Drastic Drop

The preliminary report of the Demographic Health Survey (DHS) for Zambia came out this week.  This report gives statistics from the last 6 years on all of the key health and education indicators: neonatal mortality, infant mortality, under 5yo mortality, and maternal mortality are the statistics that affect the organization with whom I’m working.

The maternal mortality rate for Zambia in 2002 was estimated to be 729 for 100,000 births. That’s huge. 1 in 19 – and compares to places like Sierra Leone and Afghanistan (who have the highest, I think - close to 2000/100,000).  Lots of money has been poured into Zambia - lots of programs – lots of trainings – and guess what? This Monday – preliminary findings say it is now 442 per 100,000. That’s almost a 300 point drop! Huge! Huge mongus. Amazing if it’s true. The question it begs – if it’s true – is what happened here? And how can it be replicated?

There is disbelief amongst the NGO community from what I gather. “That can’t be!” One well known (un-named) organization has already heard threats that they will lose major funding because of the less dire straights of Zambia.  “They need to check those numbers before they release the report. That’s CRAZY!”

So, is it true? It’s statistics only. But has something changed? I asked a Zambian doctor who works with the organization and she gave me a long and thoughtful answer in her lilting and lovely Zambian accent (A fairly geographical accent, I think – sort of a East Africa meets South Africa mix). I would have killed to have gotten her explanation on tape.

“I think it is” – she said.  I don’t know about numbers – but something drastic has changed here in the past five years. She told me that five years ago, after graduating from medical school and working in the crappy Zambian facilities for a few years – she and her husband up and moved to Botswana – where they have more resources and better facilities. “It was awful here.” She said. “The hospitals were terrible – the clinics were terrible. When you went into the field – all of the kids looked malnourished – with swollen bellies and light hair. But now? Only a few. We used to have admissions all the time for malnourishment – but now it’s rare. Things are a lot better.”

She paused.

“I think it has to do – in a strange way - with AIDS.  When the AIDS epidemic came here many people rushed here with lots of money, lots of programs, and lots of help for our Ministry.  In order to get out ARVs and do health education programs, they made the clinics better and taught the people that they needed a basic level of care.  The people now think that they deserve better – there is more of a demand.  People now think about ‘good health’ in  way that they didn’t used to talk about before.  And with ARVs, the people are stronger. Women are stronger and can give birth when they are not so weak.”

“When I returned last year from Botswana – it felt different.  It is getting better.  But sometimes I wonder – if South East Asia – and Latin America – and South Asia  - who are all in a similar economic position as Africa can get their mortality rates so low (Indeed – they hover around 50-100/100,000 women – about an eighth of Zambia) – why can’t Africa? Why can’t we?”

She concluded – “If we keep going at this pace, we will do it I think. We have far still to go – but I think we will make it.”

Wow-ee. What an exciting time to arrive. What a way to start a project in reducing maternal health. How positive. What a sense of promise.  The facilities really are changing here – there is a sense of possibility in the air – and it makes me excited to be here – and take this leap…

*Please note - the statistics on this page are a rough estimate. Exact numbers differ between sites. Luckily for me, I'm not writing a publishable paper right now - so I can be duly liberal with my numbers. Also, the theories posted in this are only that. Theories. Thoughts. Some interesting ideas.