As of 11:55 a.m. local time on April 25, 2015, health indicators in Nepal were trending in the right direction. Maternal mortality had decreased in the country by 70 percent in the 17 years between 1993 and 2010. And compared to a child in 1996, a child in 2011 was twice as likely to live past the age of five.

Then, at 11:56 a.m., progress stalled. Upwards of 750,000 people lost their homes, 17,000 people suffered injuries, and 8,600 people died from what emerged as the most devastating earthquake in Nepal’s history.

Financial Summary

Direct Relief recognizes that the generous supporters who made financial contributions to Direct Relief following the earthquake in Nepal did so for the clear purpose of assisting people in Nepal.  In accepting funds for Nepal, Direct Relief understands that both those who contributed and people in Nepal for whose benefit the contributions were made deserve to know, in detail, how Direct Relief is using these funds.

Three months into the response, this report offers a summary of Direct Relief’s activities to assist people in Nepal affected by the Earthquake and support ongoing recovery efforts.

Nepal Earthquake Donations

Direct Relief has received more than 17,000 Nepal-designated financial contributions totaling $5,508,005.

100 percent of contributions received for Nepal are restricted for the exclusive use of assisting people affected by the earthquake in Nepal.

Who donated to the response?

Of the total amount of Nepal-designated contributions —

• $3,388,300 was contributed by 17,606 individuals,
• $1,834,741 was contributed by 167 businesses,
• $215,000 was contributed by 12 foundations, and
• $69,963 was contributed by 67 other organizations.

Direct Relief does not rely on any funding from government grants. 

How were donations accepted?

Of the total number of Nepal contributions, 92 percent (16,464) were made online. Online contributions totaled $2,084,605, or 38 percent of the total amount received.

Ensuring donors’ intent

Within 24 hours of the April 25 quake, Direct Relief modified its online donation page to ensure (1) that the organization’s policy regarding designated donations for the Nepal quake was prominently featured for all visitors and (2) that, before making a contribution, a person would be required to choose whether the donation was intended to be designated for Nepal or for another specified purpose or location.

This practice was adopted several years ago to avoid potential confusion about donors’ intentions, particularly following high-profile emergencies, which often spur spontaneous online financial contributions from the public wishing to help.  Direct Relief is obligated to honor the intent of donors who make contributions, and this practice ensures that donors express their intent when making a gift.

Per Direct Relief’s Privacy Policy, Direct Relief does not disclose donor information to any outside party. Direct Relief also has a policy of not sending mail to donors on behalf of other organizations.

How and for what purposes are the funds being used?

Of the total Nepal-designated donations received to date, Direct Relief has spent $2,700,365 or 49 percent on the following earthquake response activities:

• $710,699 to mobilize, transport, and deliver to health facilities more than 144 tons of specifically requested medical material valued at $28,982,827 – a ratio of $40 in medical aid for each $1 spent. This expense would be significantly higher, were it not for the emergency airlifts donated by FedEx and  in-country logistics provided free-of-charge by the World Food Program and the UN Humanitarian Air Service.
• $197,682 to purchase urgently needed, specialized medical equipment and supplies (including ventilators, digital x-ray machines, and surgical kits for orthopedic repairs)  requested by the Government of Nepal or individual facilities, and
• $1,791,984 to support – in the form of financial grants to organizations and health facilities in Nepal, outlined below — urgently needed services in the immediate term and to begin rebuilding or expanding essential services needed in the months and years ahead.
• $0.00 spent on fundraising or marketing activities.

All medical donations to Nepal are tracked and visible on Direct Relief’s Nepal Relief Aid Map. The values for medical aid donations are tracked, calculated on a daily basis, and displayed on the map. This means that the value will increase to reflect each additional shipment of medical aid into Nepal.

Earthquake Recovery Priorities

Direct Relief’s programmatic activities are devoted to immediate relief and health-focused efforts in affected areas. Consistent with Direct Relief’s organizational capabilities and resources, the remaining Nepal-designated funds will continue to support the following activities:

• Providing Medical Resources to Under-served Areas
• Supporting Long-Term Medical and Rehabilitation Services for Earthquake Survivors
• Rebuilding, Repairing, and Re-equipping Health Centers in High Risk Areas

1.  Providing Medical Resources to Under-served Areas

The outpouring of generosity following the earthquake — combined with guidance from local organizations and support from Nepal’s National Drug Administrator, Director of International Partnership for the Ministry of Health and Population, and the Director of the Department of Health Services Logistics Management Division – has enabled Direct Relief to fast-track 288,118 lbs. — more than 10 million Defined Daily Doses (DDDs) — of high-priority medications, supplies, and medical equipment to 51 recipient health facilities and organizations in Nepal.

These medical resources were donated by more than 60 health care companies and transported, in large part, aboard humanitarian charter flights donated by FedEx.

2.  Supporting Long-Term Medical and Rehabilitation Services for Earthquake Survivors

Earthquakes often cause traumatic injuries that, even if treated successfully, result in lifelong disabling conditions for the injured persons.  Direct Relief’s experience in post-disaster situations has reinforced the importance of supporting the institutions and services that provide the specialized care for such persons – and will do so for decades.  This has been a priority during the past three months, and Direct Relief believes this use of Nepal earthquake funds is important as it will provide essential long-term benefit to those left with disabling conditions from the quakes.

Direct Relief is supporting the Hospital & Rehabilitation Centre for Disabled Children (HRDC) and the Spinal Injury Rehabilitation Centre (SIRC) with medical materials and funding to sustain and expand these essential services.  These dedicated rehabilitation departments and facilities are essential to the health outcomes and quality of life for people who have sustained traumatic injuries.

The Spinal Injury Rehabilitation Centre (SIRC) was established in 2002 by Nepali nonprofit Spinal Injury Sangha Nepal. Spinal cord injuries (SCI) require specialized treatment and life-long management. SIRC is the only facility in Nepal that specializes exclusively in the rehabilitative care, treatment, education, and disability management of patients with spinal cord injuries.  Studies have shown that the mortality rates within the first year for patients who have sustained an SCI are dramatically reduced when access to a hospital-based rehabilitation department or national rehabilitation facility is established

Specializing in musculo-skeletal disorders, HRDC focuses its treatment and rehabilitation services on children below 18 years of age with priority given to those from disadvantaged backgrounds.  HRDC also conducts medical outreach missions throughout Nepal. These missions target children living in remote and underprivileged communities, where medical care is inaccessible.

3.  Rebuilding, Repairing, and Re-equipping Health Centers

The earthquake has severely impacted Nepal’s health infrastructure. A June 10th report on post-disaster needs by Nepal’s Health and Population Sector found that 462 of the country’s health facilities had been destroyed, while 765 were partially damaged.

In Nepal’s Dolakha District, 87 percent of healthcare facilities were damaged or destroyed, leaving 40 percent of the population without access to health services. To support the reconstruction and improvement of health infrastructure in Dolakha, Direct Relief is working  with Possible Health and the Ministry of Health and Population of Nepal (MOHP).

Meanwhile, in Dhading and Sindhupalchok districts, between 65 and 75 percent of health facilities were destroyed completely. The consequences extend beyond those who suffered injuries in the quake. In post-disaster situations, pregnant women and children are often excluded from the immediate recovery plan. A combined 16,000 women in the two districts give birth each year. Without sufficient health services, many women have no alternative but to deliver their children in makeshift shelters or unsafe conditions.

To help restore maternal and neonatal health services in Sindhulpalchok and Dhading districts, Direct Relief is supporting its longtime partner One Heart World-Wide with grants to renovate five damaged facilities into certified birthing centers, equip 35 birth centers, and build 45 health posts. The grants will also enable training for 80 skilled birth attendants and educate 1,300 community health volunteers in safe motherhood practices.

