Rosie Scribble

The grim reality of childbirth in the developing world

Our hotel in Bertoua, in the Eastern region of Cameroon, was surprisingly comfortable given the rural location and the obvious poverty in the surrounding area. I was adapting to sleeping under a mosquito net, although the sound of mosquitoes hovering around the lake outside had me applying repellent in a slightly heavy-handed fashion.

Our first stop was the district hospital in the village of Nguelemendouka. There we viewed the facilities, including the storage room where the tetanus vaccines were kept in fridges to keep them at their required temperature. The District Medical Officer, Dr Wassep, discussed his work at the hospital and explained to us how outreach services took vaccines to villagers in the surrounding areas.

The last maternal and newborn tetanus campaign in the region, in February 2010, had proved successful with 81.5% of women of childbearing age now protected against a disease he explained was virtually impossible to treat. He last saw a case in 2008 – a three-week-old baby – but was unable to save him.

The hospital was very sparse, chronically under-resourced and we only saw a handful of patients during our visit. The remote location made travelling to the hospital by dirt track extremely difficult, and healthcare in Cameroon is not free, so patient numbers are determined by the ability to pay.

It was the delivery suite I found most disturbing: a hot, cramped room with no privacy, a sink with no running water and a metal bed with aggressive-looking metal stirrups. Women gave birth with no pain relief. If they wanted an anti-inflammatory post-delivery they had to pay. Those needing a C-section were given ketamin and nothing else. Again, this had to be paid for.

Giving birth at the district hospital cost US$6 – the equivalent of approximately £3.80 – and women had to bring their own equipment, including a razor blade, alcohol, blankets and a thread to tie the umbilical cord. For many women this is simply too expensive, so they are left with no choice but to give birth at home with no qualified professional on hand. It is unsurprising that the maternal death rate in Cameroon is 699 per 100,000 live births.

The unhygienic conditions in which so many women give birth and the high risk of infection highlight the importance of women and babies being vaccinated against tetanus. As many women have as many as ten children during their lifetime, the need is greater still.

As I left the hospital alarmed at what I had seen, I could think of no worse place to give birth. It also occurred to me that had I given birth to my daughter in an environment with no oxygen and resuscitation facilities, it is unlikely she would have survived.

The Pampers and UNICEF campaign runs from October to December. For every pack of Pampers products purchased with the “I pack = 1 life-saving vaccine” logo, Pampers will donate the cost of one tetanus vaccine to UNICEF. Additionally, by visiting the Pampers Village website and clicking on the Big Kiss button, a 'virtual kiss' will be sent to Pampers and UNICEF. For every 'virtual kiss' sent. Pampers will make an additional donation to UNICEF.

A first glimpse of Africa

Waking up in a hotel room in West Africa to find myself entangled in a mosquito net was a slightly surreal experience. We had arrived in Yaoundé at 4am to a city in darkness, so finding my bearings was difficult and I was looking forward to seeing Cameroon in daylight for the very first time.

Our day began with a meeting at the UNICEF Cameroon office where we were warmly welcomed by the team, some of whom would be spending the next few days with us as we travelled around the area. From my brief glimpse at the surrounding scenery, the rich red African soil, the constant beeping of car horns, the bright yellow taxis and a city buzzing with people, it was like nothing I had experienced before and I was keen to see more.

The UNICEF Cameroon team briefed us about their country and gave us some essential security information along with facts about the Eastern region where we would be spending the majority of our time.

All our journeys would be made in a convoy of 4x4 UNICEF vehicles fitted with radio communications and we could only travel between the hours of 6 am and 6p m to areas given prior security clearance by the UN. Any signs of political instability in areas of Cameroon bordering Chad and the Central African Republic would necessitate an armed escort. This is the reality of travelling to certain parts of Africa.

The statistics presented to us about infant and maternal mortality rates in Cameroon made depressing reading. Since 2002 however, with the support of partners and UNICEF, the Cameroon Government has been working towards a long-term plan for the elimination of maternal and newborn tetanus campaigns through the implementation of vaccination campaigns targeting women aged 15-49 years in 102 high risk health districts out of the 174 in the country, to try and reduce the number of deaths from the disease and help lower the country’s infant and maternal mortality rates.

Huge progress has been made since 2002 and during our trip, it was evident that support from the Pampers and UNICEF partnership was proving effective in helping the country work towards the goal of eliminating the disease*.

