I have the immense privilege to stand before you, just one doctoramong so many in Africa who try in the course of their dailypractice to save lives.
I am here because I was filmed by the BBC doing my regularwork as an obstetrician in a developing country - in my country,Chad. The documentary shows two realities. One is the reality ofthe conditions in which we work to provide health care in manycountries in Africa. The second is the more urgent - it is thereality that too many women die in Chad, as they do throughoutAfrica, of pregnancy-related complications.
These complications - hemorrhage, eclampsia, infection,obstructed labor and abortion complications - occur in Europe'Land North American as well as in the developing world. However,a woman's chance of dying in Chad is 1 out of 11, while in theUnited Kingdom, for example, it is 1 out of 5,100, because Britishwomen have good obstetric care whenever they need it. This isthe tragic inequity between women living in poor versus richcountries.
My medical colleagues and I know exactly what to do to save ourpatients' lives. The necessary skills, equipment and supplies arenot technically sophisticated.
So, why do poor women die?
Poor women in Africa die because the services they need to savetheir lives are too few and too far away. Even when women doget to a hospital, the services are too often of poor quality - drugsand supplies are not available, equipment is missing or broken,and staff are not adequately trained and supported. In short, thehealth system does not function as it must to save lives.
The health system can, however, be improved, withimmediate results.
I witnessed this in my hospital in Chad where French Cooperationprovided supplies, allowing us to treat women immediately ratherthan waiting for their families to find money to buy supplies. Whilethis assistance was available, we were able to save lives in a waythat is not currently possible.
I have also seen health systems improved and women's livessaved in countries in Asia, Africa and Latin America where I workwith Columbia University's AMDD Program. An importantprinciple I learned and want to emphasize here is that theavailability of staff, drugs and equipment is insufficient inthemselves to improve systems and save lives. What is requiredis the combination of political will and adequate funds in additionto these technical improvements.
What more must be done?
The deaths of women and newborns are directly linked tounderdevelopment and extreme poverty. Reducing poverty anddeveloping infrastructure equitably are essential to saving lives.
Every partner has a role.
Governments must be accountable to their people.
They must give priority to women's and newborns' livesand design concrete, well-defined policies and programstrategies.
They must increase the number of health facilities thatoffer good quality emergency obstetric services, especiallyin rural areas.
They must pay health professionals reasonable salaries,on time, as well as provide them with an environment thatenables them to do their life-saving work.
Health professionals must be accountable to all the patientsthey serve.
I have come to understand that some health professionalsneglect women who are poor or otherwise marginalizedand we health professionals must combat this attitude byrecognizing that all women have the right to good qualityhealth care, no matter who they are and what theireconomic status may be.
The international community must be accountable to thedeveloping world.
They must increase the amount of money for aid in orderfor poorer countries to strengthen health systems.
They must support economic and political conditions, bothglobally and locally, that are prerequisite to strong nationaldevelopment.
I leave you with two questions which are critical for all of usto consider if we want to see serious change by 2015.
Is saving the lives of women and newborns really a priorityfor all governments?
Do women from poor countries really have the same rightto life and health as their sisters in rich countries?