Earthquake Recovery Grants: By the Numbers

Direct Relief has granted a total of $1,791,984 to the following local groups and organizations that are providing essential services for earthquake survivors:

*Direct Relief had committed $70,000 to support One Heart’s work, but the planned activities have been superseded by the profoundly changed circumstances caused by the earthquake.  Direct Relief agreed with One Heart’s recommendation that those previously committed but not fully spent funds be redirected and used as part of the broader plan developed over the past three months for the same purposes of bolstering maternal health infrastructure in Dhading and Sindhupalchok districts. 

The post Nepal Earthquake: Where the Money Goes appeared first on Direct Relief.

Upon learning of the devastating quake, Direct Relief contacted and offered assistance to several Nepal-based hospitals, delivery centers, midwifery programs, and other health-service delivery organizations, as well as partner organizations in India that are responding to the e​mergency. Included among them is Doctors for You, a highly regarded Indian organization deploying a medical team Monday local time.

“In Kathmandu Valley, hospitals are overcrowded, running out of room for storing dead bodies and also running short of emergency supplies,” the United Nations stated today in its situation report on the emergency. “There are reports that the hospital stocks are depleting/used up and there is a need for a government decision on bringing kits from the military.”

The UN report also noted most people are staying outside for fear of aftershocks.

As Direct Relief responds to the tragedy, it will do so in close collaboration with local groups and the government in Nepal, which have requested international assistance. Direct Relief will also continue to work with other international organizations involved in the emergency response.

The Need for Medical Resources

Direct Relief is working with many of the world’s leading healthcare companies, who have provided much of the inventory made available today.  Direct Relief will continue to collaborate with these industry partners to provide additional resources as needed. This may include materials for bone fractures, wound-care supplies, antibiotics, oral rehydration solutions, antidiarrheals, vitamins and nutritional supplement–each of which proved critical following disasters including the 2005 quake in northern Pakistan, which claimed 80,000 lives, and the massive 2010 earthquake in Haiti.

Anticipating Logistical Challenges

In this effort, Direct Relief draws on its experience aiding in the aftermath of a 2008 quake in Kashmir. Like then, this crisis will be characterized by the hugely complex logistical challenge of responding to the unfolding emergency in both cities and remote mountainous rural villages. The emergency response will be centralized in severely affected urban centers, and decentralized in remote and inaccessible rural villages.

The emergency response in Nepal will be particularly complex given the high altitude and mountainous terrain, the landslide damage to road infrastructure, the lack of landing access for fixed-wing and rotary wing aircraft in remote areas, the damage to communication lines, and the distances between affected communities.

Coordinating with Local Responders

Recognizing this complexity, Direct Relief has reached out to the local organizations best positioned to understand local needs and inform external assistance.  Such groups include the following:

• One Heart World Wide
• Possible Health
• Doctors for You
• Himalayan Health Care

• Patan Hospital
• Rescue Network Nepal
• Fistula Treatment Centers in Nepal

Direct Relief’s initial commitment of $50,000 is from its general funds, and not dependent on whether the organization receives contributions designated for this particular event.  Moreover, consistent with the obligation to honor donors’ intentions,  100% of any and all contributions designated for Nepal by donors will be used exclusively for this purpose, not for the organization’s general support or other program activities.

The post Nepal Earthquake: Direct Relief Commits Initial $50,000 Cash to Emergency Response appeared first on Direct Relief.

Celebrating World Health Worker Week (April 5 -11, 2015), a new story map from Esri, The Earth Institute at Columbia, and Direct Relief, aims to raise support and awareness for the life changing contributions of community health workers.

In dozens of countries, tens of thousands of women and men get up each morning to travel miles over rough roads and across rivers and streams to provide primary health care in some of the world’s most remote, vulnerable, and hard-to-reach places. At any given moment, these people, known as Community Health Workers (CHWs), are monitoring Ebola contacts, counseling an HIV-positive person, surveying basic health needs, or helping a newborn at risk of pneumonia.

On Front Lines of the Ebola Crisis

When the Ebola epidemic swept through West Africa last year, international organizations had difficulty establishing and maintaining community trust. Community Health Workers, many of whom are from the communities they serve, stepped in to bridge the gap. Not coincidentally, the organizations with the most durable results to show also relied extensively on CHWs for case tracking, diagnosis, sensitization, referral, and follow up. Such groups include Partners in Health and Last Mile Health in Liberia, UNFPA in Guinea, and Medical Research Centre (MRC) and Wellbody Alliance in Sierra Leone.

Arguably, CHWs are the key for the countries now rebuilding their health systems to be more comprehensive, effective, and resilient following the shock of the Ebola epidemic. They may also be the best defense against a repeat of these events in the future.

Beyond Ebola: One Million Community Health Workers

While the Ebola epidemic spotlighted the crucial work of CHWs, their value extends far beyond Ebola and West Africa. The One-Million Community Health Workers (1mCHW) Campaign was formed by the Sustainable Development Solutions Network (SDSN) and the Earth Institute at Columbia University to advocate for CHWs and document their far-reaching value.

Direct Relief and Esri teamed up with the Campaign last year to build the Operations Room; a suite of mapping applications that track the scope and enable a detailed comparison of CHW activities.

29 Stories. 24 Hours. 13 Countries

A Day in the Life: Snapshots from 24 Hours in the Lives of Community Health Workers is the latest map in the 1mCHW Campaign. It aims to convey not only the importance of the work that CHWs perform, but the everyday texture and genuine beauty of the lives they improve. This map is a guided tour of 29 CHWs in action during one long day across 13 countries in sub-Saharan Africa. Through the CHW story map, people can learn about and become more deeply engaged in one of the great causes of our time — ensuring that every person on Earth has access to health care.

The post A Day in the Life of Community Health Workers appeared first on Direct Relief.

NetHope – a consortium of non-governmental organizations that specialize in improving information technology collaboration – has been hosting an ongoing webinar series on the use of unmanned aerial vehicles (UAVs) in development and relief. It’s been a fascinating educational series so far – beginning last July with Dan Gilman from the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) on emerging policy considerations for UAVs in humanitarian assistance, up through February when Andreas Raptopoulos of Matternet presented on new possibilities for UAV-based humanitarian distribution networks. (You can explore the webinar archive here.)

This month, we’ll be joined by Abi Weaver of the Red Cross who will be discussing the formation of International Committee of the Red Cross’s (ICRC) global UAV implementation strategy. I’ll also be recording and sharing a panel discussion from March’s SXSW festival on “Drones for Good” featuring myself, Patrick Meier of UAViators, Kate Chapman from Humanitarian OpenStreetMap and Chris Fabian from the United Nations Children’s Fund (UNICEF).

Thank you to all who have participated up to this point – whether you’ve attended one of these webinars or signed up for the working group itself. If you have not already joined the NetHope UAV working group, I encourage you to #. Please keep in mind that you do not need to be part of a NetHope member organization in order to join this group; we encourage broad participation from all who may be interested.

