Monday, December 29, 2008

Midwifery in Mozambique

From YouTube: "Original PBS airdate: Tuesday, July 15, 2008. Sub-Saharan Africa is the world's deadliest place to give birth. Each year over a quarter of a million women die in childbirth in the region. But Mozambique is combating high maternal death rates by implementing unconventional programs. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. The film "Birth of a Surgeon" follows Emilia Cumbane, one of the first midwives-in-training. She performs cesareans and hysterectomies in makeshift operating rooms in rural Mozambique. The film captures one woman's story on the frontlines of improving maternal mortality but it also demonstrates how low-cost, community-based health initiatives are changing the face of public health in Africa."

My thoughts: I would really like to see the whole film, but the PBS site doesn't load very well. A good point is brought up about midwifery: in the United States it would be unthinkable to have anyone but a doctor perform a surgery of any kind. But in Africa, the ratio of doctors to people doesn't allow for such strict ideas about medical care. I'm not sure what the number is now, but at one point while I was in Mozambique, there were around 500 doctors in the entire country, to serve a population of 10 million people. And of course most of the doctors were centered in Maputo or Beira. So to say that only doctors should be able to perform cesarean sections doesn't seem as reasonable.

It would seem part of the solution would be to train more doctors- however, a medical degree is expensive and prestigious and how likely would it be that once a Mozambican became a doctor they would choose to live and serve in a rural area? They would almost have to work in Maputo just to pay for their education. It actually makes a lot of sense to train midwives to perform cesarean sections. There are more midwives in the country, they already know a lot about childbirth and they are likely to stay in their communities once they are trained.

Sunday, December 7, 2008

Homemade Footballs

This video is really funny. In Mozambique, I always saw kids playing with homemade footballs. I think usually they were just made out of old plastic bags; there wasn't actually an excess of condoms in Monapo. But I imagine in Southern Mozambique, closer to Maputo, this could be a viable option for improved footballs. Enjoy:

This South African advertisement has a different take on homemade balls. (Click to englarge and read) This special plastic bag was an insert in a South African newspaper. It was used to bring to light that many youth in SA use plastic bags instead of actual footballs.

But the advertisement presents this fact as shameful. It never really occurred to me to say shame when I saw kids in Mozambique making their own toys. Besides balls, they could make kites, toys cars, they played games with bottle caps. I felt like they were much more creative and crafty than American kids.

But the advertisement points out that children with real athletic talent may never have the opportunity to become stars because they will never play the game with a real ball, with shoes, on a field with grass. Different sets of eyes can find different symbolism in the same image.

Saturday, December 6, 2008


I just finished up a group project concerning FGC in Mali. I feel like, since starting school, I've made a 90 degree change in my attitude about how FGC should be dealt with. Upon hearing about FGC, most Western women are usually outraged that this happens at all. Most feel immediate eradication is imperative, without exception.

But with that outrage we bring a lot of cultural baggage. For example: many of us think that loss of sexual pleasure would be devastating, we see FGC as violence against women driven mainly by men, we see it as mutilation. But we don't see that, for African women, loss of orgasm isn't nearly as devastating as never marrying or social ostracism, or that mothers and grandmothers (not men) do this to their daughters because they love them, or that some cultures might see certain Western norms, such as plastic surgery, as mutilation. Look at how the WHO presents FGC in it's latest document. A weeping women. Insisting on using FGM. By using such emotion in the discourse, the WHO risks alienating the very women it seeks to protect. Are all circumcised women mutilated? If they don't see themselves as mutilated, what right does the WHO have to say they are?

This is an interesting video-clip, interviewing a traditional cutter in Ethiopia. She lays out the reasons why she believes FGC cannot stop. There seems to be a pervasive idea in countries that perform FGC that the clitoris is poisonous to infants and men. I wonder what these women think happens to Western infants? It is possible that they don't realize Western women aren't circumcised.

I don't want anyone to mistake my beliefs: I think FGC should end and that we should do everything to stop it. But we must be careful in how we approach such an ancient and complicated tradition. Slowly, slowly. The project I just finished wrote up a plan to teach hygiene, not even mentioning FGC. The idea is that slowly, communities will piece together germ theory, wounds, the wounds created by FGC, the fevers and infections experienced by young girls. Slowly, one day, they will realize FGC is not more hygienic. It is not mandated by Islam, it does not increase anyone's pleasure. The clitoris is not poisonous. Slowly, slowly.

Tuesday, December 2, 2008

Maisha iko sawa na Trust

A Trust condom ad from's worth watching!