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Nigeria: Talking about mothers
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neither of whom sought a judicial review of the Cartwright report when it was released. The Council has stayed the charges against Green because of ill health, although they will probably never be withdrawn. The charges against Bonham, who has also been ill, will be heard on October 1. Dr Bruce Faris (part-time visiting specialist to National Women’s Hospital) and Prof David Seddon (Professor of Obstetrics and Gynaecology, University of Otago Medical School, and President of the New Zealand College of Obstetricians and Gynaecologists) face lesser charges of professional misconduct arising out of the same
investigation. A
correspondent
1. Anon. New Zealand: recall of women with untreated cervical abnormalities. Lancet 1989; i: 608-09. 2. Committee of Inquiry into Allegations Concerning the Treatment of Cervical Cancer at National Women’s Hospital and into Other Related Matters. Report of the cervical cancer inquiry. Auckland: Government Printing Office, 1988. 3. Green GH. Cervical carcinoma in situ. Aust NZ J Obstet Gynaecol 1970; 10: 41-48. 4. McIndoe WA, McLean MR, Jones RW, Mullins PR. The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol 1984; 64: 451-58.
Nigeria: Talking
about mothers
Nigerian women have a 1 in 21 chance of dying in pregnancy or childbirth. The large number of maternal deaths was noted by General Ibrahim Babangida, President of the Republic, when he met a delegation from the Society of Gynaecology and Obstetrics of Nigeria (SOGON) in Lagos recently. He called for a massive enlightenment campaign and confirmed his interest in the possible setting up of a national institute of maternal health. To bring the nation’s attention to the problems of maternal mortality and morbidity SOGON has held several regional safe motherhood workshops in various parts of the country in recent months, in preparation for the international Safe Motherhood conference in September. Prof Wilfred Chukudebelu, president of SOGON, has pointed out that since the Nigerian situation seems to be worse than that in most developing countries, there is something that is not being done right in Nigeria. Operational research projects are being conducted in various parts of the country to assess possible corrective measures. Recent data have shown a drastic decline in hospital births in most university teaching hospitals throughout the country, accompanied by an increase in the incidence of maternal deaths in the hospitals. For example, at Ahmadu Bello University (ABU) Teaching Hospital, Zaria, the number of obstetric admissions declined from 7450 in 1983 to 5437 in 1985, and to 3376 in 1988, whereas the maternal deaths in the hospital increased by 56% between 1985 and 1988. Some researchers have attributed such changes to a delay in the decision to use the hospital services because of new or increased hospital fees. Hospital workers traditionally highlight the culture and traditional factors that make women reluctant to use their services. Recently, there has been an increasing number of complaints about deterioration of the hospital services due to lack of funding. But, as the Minister of Health, Prof Olikoye Ransome-Kuti, pointed out earlier in the year, achievement of the aims of primary health care is not handicapped by funds alone. More disturbing, he noted, is
the attitude of the doctors. Recent "focus groups" studies in some rural communities have shown that the people there feel that the modern health services are often too far off, too alien, and too costly (made worse by the need to tip), and that the staff-young pompous doctors and rude midwives-are too unapproachable. The long waiting time at clinics, compared with that in urban areas, is another criticism. Although most rural women either do not voice their concerns or accept the complications of childbirth as one of the unavoidable penalties of womanhood, some women’s organisations are becoming increasingly active in highlighting the plight of rural mothers. For instance, to cope with the high prevalence of obstetric (vesico-vaginal) fistulae and the long waiting lists for treatment, many have mobilised resources to build theatres; wards, and hostels for the treatment of these fistulae; mobilising gynaecologists and surgeons to offer their services has, however, proved much more difficult. Meanwhile, traditional birth attendants are smarting under the accusation, from a professor of obstetrics, that they are part of a "dangerous system of health care". How, they ask, are they to cope with emergencies in the middle of the night when there is no transport and no hospital nearby to provide back-up? At a recent workshop on prevention of maternal mortality in Nigeria, Professor Lucas, chairman of the Carnegie Corporation’s programme for strengthening human resources in the developing countries, which has sponsored some of the important aspects of the safe motherhood research programmes in Africa, pointed out that the creation of multidisciplinary teams of researchers for the maternal mortality activities had been one of the goals of his programme. Some years ago social scientists and doctors were not talking to each other. Then they began to talk at each other, and gradually they are listening to and talking with each other. To prevent maternal deaths the need for the rural communities and the medical workers to talk to each other is just as great.