As interest grows and the series and discussions continue, it’s time for the working group to start convening and collaborating around key areas of work. I think there are a few promising potential focus points:

1. New webinars (particularly focusing on organizational case studies). Many organizations are starting to develop projects with a UAV component. If you’re interested in speaking to your initiative(s), please get in touch and we can add you to our webinar calendar; these presentations have proven to be a great platform for those looking to gain exposure and support for their projects and engage in constructive dialogue with others in the humanitarian technology community. If you have any connections with interesting vendors, academics or others working in this space that you think the NetHope community might benefit from getting to know better, we would be very interested in inviting them to speak as well.
2. Training opportunities. Another possible focus area for the NetHope community is to improve training for NGO staff interested in developing projects utilizing UAVs. This training could focus on a number of different aspects of UAVs– from flight experience to image processing and analysis, to policy, law and regulations. This May, UAViators is hosting a training session on this range of topics in Bruges, Belgium. I will be participating in the session and would be more than happy to collaborate with others who have background in developing an NGO-focused training curriculum, with the intent of possibly setting up a NetHope UAV training event for sometime later this year.
3. Collaborative projects. As more NGOs begin to consider UAV applications in crisis response efforts, we will need to think clearly and creatively about coordination and collaboration structures so as to maximize effectiveness and minimize the potential backlash against poorly coordinated and executed activities. One role for the NetHope working group could be to frame UAV applications within the pragmatic context of preparedness for collaboration during crisis response. If there are members who are interested in beginning to develop working models of UAV collaboration in preparation for crisis response implementations there might be an excellent opportunity for our entire community to get out in front of this technology while its parameters are still fairly fluid.

One of the key next steps, regardless of what we decide to do as a group, is to put together a steering committee to take responsibility for helping set strategic directions, organize projects, facilitate meetings and reach out to potential new members and partners. We are looking to put together a steering committee of no more than 3-5 people who can commit at least a couple of hours each month to drive the work of this group forward. If you are interested in volunteering as a member of the steering committee, please contact me directly at aschroeder@directrelief.org (again, you do not need to be a NetHope member in order to volunteer for the steering committee).

I would also like to extend an invitation to members of the UAV vendor community to reach out to us if interested in supporting the NetHope UAV working group in terms of providing financial, technical or advisory resources. Impactful work in this field will be difficult to accomplish without strong industry partnerships. We welcome all levels of involvement by our colleagues in the UAV industry– from participating in pilot project implementations to direct contributions to the overall work of this group. Please feel free to contact me directly to discuss opportunities for greater involvement.

I’m sure there are a number of other opportunities for us to work together as a humanitarian technology community in this rapidly developing space. Please don’t hesitate to get in touch if you have ideas or information you would like to share. I’d be happy to set up a conference call at some point over the next month or so in order to begin talking through some of the options for how we can start to proactively move forward.

Thanks once again for your participation thus far. I’m looking forward to continuing our discussions as a group.

Visit the dedicated NetHope Solutions Center UAV Community Page

A version of this post first appeared on the NetHope Solutions Center blog.

The post An Open Letter to the Humanitarian UAV Community appeared first on Direct Relief.

Restoring Capacity as Ebola Wanes

Today, Andrew (Director of International Programs and Emergency Response) and I visited the Holy Spirit Catholic Hospital in Makeni, a beautiful 85-bed capacity hospital in the third largest city in Sierra Leone.  The facility was clean, spacious, and well-kept.

Infection control procedures prevented us from visiting patient care areas of the hospital without properly donning protective clothing, which we were not prepared to do.

Dr. Patrick Turi told us that the hospital was closed during the height of the Ebola crisis and is now running at about half capacity because of the sharp decrease in patients seeking care at medical facilities. He believed that the hospital would run at full capacity again as the surrounding communities regain trust in the health care system.

In the pharmacy, we took turns identifying items that we recognized as having been donated by Direct Relief through local partner Medical Research Centre.  Noticeably, several Teva drugs were being distributed to patients, such as the antibiotic azithromycin.  Dr. Turi was excited about the prospect of receiving more specialized drugs for cardiovascular disease, diabetes, and hypertension, which could help offset costs, such as rehiring of staff.

Support Continues for Successful Ebola Treatment Unit

Next, we visited the Ebola treatment unit dubbed Hastings II, which still boasts the highest survival rate in the country at about 70 percent.  The unit is operated by the Sierra Leonean military but the hygienic tasks and nursing duties are carried out mostly by volunteers. These individuals choose to work in a dangerous environment in hopes of getting priority for paid work.

When we arrived, there were no less than a dozen men and women in matching blue scrubs cooling in the shade outside the treatment ward.  In the compound that houses the Ebola treatment unit (a converted police training facility), there is an administrative building, a storage unit, and the Ebola ward itself, which is divided into several sections.  The Ebola ward is partially visible from the common area.

Recovering patients watched us as the doctor pointed to the notes stuck on the inside of the plexiglass and explained that this was a form of communication, as no items are physically transferred in and out of the ward.  Direct Relief, through Medical Research Centre (MRC), shipped significant amounts of pharmaceuticals and supplies to Hastings.

Supplies Stocked in Country

Down the street from the Hasting Treatment facility, MRC Director Abdul Jalloh showed us the warehouse rented by MRC to store donated drugs and supplies.  Direct Relief provided a grant to MRC to rent and operate this warehouse as well as purchase a truck to transport the supplies to more than 50 facilities in three districts.

The warehouse was beautifully clean and organized, and stocked entirely with supplies sent by Direct Relief: Ansell gloves, Baxter fluids, We Care Solar panels, and much, much more.  A small team was loading up the truck to take to Bo – the second largest city in Sierra Leone.  Andrew and I were very impressed.

Abdul recalled how Hastings II once ran out of ceftriaxone, which was essential to treat patients with certain types of bacterial infections, and MRC was able to provide the drug immediately because of the donation. He said the Central Stores would have taken two weeks.

Reinstating Maternal & Child Health Services

To end our day, we visited Aberdeen Women’s Centre in Freetown, a facility which we have supported through the Obstetric Fistula Repair Program.  Aberdeen is the only permanent facility providing obstetric fistula repair in Sierra Leone.

Through funding from the United Nations Population Fund (UNFPA) and others, and supplies from Direct Relief, Aberdeen strives to provide at least 200 fistula repair surgeries per year (an incredible number).

Because of reallocation of resources to fighting Ebola, they have not been able to provide fistula repair services since April, but they plan to restart soon and continue to provide birthing services. The facility delivered 1,228 babies in 2014, several by caesarian section.  Painted on the wall toward the entrance is “YU NOR DEY PAY NO MONEY” – all services are free of charge.

Looking Toward Life After Ebola

After only a few days, but endless discussions about Ebola with health authorities, politicians, local leaders, and medical practitioners, it is apparent that the complexity of the issue is staggering—the disease, the politics, the unintended consequences, the international response, the messaging, the historical implications, and on.  Sierra Leone’s history will forever be divided into “before Ebola” and “after Ebola” just as it is colloquially divided by the civil war.

The post From the Field: Health Facilities in Sierra Leone Work to Restore Services appeared first on Direct Relief.

The field of humanitarian unmanned aerial vehicles (UAVs) has moved forward at a tremendous pace since Direct Relief and DanOffice first experimented with the technology during Typhoon Haiyan in the Philippines 14 months ago. New applications have emerged, from mapping to multi-spectral sensing to goods transport. Software innovations have improved coordination, data sharing, and analysis. Significant improvements in hardware, from vehicles to batteries to sensors, has also expanded the field of potential use cases. Meanwhile, costs have continued to decrease, bringing UAVs closer than ever to routine applications for a wide range of individuals and organizations.

Direct Relief, in collaboration with NetHope, has closely tracked these developments and helped to facilitate new implementations of humanitarian UAVs through a working group and regular webinar series on the subject. Over the course of seven months, presenters that include the UN Office for the Coordination of Humanitarian Affairs, UAViators, 3D Robotics, Esri, and Singularity University have weighed the implications of humanitarian UAVs from the standpoint of policy, law, technology, and data analysis.

Next Wednesday at 11 am EST, Matternet CEO Andreas Raptopoulos will join the webinar series to discuss the future of goods transport and his vision for the future of drone-based humanitarian transportation networks. Matternet’s approach to humanitarian drone deployment, based on case studies from Bhutan to Haiti, is among the most interesting and well developed in the field. Raptoploulos is sure to offer a fascinating perspective as he explains the possible and not-so-distant future for drones in emergency response.

