"Save My Wife: (2): Prudence’s Struggle Ends

By NICHOLAS D. KRISTOF

YOKADOUMA, Cameroon: As Prudence Lemokouno lay on a hospital bed here, spitting blood, her breath coming in terrible rattles, it was obvious that what was killing her wasn’t so much complications in pregnancy as the casual disregard for women like her across much of the developing world.

Prudence's last hours (c) N. Kristof

Neither Western donor countries like the U.S. nor poor recipients like Cameroon care much about Africans who are poor, rural and female, and so half a million such women die each year around the world in pregnancy. It’s not biology that kills them so much as neglect.

I began Prudence’s story in my column last Sunday, and for a while I thought I would have a happy ending.

Prudence, 24, was from a small village and already had three small children. As she was in labor to deliver her fourth, an untrained midwife didn’t realize she had a cervical blockage and sat on Prudence’s stomach to force the baby out — but instead her uterus ruptured and the fetus died.

Prudence’s family carried her to the hospital on a motorcycle, but once she was there the doctor, Pascal Pipi, demanded $100 for a Caesarian to remove the fetus. The fetus was decomposing inside her, and an infection was raging in her abdomen — but her family had total savings of only $20, so she lay down in the maternity ward and began to die.

I arrived the next day, interviewed Dr. Pipi about maternal mortality — and found Prudence fading away in the next room. Dr. Pipi said she needed a blood transfusion before the operation could begin, so a Times colleague, Naka Nathaniel, and I donated blood (yes, the needles were sterile) and cash.

The transfusion helped Prudence, and she grew strong enough to reach out her hand and respond to people around her. Dr. Pipi said the operation would begin promptly, and Prudence’s family was ecstatic. But as we waited in the hospital lobby, Dr. Pipi sneaked out the back door of the hospital and went home for the night.

It wasn’t just the doctor who failed Prudence, but the entire system. He did operate the next morning, but by then the infection had spread further — and the hospital had no powerful antibiotics. Prudence’s breathing grew strained, as her stomach ballooned with the infection and the bag of urine from her catheter overflowed. The nurses couldn’t be bothered with a poor villager like her.

That night she began vomiting and spitting blood. She slipped into a coma, and a towel beside her head grew soggy with blood and vomit. On Tuesday afternoon, she finally passed away.

Intellectually, I knew that women in Africa had a 1-in-20 lifetime risk of dying in childbirth. But it was wrenching to see this young mother of three fade and die so needlessly.

There’s no doubt that if men were dying at this rate, poor and rich countries alike would make the issue a priority, but the problem seems invisible, like the victims.

The U.N. Population Fund has a maternal health program in some Cameroon hospitals that might have saved Prudence’s life, but it doesn’t operate in this region. And it’s difficult to expand, because President Bush has cut U.S. funding for the population fund — even for African programs — because of false allegations that it supports abortions in China.

That’s shameful. Two women have tried to recoup American honor by starting a group, 34 Million Friends of U.N.F.P.A., to make up the shortfall with private donations.

(I discuss some of the groups active in this area at nytimes.com/ontheground, and I’ll also have a link to video of Prudence.)

Neither left nor right has focused adequately on maternal health. And abortion politics have distracted all sides from what is really essential: a major aid campaign to improve midwifery, prenatal care and emergency obstetric services in poor countries. We know exactly how to save the lives of women like Prudence, partly because a few countries like Sri Lanka and Honduras have led the way in slashing maternal mortality.

Lynn Freedman, head of the Averting Maternal Death and Disability program at the Mailman School of Public Health at Columbia University, notes that we could provide all effective interventions for maternal and newborn health to 95 percent of the world’s population for an additional $9 billion per year.

Sure, that’s a lot. But think of Prudence and women like her dying in childbirth at a rate of one a minute — and after all, the world spends $40 billion a year on pet food.

Click here to watch a video of Prudence's final hours

Comments

[AngryMan]

I am royally pissed! It is in times like this that one is overwhelmed by helplessness, blinding rage, and deep anguish. the most frightening part of it all is that this happens EVERY DAY in that God forsaken country. It just happens that Mr. Kristof was in the neighborhood at the right time. I wonde rhow this doctor can sleep at night...

[kwensi]

Angry man,
It is ok to be pissed just make sure your anger is directed at the right target.
That is problem I have these days.. I don't know who to be mad at. In this particular case is it the government that fails the people by admitting people without the moral and intellectual fibre into medical school? Or the director who takes the bribe to admit unqualified candidate into CUSS? Ïs it the indignant American who bemoans his government's unwilling to help while failing to point out that the Cameroonian problem like that of Africa as whole stems from a merciless dictatorship propped up by the West including his own governmemt?

[international herald tribune]

Regarding "Prudence's struggle ends" by Nicholas Kristof (Views, Sept. 25): Twenty years ago in Douala, Cameroon, I witnessed the same kind of death that Kristof saw in Yokadouma - women and girls with obstructed labor and botched abortions left to die, the one doctor totally overwhelmed and without basic supplies.

Things are probably somewhat better in Douala today, especially for those with money, but not in Yokadouma or countless other places like it throughout sub-Saharan Africa, South Asia and impoverished parts of Latin America.

Kristof is right that the United States should do much more and could start immediately by restoring funding to the United Nations Population Fund.

Lasting change, however, requires that donors and recipient countries dramatically change their strategies, which means sustained investment in accessible primary care, strong systems to deliver supplies, trained and well-treated health professionals other than doctors, especially midwives, and a functioning referral system for higher levels of care.

Adrienne Germain, New York President, International Women's Health Coalition

http://www.iht.com/articles/2006/09/28/opinion/edlet.php