Farhang Tahzib
Conference IPPNW in
a
changing world
As the 5th European symposium of International Physicians for the Prevention of Nuclear War assembled in Coventry on Sept 13-16, reports were arriving of up to 450 nuclear weapons marshalled in the Persian Gulf aboard warships of the United States, Britain, France, and the Soviet Union. This response to Iraq’s annexation of Kuwait hung grimly over all the proceedings in Coventry and injected unforeseen urgency into the renewed words of peace and reconciliation evoked by the 50th anniversary of the German onslaught on the city from the air. The symposium, attended by over 400 people from 26 countries, had been planned, under the title Health and Security 2000: New Thinking in Europe, as a forum for IPPNW’s European affiliates to discuss their response to the rapid reformations in the fragmenting Communist union and to the almost unbelievable prospect of a world in which the United States and the Soviet Union were no longer in deadly confrontation. What was IPPNW to do now? Should it still be a campaign with the single purpose expressed in its title? Or should it expand and join, with many other organisations, in the defence of a planet
neither of whom sought a judicial review of the Cartwright report when it was released. The Council has stayed the charges against Green because of ill health, although they will probably never be withdrawn. The charges against Bonham, who has also been ill, will be heard on October 1. Dr Bruce Faris (part-time visiting specialist to National Women’s Hospital) and Prof David Seddon (Professor of Obstetrics and Gynaecology, University of Otago Medical School, and President of the New Zealand College of Obstetricians and Gynaecologists) face lesser charges of professional misconduct arising out of the same
investigation. A
correspondent
1. Anon. New Zealand: recall of women with untreated cervical abnormalities. Lancet 1989; i: 608-09. 2. Committee of Inquiry into Allegations Concerning the Treatment of Cervical Cancer at National Women’s Hospital and into Other Related Matters. Report of the cervical cancer inquiry. Auckland: Government Printing Office, 1988. 3. Green GH. Cervical carcinoma in situ. Aust NZ J Obstet Gynaecol 1970; 10: 41-48. 4. McIndoe WA, McLean MR, Jones RW, Mullins PR. The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol 1984; 64: 451-58.
Nigeria: Talking
about mothers
Nigerian women have a 1 in 21 chance of dying in pregnancy or childbirth. The large number of maternal deaths was noted by General Ibrahim Babangida, President of the Republic, when he met a delegation from the Society of Gynaecology and Obstetrics of Nigeria (SOGON) in Lagos recently. He called for a massive enlightenment campaign and confirmed his interest in the possible setting up of a national institute of maternal health. To bring the nation’s attention to the problems of maternal mortality and morbidity SOGON has held several regional safe motherhood workshops in various parts of the country in recent months, in preparation for the international Safe Motherhood conference in September. Prof Wilfred Chukudebelu, president of SOGON, has pointed out that since the Nigerian situation seems to be worse than that in most developing countries, there is something that is not being done right in Nigeria. Operational research projects are being conducted in various parts of the country to assess possible corrective measures. Recent data have shown a drastic decline in hospital births in most university teaching hospitals throughout the country, accompanied by an increase in the incidence of maternal deaths in the hospitals. For example, at Ahmadu Bello University (ABU) Teaching Hospital, Zaria, the number of obstetric admissions declined from 7450 in 1983 to 5437 in 1985, and to 3376 in 1988, whereas the maternal deaths in the hospital increased by 56% between 1985 and 1988. Some researchers have attributed such changes to a delay in the decision to use the hospital services because of new or increased hospital fees. Hospital workers traditionally highlight the culture and traditional factors that make women reluctant to use their services. Recently, there has been an increasing number of complaints about deterioration of the hospital services due to lack of funding. But, as the Minister of Health, Prof Olikoye Ransome-Kuti, pointed out earlier in the year, achievement of the aims of primary health care is not handicapped by funds alone. More disturbing, he noted, is
the attitude of the doctors. Recent "focus groups" studies in some rural communities have shown that the people there feel that the modern health services are often too far off, too alien, and too costly (made worse by the need to tip), and that the staff-young pompous doctors and rude midwives-are too unapproachable. The long waiting time at clinics, compared with that in urban areas, is another criticism. Although most rural women either do not voice their concerns or accept the complications of childbirth as one of the unavoidable penalties of womanhood, some women’s organisations are becoming increasingly active in highlighting the plight of rural mothers. For instance, to cope with the high prevalence of obstetric (vesico-vaginal) fistulae and the long waiting lists for treatment, many have mobilised resources to build theatres; wards, and hostels for the treatment of these fistulae; mobilising gynaecologists and surgeons to offer their services has, however, proved much more difficult. Meanwhile, traditional birth attendants are smarting under the accusation, from a professor of obstetrics, that they are part of a "dangerous system of health care". How, they ask, are they to cope with emergencies in the middle of the night when there is no transport and no hospital nearby to provide back-up? At a recent workshop on prevention of maternal mortality in Nigeria, Professor Lucas, chairman of the Carnegie Corporation’s programme for strengthening human resources in the developing countries, which has sponsored some of the important aspects of the safe motherhood research programmes in Africa, pointed out that the creation of multidisciplinary teams of researchers for the maternal mortality activities had been one of the goals of his programme. Some years ago social scientists and doctors were not talking to each other. Then they began to talk at each other, and gradually they are listening to and talking with each other. To prevent maternal deaths the need for the rural communities and the medical workers to talk to each other is just as great.
Farhang Tahzib
Conference IPPNW in
a
changing world
As the 5th European symposium of International Physicians for the Prevention of Nuclear War assembled in Coventry on Sept 13-16, reports were arriving of up to 450 nuclear weapons marshalled in the Persian Gulf aboard warships of the United States, Britain, France, and the Soviet Union. This response to Iraq’s annexation of Kuwait hung grimly over all the proceedings in Coventry and injected unforeseen urgency into the renewed words of peace and reconciliation evoked by the 50th anniversary of the German onslaught on the city from the air. The symposium, attended by over 400 people from 26 countries, had been planned, under the title Health and Security 2000: New Thinking in Europe, as a forum for IPPNW’s European affiliates to discuss their response to the rapid reformations in the fragmenting Communist union and to the almost unbelievable prospect of a world in which the United States and the Soviet Union were no longer in deadly confrontation. What was IPPNW to do now? Should it still be a campaign with the single purpose expressed in its title? Or should it expand and join, with many other organisations, in the defence of a planet