Please register for the webinar on Nethope’s events page. Visit Nethope for more information on the Humanitarian UAV Working Group.

The post Beyond Drones: UAV Networks and The Future of Transportation appeared first on Direct Relief.

The event is called the Global Humanitarian Policy Forum. This year, under the banner of “interoperability” (the ability of making systems and organizations work together) and humanitarian action, Direct Relief was invited to participate.

While a surprising succession of speakers criticized the term “interoperability” as unwieldy and nondescript, throughout the proceedings a clever and subtle shift of emphasis could be heard in the endless debates over data sharing and humanitarian effectiveness.

Rather than hewing to the path of negotiated inter-agency settlements (almost inevitably a political minefield), this year’s Forum zeroed-in on interoperability as an informational problem. Questions that arose included:

• How can software mediate institutional interests in data security and competition?
• To what degree is humanitarian coordination as such really a software problem more than a political problem?
• What sorts of informational standards, from newcomers like Humanitarian eXchange Language (HXL) to standbys like Common Alerting Protocol (CAP) and Open Geospatial Consortium (OGC), best allow software to play a greater and more helpful role in humanitarian coordination?
• Can the shift to a more self-consciously informational set of problems in humanitarian space help to improve the relevance and positive impact of actors in the global humanitarian system amid a set of tectonic geopolitical shifts? (These shifts range from rapidly increasing wealth in emerging market countries, to new assertions of sovereignty and regional priority throughout the global south, to a startling set of post-financial-crisis shifts in the impact of private capital, the dissemination of mobile networked technologies and the potentially diminishing willingness of states to fund humanitarian action).

As the conversation shifted to more intimate group discussions by the second day, we heard compelling claims that humanitarian agencies may need to shift away from “innovation” per se as an organizing paradigm for humanitarian investment, in favor of pragmatic interests in “absorptive capacity” and appropriate technologies.

For more than a decade, NGOs have been funded to produce a huge array of pilot technology and data projects, the vast majority of which have had no impact whatsoever upon humanitarian operations. Representatives from the Harvard Humanitarian Initiative in particular emphasized that the humanitarian sector as a whole has been producing far more projects than can ever be meaningfully deployed in practice, leading to a classic risk of speculative crash and backlash.

Likewise, sacred cows of innovation funding, such as the imperative to take new technologies “to scale” as a demonstration of success, came under criticism for neglecting to think seriously about scale in ways that differ from private technology investments and which respect the multiplicity of spatial scales which define the problems that require humanitarian action.

As the Forum came to a close, OCHA marked out a series of new events over the next two years which will carry forward this discussion of coordination as an informational problem. Direct Relief, and through us our partners, will continue to be in the midst of this dialogue.

The post Reflections on the 2014 UN Global Humanitarian Policy Forum appeared first on Direct Relief.

Using UAVs to Inform Relief & Development

International humanitarianism is fast approaching the moment when remotely sensed data – or the science of obtaining information about objects or areas from a distance, typically from aircraft or satellites – stretches ubiquitously throughout disaster relief and development operations. UAVs are on the cusp of that change, with implications for a significant range of Direct Relief’s operations and analytics.

Satellite imagery already informs programmatic activity, from post-disaster assessment to studies of slum growth to vegetation, water and soil analysis for food security planning. Often, however, non-governmental organizations (NGOs) and UN agencies alike find themselves in need of higher resolution, lower-altitude imagery than may be available for certain areas or time frames from satellite providers, or a broader array of sensors, or the ability to create three-dimensional models of key points of interest such as damaged structures.  Each of these tasks, and many others, can be performed effectively by UAVs.

Thinking Through the Implications of UAV Use in Humanitarian Activities

Over the next 18-24 months, UAVs are poised to be deployed into a wide range of humanitarian activities in many different parts of the world.  Right now is the moment to think through not only the theoretical implications but also the many practical questions associated with UAVs, including: technology procurement, training, image analysis, data integration, and emergent legal and regulatory issues.

Key areas of conversation included:

• collection of use cases to determine the scope of demand for humanitarian UAVs
• outlining of privacy concerns
• certification and training for piloting and analytics
• insurance and liability questions
• direct community participation in UAV-based mapping and image production
• data security for high-granularity image data
• ethics, human rights and the establishment of a community-wide code of conduct
• specific issues pertaining to UAVs in conflict zones
• using UAVs to deliver essential health care and relief goods to areas with poor or damaged transport infrastructure

By the end of the day, we forged a stronger understanding among the various stakeholders about the scale of the issues at hand, the types of interests to be represented, and the nature of the agenda for at least the short- and medium-term future. New training and research opportunities will be upcoming, as well as a range of presentations, discussion forums and publications on all aspects of the humanitarian UAV landscape.

Through the Nethope UAV working group, my own participation in various public forums, and early experimental forays into UAV support for humanitarian activities, the next 18-24 months should be a very exciting time to participate in the development and maturation of an important new field of humanitarian technology.

The post Reflections on the First UN Expert Meeting on Humanitarian UAVs appeared first on Direct Relief.

1. War crosses all classes

Some of the people we cared for were farmers and from small villages; others were middle-class urban families. Some were living in ad-hoc camps, in fields, or on the outskirts of a village, while others were living together with several other families in apartments in Amman. Some were barely literate while others were well educated. Most of the people we treated were either women or elderly, although the majority of the people came with children. The refugees aren’t allowed to work in Jordan. They live off of the benevolence of others or assistance from the United Nations Human Relief Agency.

My parents were Jewish Holocaust survivors and the horrors these people are going through in Syria and Jordan are very similar to the experiences my parents, their friends and relatives, went through during World War II. The stories we heard ran the gamut from neighborhoods being destroyed to relatives raped and then thrown into ravines. Families fled in terror hoping for some safety.

2. Among their worst fears is that of being ignored

In addition to the horrors of this war, the lack of hope and the sadness of knowing that their homes and their world have been destroyed, leaving nothing to go back to, many people expressed that their worst fear is that their plight is being ignored and forgotten by the rest of the world. We tried to assuage them a bit of that hopelessness. Children and adults would quickly number a thousand wherever we would set up. We were a small group—psychiatrists and psychologists as well as physicians, dentists, nurses, and pharmacists—but we were able to do good work and I hope help them feel less alone.

3. The resources provided were critically needed

Direct Relief provided essential medicines and medical resources to support this mission. Direct Relief’s aid made available medicines that would have otherwise needed to be purchased, which would have proved too great an expense. This assistance freed up money to buy formula, diapers, and other essential non-pharmaceutical products to care for people who have been displaced.

4. Of the most important things we brought were 300 pairs of reading glasses

Glasses that had been unavailable to refugees until now had an immediate impact on their lives. This woman received an eye exam from my sister, who is a pediatric opthamologist living in Miami. The Syrian woman was living in the Za’taari Refugee Camp and was nearly blind with bilateral cataracts. Glasses improved her vision dramatically.

5. Hope remains

Amidst the despair and suffering, I saw moms and dads who love their children, care for their families, and want just what we want. They hope for safety, for freedom, to be treated humanely and respectfully and to care for and love their children. They want to know that the rest of the world hasn’t forgotten them. We have a unique opportunity to show them that we do care.

To support Direct Relief’s life-saving work, donate here.

The post 5 Impressions From Caring for Syrian Refugees appeared first on Direct Relief.

The map supports the 1 Million Community Health Workers Campaign — a collaboration between the United Nations and the Earth Institute at Columbia University, which aims to expand community health worker programs across the region – the very kind that may have caught the current outbreak earlier and may help prevent future outbreaks from occurring.

About community health workers

What is a community health worker?