• Life expectancy at birth is 51 years
• The under-five mortality rate (probability of dying between birth and five years of age) is 144 per 1000 live births, compared with 6 per 1000 live births in the UK
• The infant mortality rate (probability of dying between birth and one year of age) is 74 per 1000 live births, compared with 5 per 1000 live births in the UK
• The maternal mortality rate is 669 per 100,000 live births, compared with 8 per 100,000 live births in the UK
• 77% of newborns are now protected again tetanus
• Pampers has donated over $1 million to help support the elimination of MNT in Cameroon and contributed over half the funding received for the MNT elimination programme in Cameroon since 2008

From Yaoundé we took a four-hour drive to Bertoua in the Eastern region and I was able to see Africa properly for the first time. I was struck by the obvious poverty as the larger buildings of the urban centre made way for mile upon mile of very basic mud huts.

Groups of children could be seen playing outside in the soil. Many others could be seen selling their wares at the roadside or walking the long distances from the surrounding farms to their homes with essential food supplies for their families.

I had witnessed nothing like it before. The most basic mud huts had no running water, no electricity, poor sanitation and no refrigeration and were typically home to very large families, the majority of whom were children. This is a young country. We would see very few people aged over 50 during our trip. Yet these children are living in conditions which would be considered completely unacceptable in the developed world. In Cameroon alone, 33% of the population live below the International Poverty Line of $1.25 a day *.

It is a sobering experience and a world away from life with my daughter in the UK. The following day I would get the rare opportunity to travel to some of the remotest parts of Cameroon, to meet the villagers who live in conditions like these, to sit in their homes and find out firsthand what life is really like for them. I would see the conditions in which women give birth and why being vaccinated against tetanus really is a matter of life and death.

*UNICEF Cameroon statistics

A straightforward journey that was anything but

Prior to our trip, the Pampers and UNICEF team heading off to Cameroon had met only once for a briefing meeting about our field trip. As we began our journey to Africa, we quickly discovered that the best way of getting to know a group of people you have only just met is to experience a stressful situation together and live to tell the tale. That was the situation we found ourselves in minutes after taking off from Paris-Charles de Gaulle airport, travelling at 400 mph, at around 20,000 feet.

We were still gaining height when the alarms sounded signalling a problem with the aircraft. Minutes later the pilot made an announcement, only part of which I could understand, but it contained, without doubt, the word ‘fire’.  It is really not a word you want to hear under such circumstances. As I looked out of the window I could see what appeared to be smoke billowing out of the left wing and I was engulfed with the overwhelming disappointment that, after all the excitement, we would never make it to Cameroon.

For what felt like an eternity, but can only have been about three minutes, I was acutely aware of our distance from the ground and my urgent need to be anywhere in the world apart from on board a plane. We were then informed, a little reassuringly, that it was not smoke we were seeing but fuel. The pilot was dumping his fuel to make an emergency landing back in Paris.

He landed the plane minutes later to a round of applause and we were greeted on the tarmac by a team of fire engines. Never in my life had I been more relieved to step off an aeroplane. I made a mental note of the plane’s serial number and made the decision never to get back on that particular plane. In fact, for about half an hour I wasn’t certain I was prepared to get back on any plane.

The ten-hour delay in Paris which followed gave me a chance to relax and calmed my nerves. The rest of the group did not seem overly anxious so I took my cue from them and decided to continue, more determined than ever that I would make it to Cameroon.

The delay provided the perfect opportunity to catch up on some sleep and to get to know the rest of the team a little better. By the time we arrived in Yaoundé, Cameroon, over 24 hours after that early morning alarm call, it felt like we had completed an epic journey.

Yet that was only the beginning.

Sometimes we are more capable than we realise. Sometimes we need a challenge to help ourselves discover that. This was my challenge. Over the next few days I would witness levels of poverty I could never have imagined, view delivery suites that would horrify me, see emergency food supplies for malnourished children that would move me to tears, and meet the villagers who have benefitted from the Pampers and UNICEF MNT campaign and those who still need our support.

I would document every detail of the trip and would home return feeling positive, energised and determined to do my bit to help raise awareness and support the Pampers and UNICEF campaign.

And it would change my life.

London, Heathrow: Destination Yaounde, Cameroon

My field trip to Cameroon with the Pampers and UNICEF team began with a 3am alarm call and a short taxi ride to Heathrow Terminal 4 where, feeling excited and a little apprehensive, I met the rest of the group. I would be spending my week in Africa with Jemma Walton, features editor for Mother and Baby magazine, Nicola Westoby, a midwife from the Royal College of Midwives, Alex Lee and Liz Jones from UNICEF UK, Catherine McGough, Pampers PR manager and Bronwyn Fieldgate from Fleishman-Hillard. We will be joining the UNICEF Cameroon team on our arrival.

