Kissito Healthcare Presient and CEO, Tom Clarke, met with OB-GYN professionsals from Carillion Hospital on September 30th to discuss Kissito's international child and maternal healthcare operations in Uganda and Ethiopia.

1. Maternal, Newborn, and Child Health in East Africa

2. Discussion Topics Current State of MNCH in East Africa. Kissito Healthcare Interventions. Why Global Health Matters.

3. “The probability that a woman will die from a maternal cause is 1 in 31 in sub-Saharan Africa compared with 1 in 4,300 in developed regions. The risk of stillbirth during labour for an African woman is 24 times higher than for a woman in a high-income country.” The State of the World’s Midwifery 2011, Delivering Health, Saving Lives, UNFPA

4. “Every year approximately 350,000 women die while pregnant or giving birth – almost 1,000 a day. Of these women, 99 percent die in developing countries. An estimated 8 million more suffer serious illnesses and lifelong disabilities as a result of complications at the time of childbirth.” The State of the World’s Midwifery 2011, Delivering Health, Saving Lives, UNFPA

5. “Every year up to 2 million newborns die within the first 24 hours of life. In addition, there are 2.6 million stillbirths, of which approximately 45 percent occur during labour and birth. Millions more newborns suffer birth traumas that impair their development and future productivity.” The State of the World’s Midwifery 2011, Delivering Health, Saving Lives, UNFPA

8. MNCH Specific Goals Goal 4: Reduce child mortality rates Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Under-five mortality rate Infant (under 1) mortality rate Proportion of 1-year-old children immunized against measles Goal 5: Improve maternal health Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Maternal mortality ratio Proportion of births attended by skilled health personnel Target 5B: Achieve, by 2015, universal access to reproductive health Contraceptive prevalence rate Adolescent birth rate Antenatal care coverage Unmet need for family planning

9. Infant Mortality Rate Trends Uganda, Ethiopia, Sudan, and USA 1990, 2009, 2015 Target Source: UNICEF 2010 A = Actual T = Target

10. Maternal Mortality Ratio Uganda, Ethiopia, and Sudan 1990, 2009, 2010, 2015 Target Source: UNICEF 2010 A = Actual T = Target

11. Mortality of Children Under Five Uganda, Ethiopia, Sudan, and USA 1990, 2009, 2010, 2015 Target Source: UNICEF 2010 A = Actual T = Target

12. Causes of Maternal Death The world health report 2005 – Make every mother and child count. Geneva, World Health Organization, 2005 (http://www.who.intwhr/2005/en, accessed 14 August 2008).

13. Root Causes of East African Maternal/ Newborn Death and Disability Access to at least one antenatal visit (Ethiopia 28% / Uganda 94%). Births Attended by Skilled Health Professional (Ethiopia 6% / Uganda 42%). Lack of basic EmONC systems and referral interventions. Availability of human resources, essential drugs, supplies, and equipment throughout the health system. The State of the World’s Midwifery 2011, Delivering Health, Saving Lives, UNFPA

14. The Role of Human Behavior in Maternal Death A sense of fatalism…it was meant to be. Acceptance…this is the way it has always been. Greed…a lack of regard for the value of human life. Transference of responsibility …she should have gotten here sooner.

15. Maternal Death in Mbale, Uganda September 20, 2011

16. New York Times July 29, 2011

17. Global Health’s Unintended Consequences Each donor dollar has resulted in a $0.43 to $1.14 decline in developing nation funding. Physician migration to non-patient services/private hospitals/out of country. Donor funding is transitory (the 3 year grant project) resulting in a continual regression to the mean. Capacity building is silo based…new hospitals without staff or supplies. Quality is forgotten in a frenzy to spend donor dollars on capacity building. Little attention is focused on behavior change. Getting what you asked for…the India Hospital Birthing experience. Incentives to misreport Health Statistics. Donor reporting and site visit burden.

18. Wall Street JournalJuly 29, 2011

19. Kissito on the Map

21. Malaria Intervention and Treatment

22. Pediatric Diarrhea Intervention and Treatment

23. Community Based Health and Referral Interventions

24. Health Sector-Human Resource Development

25. Nutrition and Acute Malnutrition Management

27. Comprehensive solutions/processes…versus one time events.

28. Always seeking a better understanding of community needs/problems. Engaging all stakeholders.

29. Long term partnerships versus short-term projects.

30. Clinical Skills/Professional Management development of National staff.

31. Limited resource solutions.

33. Training, practicing, and testing ourselves. When this is accomplished, we will train, practice, and test ourselves again…it will never end!

36. Massachusetts General Hospital Maternal, Newborn, and Child Survival “Tool Kit”

37. Massachusetts General HospitalMaternal, Newborn , Child Survival

38. Massachusetts General HospitalMaternal, Newborn, Child Survival

39. Massachusetts General HospitalMaternal, Newborn, Child Survival

40. Massachusetts General HospitalMaternal, Newborn, Child Survival

41. Massachusetts General Hospital “With regard to FHW practices in the 2-3 months since training, participants reported an average of 3.0 referrals (range 0-20) to a higher level of care. Furthermore, 78.3% of FHWs were more likely to refer patients as a result of the training they received.” Maternal, Newborn, Child Survival (MNCS) Initiative Interim Evaluation: Executive Summary DRAFT, September 2011

43. Maternal Mortality Ratio

44. Child Mortality Rate

45. Malaria Mortality Rate

47. Rural Ottoro Hospital is expected to open in January of 2012, in an area where obstetrical complications frequently result in death or disability.

48. Supporting neighboring facilities with EmONC physicians and supplies.

49. Kissito is fully committed to treating acutely malnourished children, like 4 year old Mane.

50. Volunteers Carlos and Carolina Tovar at the Bugobero Malnutrition Center.

51. Building capacity one brick at a time…Kamashi, Ethiopia.

52. Kissito has eliminated essential drug shortages in Bugobero while treating over 200 patients a day.

53. Public Private Partnerships…the only path to sustainable outcomes!

54. Dr. Kiprono introduces Doppler and Portable Ultrasound to the L&D of Mbale.

59. When you have one physician for over 330,000 people…then one more physician will have a meaningful impact. When patients are dying from the lack of sutures…then saving the sterile but discarded sutures at your hospital will have a meaningful impact. When basic skills are lacking…taking the time to share your knowledge will save lives.

60. When Global Health does not matter to us: We are really saying…human life…at least in certain places…is no longer important. As individuals we can make a difference…collectively, we can transform the world!