In 2008, the International Labor Organization (ILO) developed a standard definition of a community health worker, which the Campaign uses to define, categorize, and count CHWs: “Community health workers provide health education and referrals for a broad range of services and provide support and assistance to communities, families and individuals with preventive health measures and gaining access to appropriate curative and social services. They create a bridge between providers of health, social and community services and communities that may have difficulty in accessing these services.”

What is the One Million Community Health Workers Campaign?

The One Million Community Health Workers (1mCHW) Campaign promotes the efficient use of community health workers in achieving universal health coverage and works to increase knowledge about the importance of CHWs in the post-2015 development agenda. As part of this advocacy, the Campaign urges financing organizations to support CHWs and tries to motivate countries to demand this support from donors.

Why one million?

A CHW Technical Task Force commissioned by the Earth Institute in 2011 agreed that there will be a total of 1 million CHWs needed (1 CHW per 500 people) to achieve systematic Human Resources for Health (HRH) coverage of the low-income, rural sub-Saharan African population of 500 million by 2015. The Campaign was set up to support sub-Saharan African governments reach this number.

About the data

How was the data collected?

Beginning in August 2013, the One Million Community Health Workers (1mCHW) Campaign surveyed community health organizations throughout sub-Saharan Africa. With respondents ranging from Ministries of Health to NGOs, the questions addressed topics such as the number of CHWs employed and the training they receive. The Campaign continues to collect CHW information in both English and French through the Operations Room and organization outreach.

How current is the information on the map?

The Campaign is continually soliciting new data via the Operations Room surveys. The date of the last update can be found in the legend.

How frequently is the map updated?

The map was designed to be a constantly evolving tool, regularly updated with information submitted by organizations deploying community health workers across sub-Saharan Africa. The map is refreshed every month as new data becomes available. The date of the data update can be found in the legend.

Why are not all countries on the map?

The 1mCHW Campaign works with the 35 countries that fall in the World Bank’s classification of low- to middle-income countries in sub-Saharan Africa. While we’re happy to learn about CHW programs in countries outside these 35, we have chosen this group of “target countries” as our priorities for funding and implementation.

Why do some countries not have district-level data?

Some countries do not have open-source, district-level demographic data available. The best attempts are made to find appropriate data at sub-national levels through sources such as the Demographic Health Survey StatCompiler, World Health Organization’s Global Observatory, and the World Bank.

How can I add information to the map?

You can add your information to the map by accessing our English and French surveys.

Where does the information for the demographic layers come from?

Much of the demographic information comes from DHS StatCompiler. Other sources used are the World Health Organization’s Global Observatory, World Bank, and government open data sites. You can find all the data sources here.

The post A Map of Community Health Workers in sub-Saharan Africa appeared first on Direct Relief.

Days 7 & 8: Week Concludes, Preparation Begins for Operations Room Launch

The week is over. The applications are not entirely complete. But it’s OK. They’re close. And with the help of our colleagues at Esri this week has exceeded all expectations.

Thursday morning kicks off with a deeper dive into this emerging concept of a social landscape tied into tactical workflow tools. Sharon is at the whiteboard diagramming the general structure governing community health worker (CHW) distributions in Ghana. This is in many ways a classic problem of resource allocation under conditions of scarcity, with the added requirement of spatial precision. CHWs ought to serve an estimated total population of around X persons, who will in general be reached via pedestrian transit, within zones of Y area defined in part by political boundaries, in part by need, and in part by proximity to existing health infrastructure. The specifics of that problem describe a set of base data requirements, analytic rules, and possibly agent-based rules for interactions under varying conditions.

What if, instead of simply dispensing consulting advice on this problem, non-governmental organizations (NGOs) actually contributed to the composition of the base data requirements and analytic models? What if a tool could be built which encoded the contours of health access scenario planning? What if that tool could be deployed collaboratively between public, private and non-profit stakeholders, across national and international scales? What if the methods and data so deployed could be standardized and commonly referenced as part of a generalized baseline understanding? How would that change our concepts of the known, the know-able and the possible in global health, development and relief operations? Let us call this idea, “social landscape design” – part science, part aesthetic and part collaborative social practice towards a better set of solutions to the world’s most difficult problems.

Heady stuff. But to get there you still have to write proposals, schedule meetings, attract resources, write blog posts and tweets describing what the heck is going on in those fishbowl conference rooms. Afternoon hours fill up with coding, art design and planning for an imagined future of genuinely geo-enabled, strategic humanitarianism.

Friday morning comes early and brings with it the pressure to tie up any remaining loose ends. One of those is my frustration with the open data portal. As expected, once I know which settings to put in place the development arc cascades smoothly. By 10 a.m. I’ve got datasets populating to the Campaign site, making good on the promise to make maximal data sharing the new default assumption.

3:30 p.m. is group photo time for those of our Esri colleagues we can track down. Sharon is heading back to LAX. Jen, Jon and I are laying the last bits of groundwork in place. Communications strategies are plotted for the launch of the operations room sometime in early October and the participation of our team in Esri’s GIS for Health conference in Colorado Springs in early November.

The team is scattering for now to the far corners of the country. But the world’s community health workers are gaining a new set of tools for visibility, advocacy and analytic integrity. We’re all incredibly grateful to Jack Dangermond, Hugh Keegan, and the entire team at Esri for making these fantastically productive days possible.

Days 5 & 6: Building a Map That Shows Where Gaps in Health Services are Greatest

Perhaps we lost a few members of the Esri team, but we’ve gained Sharon Kim, our colleague from the Earth Institute at Columbia University and the 1 Million Community Health Workers Campaign. The Operations Room mapping application is essentially Sharon’s project, and we’re a little anxious to know what she thinks of our work.

Following the decision to break our singular comprehensive application into three or more specialized applications, we did review things over the phone. But Tuesday morning is the first time we’ve demonstrated the new applications live for someone not already sitting with us in the prototypes lab.  And it’s a success. At least for now on the conceptual level. Sharon approves of the direction we’re heading. Phew!

With the demonstration of current development out of the way we can refocus for a moment on some of the longer-term visions. The path leads back to Nigeria.  Based on contributions to the polio eradication effort in Nigeria, Esri has compiled what is arguably the world’s most accurate, detailed and comprehensive population map ever built.

That work was led by their chief demographer, Earl Nordstrom.  The key innovation in this population map, as I understand it, is to have linked the best of the raster image-based population datasets and national census data with new means of extracting settlement locations and extents from satellite images to create a high resolution surface model of total persons per 250 square meters. Each of those grid cell locations is called a “Nordy point,” after Earl Nordstrom’s last name. Only a select few geographers can aspire to such branding.

Why is this useful for community health workers (CHWs)? Because it potentially lets us achieve, in combination with a bunch of other data layers, a new level of precision in understanding where gaps in health services are greatest, along with where and to what degree CHW outreach programs may need to be scaled up.

We have a meeting set up with Earl for Thursday afternoon to discussion spatial modeling of access to health services. Partially in anticipation of that conversation, we have a long and fruitful dialogue with Esri’s Ed Carubis about how such population and health access modeling might work, both theoretically and practically, to help the country of Ghana with its immediate planning needs. There’s something coming together there if we can align the pieces properly.

Wednesday is, however, at least for me, mostly a day of frustration. One of the things that really drives me nuts about information technology is encountering a process that really seems like it ought to be straightforward and obvious but for whatever reason just … won’t … work. I’m building an open data portal for the campaign and no matter what I do my data layers will not show up in the portal. By late in the day, I’m reducing to peeling through a dense screen of code which is for the most part impenetrable to me. I turn my laptop around and ask Jon, “Say, can you help me understand this?” He laughs and says that he’s seen that somewhere before … in The Matrix.  Fortunately, tomorrow, I’ll have help.