Despite the early hour, I was wide awake having decided not to sleep and risk sleeping through my alarm. Looking around the group at the check-in desk, it quickly became obvious that my idea of packing light differed slightly from everyone else’s as I seemed to be carrying a great deal more luggage. It is likely that I am one of the few people who have travelled to rural Africa with mini hair-straighteners and a travel hairdryer.

As there was the possibility of my luggage getting lost en route, I had also decided to pack all my ‘essentials’ in my hand luggage, together with every single anti-mosquito repellent I could get my hands on.

I was a little over-excited to see my visa from the Cameroon Embassy stamped in my passport and realise that the trip was really happening. I had never travelled to a developing country before or done anything as significant as this and it was hard to believe that despite the vaccinations and the weeks of preparation, I really was travelling to Africa.

The purpose of my field trip to Cameroon was; to see in action the success of the Pampers and UNICEF partnership, which aims to help eliminate maternal and newborn tetanus (MNT), to experience firsthand the conditions faced by women and babies in developing countries, gain an understanding of why tetanus vaccines are essential and see the work that still needs to be done to make sure every woman and her baby is protected against the disease. I had come armed with the facts:

• To date, Pampers have donated funding for 300 million vaccines, which is helping to protect 100 million women and babies from maternal and newborn tetanus
• Since 2006,  Pampers have helped protect mums and their babies in 21 countries across two continents
• More than 80 years after the tetanus vaccine first became available, MNT still threatens the lives of 170 million women and their newborn babies in 40 countries around the world
• In 2010, it has been calculated that approximately 59,000 newborns die annually from newborn tetanus, and thousands of women from maternal tetanus *
• Every nine minutes, one baby dies needlessly from MNT *

I had no idea what to expect. I had never witnessed hardship and abject poverty to the extremes I was about to encounter. It felt important to embrace every single aspect of the trip, to document my thoughts and experiences and return in a position to be able to help. Spending my last couple of hours on British soil, the weight of responsibility suddenly felt huge and I wondered if I was up to the task in hand.

At that point our journey from Heathrow to Cameroon via Paris-Charles de Gaulle seemed straightforward. None of us could have envisaged as we sat in the departure lounge waiting to board our plane that it would be anything but.

* Based on CHERG/ WHO estimates for annual MNT deaths, 2008 as published in Lancet on 12.05.10

Pampers, UNICEF and my blogging trip to Africa

Some time ago I mentioned a trip to Cameroon, so perhaps this post should be called: What I really did this summer.

Perhaps it should end with a reference to the fact that you never really know what lies around the corner and what opportunities will suddenly present themselves.

For me, I did not think I would ever find myself sitting in a hospital in one the most remote parts of West Africa, being photographed with a group of women and their babies.

Because opportunities like this simply don’t happen.

Do they?

This August, while IJ holidayed with her grandparents in the Lake District, I travelled 3000 miles to Cameroon -- a trip which proved to be emotional, inspiring, moving and thought-provoking.

I went to Cameroon, as a blogger, with the Pampers and UNICEF teams to witness the progress of their “1 pack = 1 life-saving vaccine” campaign which is helping to eliminate maternal and newborn tetanus (MNT).

My role was to see the work of the campaign firsthand, to meet the women and children it was helping, experience the conditions the villagers live in and report it all back. So over the next ten days I will be posting my experiences of a trip which was emotional at times, yet on the whole positive and without doubt the best thing I have ever done.

The campaign background

Pampers and UNICEF joined forces in 2006 to help raise funding for vaccines to protect women and their babies against MNT. Now in its fifth year, the partnership has expanded across the globe reaching 21 countries in two continents and is helping to protect 100 million women and their babies.

The Pampers and UNICEF campaign runs from October to December. For every Pampers product purchased with the “1 pack = 1 life-saving vaccine” logo, Pampers will donate the cost of one tetanus vaccine to UNICEF.  Additionally, by visiting the Pampers Village website and clicking on the Big Kiss button, a ‘virtual kiss’ will be sent to Pampers and UNICEF. For every ‘virtual kiss’ sent, Pampers will make an additional donation to UNICEF.

 

Tetanus is a disease which can be eliminated in our lifetime and a goal that is within reach, with our help.

It was a privilege to travel to Cameroon, to see the campaign in action and to be so warmly welcomed by the communities we visited. I gained a rare insight into the lives of the villagers and the exceptional work of UNICEF.

Preparing for the trip I did not think it was possible to visit a developing country, spend time with some of the poorest people in the world, and not be altered by the experience.

And I was right.

Tomorrow my journey begins, at London Heathrow, with a 3am start, excitement, apprehension and slightly too much luggage.