on the strong foundation laid by Dr. Skankey, we are continuing to take small steps
towards making this a reality for the most neglected population in one of the poorest countries
in the world. It is my sincere hope that we can continue this work.