Day 4: Moving Forward With the A-Team

Monday morning at the Esri prototypes lab is a hive of activity.  Some of the engineers are being assigned to new projects which require immediate travel.  A couple of them have been working with us for the past few days to get our ideas into shape. We’ll miss them — a lot. But fear not: Jack Dangermond, Esri’s CEO, assures us that we still have the A-team with us for the next wave of development through Friday.

Twenty minutes later the A-team piles into our side conference room to review our app storyboards from Friday. These designs evolved in my mind over the weekend as I had a chance to reflect on the previous three days. I get to work early, so well before anyone else arrives, I’ve already erased and re-written all of our designs a couple of times. With the rest of the group gathered around now this iterative design process continues. Inspired by apps like the Urban Observatory, we’re narrowing in on the concept that community health worker (CHW) programs should be compared across a landscape which varies based upon demographic and health conditions.

Within a single space, across a common scale and extent, we want users to see how program activity for multiple organizations relates to key issues in the local population. Our closest measure locality is the administrative district. This is an intellectual trade-off — one of many which need to be made during app development. On the one hand, we need as much spatial granularity as possible. On the other hand, we need to have as much comparable and consistent data as possible at the same scale. The imperfect outcome of this trade-off  is to use the first administrative level below the national level as our unit of local analysis. These applications are, however, designed to be active, living documents. In the future, based on data availability, this set of analytic and design trade-offs may change.

Data availability is also, not coincidentally, the theme of our phone conversation with Partners in Health’s (PIH) monitoring and evaluation staff in Boston. At least a few of PIH’s African programs (Rwanda, Malawi and Lesotho) have been able to use GIS effectively to map clinical service locations and estimate values like service availability and travel distance from area villages. While we cannot supply data like this for all programs represented in the map, the PIH discussion feels like a starting point toward a new level of locality and a more detailed understanding of where community health workers may be needed most.

Meanwhile, Jon continues to wrestle the Javascript into submission. In a matter of hours Jen builds the base web map which powers our comparative app. Perhaps it’s not all working exactly as predicted, but the pieces are definitely coming together.

Day 3: Conversations on Comparative Mapping

Mid-morning Friday finds me scribbling on a large whiteboard in a low-lit conference room before a cluster of Esri’s technical advisers. We’re going through the storyboarding process for a new mapping application aimed at making dynamic comparisons between community health worker (CHW) organizations, demographics and health issues across space and time. Storyboards are a technique borrowed from film and video production to make sure we have the links between our ideas and our screen images properly thought out in schematic form before we actually spend time building something.

Hugh, the director of the prototypes lab, is grilling me on the problem of scale. For cartographers, digital or otherwise, scale is always a core issue. Maps are visual abstractions which stand in as representations of real-world space. If we don’t have our scale right from the start then we can end up presenting serious distortions of that real-world space. Values such as disease rates or population densities at one map scale may take on entirely different meanings at another map scale.

What might seem at first like an arcane cartographic debate actually leads us to discard a few of our initial ideas and focus on a handful of new ones. We’re trying to help users understand two different things with different scale dependencies. How do CHW programs measure up against one another across different locations? And how does the same CHW program measure up against different demographic and health variables within the same location? Turns out, we may need more than one mapping application. Over the next hour, the whiteboard fills up with diagrams and sketches. Our best options for linking intellectual value to visual display come into focus.

As lunchtime approaches we’re heading towards a newfound clarity about exactly what comparative mapping will help us to accomplish and how those comparative dimensions should be represented. The whiteboard gives way to the projector screen as our schematic diagrams are linked to a set of concrete examples based on apps previously developed for other issues, from climate change to criminal justice.

Later on in the afternoon, we have the opportunity to sit in on a presentation by a group of astonishingly talented interns finishing up their summer stints at Esri. They’ve been hard at work for the past three months on application development. One shows off an Android app, built in just two weeks, called Snap2Map, which allows users build complete Esri story maps right from their phones. Another demonstrates how Flickr’s geo-referenced photo-sharing API allows users to map subjective urban landscapes of attention and interest. Alongside our own ideas about using GIS to improve the health of people in vulnerable situations around the world, we can see more of the future of GIS as a medium coming into being.

Day 2: Solving Kinks Through Collaboration

It’s 11 a.m. on Thursday and our coder Jon Zaid is neck deep in Javascript. When I ask him about the vaguely pained look on his face he replies, “Well, there’s good news and bad. The good news is that I managed to upgrade the application programming interface (API) to the new version. And now everything is running much faster than it was before.” And the bad news? “Of course, now none of our data is displaying.” None? “Nope. Nothing. And I’m not sure why – it’s probably something that was programmed incorrectly before, then was fixed in the new version, but knocked something else off in the process, and now we’ve got nothing but blank polygons over Africa.” Unfortunate. But this, I tell him is exactly why we made the trek down to Esri.

Around the corner in a glass paneled office sits one of Esri’s best Javascript coders. He grabs a cup of coffee and joins us for about 15 minutes, during which time he redirects the reference calls, notes several syntax changes and a series of subtleties buried deep in the documentation. Almost like magic, up pops the demography for Nigeria. A cry goes up around the table, “There it is!” At least for a moment, all is right with the code. “How long,” I ask Jon, “might that have taken to uncover without help?” “Oh I don’t know, he says, maybe a day and a half?” Exactly.

Later, we meet with members of Esri’s team that have been assisting with the World Health Organization (WHO) project underway in northern Nigeria to bolster polio eradication efforts through intensive mapping support. They’ve come up with some remarkable methods for extracting data from imagery, linking that data to vaccination teams in real time, and understand down to a granular household level whether the campaign is meeting its goals. The discussion is about how this sort of work can be extended out from specific diseases like polio to support much broader global health and mobile outreach efforts. CHWs may be a perfect application.

We’re joined by a new employee at Esri who has just arrived from Partners in Health Rwanda. He’s full of tremendous insight into the issues we’re dealing with in terms of mapping support for community health workers. The brainstorming leads to a discussion of open spatial data, inter-organizational coordination and the deep trouble facing Ebola containment efforts in West Africa. Early stage ideas are emerging which may have a significant impact on how we can help our local partners manage epidemiological crisis.

By the close of the day we have brand new spatial feature services populating our Javascript interface, corrected health center program locations and a host of emerging ideas around geographic information systems (GIS), crisis response and global health. Several important steps forward toward the finish line.

Day 1: Arrival at Esri’s Prototypes Laboratory

I arrived at Esri’s Prototypes Laboratory in Redlands, Calif. yesterday with two colleagues for an intensive ten-day collaboration to develop mapping applications for the “Operations Room” of the One Million Community Health Workers Campaign (1MCHWC).

A joint effort by the United Nations and Columbia University’s Earth Institute, 1MCHWC aims to highlight community health workers (CHWs) and their efforts to deliver life-saving health care services in poor rural communities – particularly in sub-Saharan Africa, where 10 to 20 percent of children die before age 5.

The “Operations Room” will play a vital role in the larger campaign by gathering and displaying information on where CHWs operate, what services they provide, how many people they reach, which health concerns they impact, and where needs are greatest.

As the campaign scales its efforts over the coming years, the Operations Room will offer continuous insights into the landscape of CHW activities, needs and outcomes.

Over the next 10 days, we will be documenting our progress on these mapping applications, demonstrating the power of public/private partnerships, and offering insights into how these sorts of humanitarian data products are produced. Stay tuned for more updates.

The post Mapping One Million Community Health Workers appeared first on Direct Relief.

Obstetric fistula is a hole in the birth canal that results from prolonged and obstructed labor when women do not have access to a skilled birth attendant and emergency obstetric care. The injury is largely treatable by surgery and can dramatically improve the health and lives of women affected.

The supplies shipped to the camp included sutures, catheters, urine bags, syringes, spinal needles, and other equipment. By providing the camp with the necessary materials to successfully treat over 100 women the hospital (80 of whom were operated on), organizers were able to spend their limited resources on providing food and other supplies for their recovering patients.

Grace Hiwa, coordinator of UNFPA’s Malawi program, said, “I am so grateful [for Direct Relief’s] collaboration with UNFPA as we are reaching more women.”

In addition to providing supplies for the camp, Direct Relief also supports the fistula repair services provided at the Bwaila Fistula Center in Lilongwe, Malawi, as well as dozens more facilities throughout sub-Saharan Africa and Southeast Asia.

Help more women access this life-changing treatment. Click here to support Direct Relief’s maternal and child health programs.

Related posts: Updated Global Fistula Map, Expanded Efforts to Overcome Barriers to Care

The post Fistula Repair Camp Helps 100+ Women in Malawi Access Treatment appeared first on Direct Relief.

Obstetric Fistula Explained

Obstetric fistula is a hole in the birth canal  caused by prolonged and obstructed labor. If untreated, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces. In addition to physical injuries, many women with fistula suffer humiliation, isolation, and stigma as a result of the smell and constant leakage. And in most cases of obstructed labor in which a fistula develops, the baby is stillborn.

In the year since the first International Day to End Obstetric Fistula was recognized, the efforts of many organizations and doctors around the world helped provide more than 14,000 estimated repair surgeries to women who were able to access care. However, the growing number of such life-restoring surgeries still doesn’t meet the needs of  women newly developing the condition. With the scourge of fistula still growing, the fight is far from over. However, progress is being made to help turn the tide.

Major Challenges to Ending Obstetric Fistula

Major barriers stand in the way of ending fistula, and overcoming them requires partnerships among many organizations, none of which can fully address the challenges alone.  Below are three of the major challenges to ending obstetric fistula and how Direct Relief is taking part in the efforts.

1. Documenting the Extent, Location of Fistula Cases and Raising Awareness

Direct Relief’s Global Fistula Map survey found that the number one reported barrier to a woman accessing care and treatment for her obstetric fistula is lack of knowledge that help is available. An overwhelming 78 percent of facilities chose this lack of awareness as one of the top three reasons women do not go to their facility for care.

Not only is it an issue that the women with fistula often do not know what their condition is or how to treat it, but most people in general are not aware of it. Fistula was once common throughout the world, but over the last century has been virtually eradicated in Europe and North America through improved medical care.  This means the countries with the biggest ability to aid the efforts have very few people who know what obstetric fistula is. Without broader awareness, it is difficult to find the support needed to reach the goal to end fistula.

To better help people understand what fistula is, where fistula exists, and where it is being treated, Direct Relief, in partnership with the United Nations Population Fund (UNFPA) and The Fistula Foundation, created the Global Fistula Map to consolidate and publish information on fistula treatment capacity and activity worldwide.

With this third update of the map, there are now four years of data that cover 262 facilities in 44 countries. Included in the map are also stories of the surgeons and women who bring the fight to end fistula to the fore of the work they do and the lives they now lead. The Global Fistula Map provides a range of information for anyone looking to learn more about the disease that can then be shared with others to help bring awareness to this devastating condition.

2. Reducing the Cost of Surgeries by Providing Essential Surgical and Medical Supplies

Surgical and medical supplies are a critical component of fistula care and can be expensive and difficult to obtain in areas of high need. According to the most recent Global Fistula Map survey, 64 percent of facilities reported that costs were a barrier to expanding treatment.

To ensure health providers have a reliable flow of supplies to improve access to treatment, Direct Relief maintains a robust inventory of surgical and medical supplies to meet the diverse needs of fistula care providers across the world. For more than ten years, Direct Relief has supported fistula repair centers throughout Africa and Asia with donations.

Direct Relief’s Fistula Repair Module includes essential medicines and surgical supplies and is provided at no cost to facilities providing fistula repair surgery worldwide. In the last year alone, Direct Relief has supported 18 hospitals in 14 countries with more than $650,000 in medicines and supplies – enough to support over 2,000 repair surgeries. This support will continue to grow going forward as Johnson & Johnson has made a Clinton Global Initiative commitment to provide Direct Relief with enough sutures to help facilitate 7,500 repair surgeries.

3. Expanding Surgical Expertise for Fistula Repair

Obstetric fistula surgical expertise is a very scarce skill that involves several medical specialties, including urology, obstetrics, gynecology, skin graphs and more.  In most of the high-poverty countries and areas countries where obstetric fistula occurs, the scarcity is more severe because of general shortages that exist for trained health professionals.

Moreover, since the condition typically affects only women who themselves are very poor, few if any financial incentives exist for surgeons to develop the range of skills needed and then devote their time to these procedures. Lack of surgical staff trained in obstetric fistula surgery was cited by almost half of Global Fistula Map facilities as being a limiting factor in the facility’s capacity to provide care.

Direct Relief’s efforts to identify and map the global points of care for fistula repair surgery (#1, above) is an essential element of the organization’s strategy noted above (#2, above) to furnish essential material resources that otherwise would only add to the cost barrier of restorative surgery.

In addition to targeting material support for fistula surgeries broadly, Direct Relief is working closely with health facilities and doctors who conduct fistula repair trainings to link specialized training resources. Dr. Steve Arrowsmith, who has dedicated much of his time to training others on fistula surgery, is a valued partner and serves as a key adviser to Direct Relief’s obstetric fistula programs (as well as those of our partners), helping foster key linkages to surgical expertise and Direct Relief target for support facilities that are investing not only in the women cared for, but the staff who care for them.

How You Help Prevent Obstetric Fistula:

Donate to Direct Relief’s efforts

$25 can provide the tools needed for a trained midwife to protect a mother during birth and deliver a baby safely, helping prevent an obstetric fistula from developing.

$50 can be leveraged into nearly $2,500 worth of wholesale medical aid to stock fistula repair facilities with the medical supplies they need.

$100 can provide dignity kits to comfort five women living with obstetric fistula, a devastating childbirth injury.

$1000 can provide one life-restoring fistula repair surgery and post-rehabilitative treatment for a woman suffering from this devastating birth injury.

Spread the Word

Many of these women are abandoned by their communities and shunned from their social circles, leaving them without a voice. Be their advocate by telling your friends, family, and other people you meet about this devastating condition and how they can help end fistula. Whether you tweet, text, or talk, find ways to raise awareness.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

The post Updated Global Fistula Map, Expanded Efforts to Overcome Barriers to Care appeared first on Direct Relief.

Earlier this month, I had the opportunity to join the United Nations Working Group on Emergency Telecommunications (WGET) forum on humanitarian innovation held April 10-11 in Luxembourg to speak about two significant technology projects which Direct Relief has been involved in during the response to Typhoon Yolanda (Haiyan) in the Philippines.

The WGET is one of the key forums within the UN system for discussing the implications and applications of new technologies to disaster response. Serving as a critical advisory body for the UN Interagency Standing Committee and the Emergency Telecommunications Cluster, the WGET brings together a wide range of UN agencies, bilateral aid agencies, nongovernmental organizations (NGOs) and private sector representatives to explore the diverse ways technology can improve responses to complex international emergencies.

Along with my colleague Brian Fishman from Palantir Technologies, I laid out the vision of the MIMOSA (MIniature MObile SAtellite) emergency response platform.  MIMOSA allows aid workers from all sectors to collect structured data in remote environments where cellular networks may be broken or weak, using satellite-connected short message service (SMS) communications devices.

In the Philippines, we helped to implement this system along with our colleagues in Team Rubicon, Access Aid International, Philippines Red Cross, Gawad Kalinga and the Tacloban Health Cluster. With the success and spread of MIMOSA, we can glimpse a future in which large numbers of response organizations are able to gather data, coordinate, analyze and evaluate their activities in real time right from the opening moments of crisis response operations. MIMOSA was named a finalist in this year’s Vodafone Americas Wireless Innovations Program awards.

I was also joined by my colleagues at DanOfficeIT to discuss the emergent field of unmanned aerial vehicles (UAVs or “drones”) as critical data collection tools during crisis response. In the Philippines, Direct Relief collaborated with DanOfficeIT to deploy a Huginn X-1 UAV for search and rescue, health facility damage assessment and logistical evaluation.

UAVs promise massively enhanced access to precise and rapidly produced imagery within disaster situations. In subsequent months interest in UAVs for humanitarianism has grown significantly. I am now in the process of assembling a working group on this topic within Nethope.org to engage our NGO colleagues in the cutting edge of data for disaster response.

Although serious disasters appear to be growing in frequency and severity worldwide, the high quality of thought, practice and discussion at this year’s WGET offers a hopeful thread for our collective ability as an international community to care for the survivors of such events and to construct stronger societies in their wake.

Related posts: Civil Drones Improve Humanitarian Response in the Philippines; How Technology Can Enable Collaboration for the Common Good; Direct Relief Named Finalist in Wireless Innovation Project Competition

The post Applying New Technologies to Disaster Response appeared first on Direct Relief.

Nearly six months ago, Bridget*, 28,  received fistula repair surgery at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi during the UNFPA Malawi outreach fistula repair camp that Direct Relief supported with surgical supplies. While traveling, I was able to meet Bridget and her extended family who live in the rural Mangochi District.

*indicates name has been changed for privacy purposes

Bridget became pregnant with her first child when she was very young – around 13 or 14 years of age. When she went into labor, her family encouraged her to stay at home with a traditional birth attendant. She labored for four days before it was finally decided she should go to the hospital.

Upon arriving, she received a cesarean section. They removed her stillborn baby. Soon after leaving the hospital, she started leaking urine continuously, but didn’t know she had developed an obstetric fistula – a hole in the birth canal caused by prolonged and obstructed labor.

Bridget lived with the condition for 13 years. During this difficult time, she had sores on her legs because of the constant wetness. She said she felt like a baby because she was continuously leaking. Moreover, her husband abandoned her.

Bridget felt ashamed and preferred to isolate herself from her family and friends.  When she went to the field to garden she said it was as if someone was pouring water down her legs, which made it nearly impossible for her to do her work. It was a burden she was unsure she would ever overcome.

Fortunately for Bridget, she met a very supportive man during this time who wanted to marry her despite the challenges she faced. She was raised by her aunt and grandmother, and her family stuck by her side, even though she felt ashamed and embarrassed by her condition. Her family was sad she could not come to the mosque because she was unclean and therefore could not participate in religious life so important to their community.

One day, she met an outreach worker who was conducting community meetings to raise awareness about obstetric fistula. She learned about her condition and that help was available. At first, her family was afraid to let her go for treatment, as she would have to travel more than 200 kilometers to Queen Elizabeth Central Hospital (QECH) in the big city of Blantyre. But eventually, they encouraged her to try her luck and see if she could get help.

Bridget received surgery repairing the physical wounds to stop the leaking in May 2013 at QECH. While there, she was joined by over 60 women who also received treatment. She had no idea that so many other women also suffered from this condition. Together, they made handicrafts while on the ward, and supported each other during their two week post-operative stay.

Nearly six months later, back at home, Bridget is happy and dry. She says she no longer has pain from the sores on her legs and she is able to freely socialize with her friends and family. She is now able to go to the mosque and this year – for the first time in over a decade – was able participate in the observance of Ramadan, a very important holiday for her family and community.

Her husband sits beside her and says she is doing much better and he feels that she is much improved. When she first came back after her operation, her family couldn’t believe she was cured after so many years living with the condition. They kept checking where she sat to see if it was dry until they really did believe she was better. They all gather around Bridget to express their support, and to offer their gratitude that this service was available her, as well as to others that may suffer.

In order for Bridget and other women like her to receive fistula repair, hospitals must have the necessary medicines and surgical supplies. Direct Relief is dedicated to providing the necessary supplies to QECH and other hospitals providing fistula treatment in Malawi.

While the supplies are not sophisticated or high tech, they are critical for the operation and post-operative care. Ms. Grace Hiwa, coordinator of UNFPA Malawi’s fistula program, says that the donation of supplies from Direct Relief that arrived prior to the camp last May made it possible for Bridget and the other women to get treatment. This was because there was a major shortage of the appropriate size Foley catheter—an essential item for fistula repair surgery—which could not be found anywhere in hospitals and private pharmacies through the entire country. Ms. Hiwa emphasized that the Direct Relief donation came at a critical time and allowed the camp and treatment for these women to go forward.

Judging from the large number of women that turn out at every UNFPA-supported fistula camp and the long waiting list that remains, there is a serious need to continue and accelerate availability of fistula repair services in Malawi. As long as there is a need, Direct Relief is committed to providing the medical and surgical supplies critical to support this life-transforming care.

The post Life After Fistula: A Malawi Survivor’s Story appeared first on Direct Relief.

Walking into the post-operative ward at Queen Elizabeth Central Hospital, in Blantyre, Malawi, the room full of more than 80 women erupt into song, expressing their happiness to be dry and the chance to live free of their condition.

They are celebrating the end of suffering from obstetric fistula, a debilitating childbirth injury that occurs primarily during  prolonged, obstructed labor and leaves the woman with a hole in the birth canal, causing chronic incontinence.

With just a couple days left of the three week fistula repair outreach camp, organized by the United Nations Population Fund – Malawi (UNFPA – Malawi), an estimated 82 women from districts throughout Malawi and neighboring Mozambique will receive free treatment. The women range from 15 to 50 years old and had lived with the condition for as little as a few months to more than 20 years.

Direct Relief provided the essential medicines and medical supplies to support the fistula treatment services at Queen Elizabeth Central Hospital in partnership with UNFPA Malawi. Direct Relief also supports the fistula repair services provided at the Bwaila Fistula Center in Lilongwe, Malawi, as well as over 25 facilities throughout sub-Saharan Africa and South East Asia.

One young woman on the ward, Esmie (pictured above), was 17 when she became pregnant. She did not receive any pre-natal care during her pregnancy, so by the time she went into labor she felt it was too late to seek help at a health facility. She went into labor on Friday, and stayed at home with only her grandmother until she finally delivered on Sunday. The baby was stillborn. She began leaking immediately but for several years was unable to find help.

Finally, after hearing from her aunt that treatment might be available at Queen Elizabeth Central Hospital she came seeking help—and was registered for an operation during the twice-annual outreach camp. She is feeling better now and she is ready to go home and tell other people that help is available. She hopes she will be able to start a business selling fish, and hopes at some point to get pregnant again, at which point she will attend antenatal care visits and will come to the hospital when she goes into labor.

The post Fistula Surgeries Provide Renewed Hope for Women in Malawi appeared first on Direct Relief.

Obstetric fistula is a devastating childbirth injury that happens when women lack access to skilled birth attendants and emergency obstetric care. The condition is largely treatable with a surgical procedure.

Direct Relief supported the camp by air-freighting a shipment of essential medicines and medical and surgical supplies in response to an urgent request from UNFPA. The shipment arrived just in time to be put to use during the camp.

According to the report submitted by the UNFPA Malawi office, the Direct Relief supplies were particularly crucial because of a nationwide shortage of Foley catheters, one of the tools most essential for obstetric fistula repair.

Additionally, the donated supplies from Direct Relief allowed the hospital to spend its limited resources on procuring food for the patients, instead of spending the money to purchase medicines and supplies.

As indicated in the report by Dr. Ennet Chipungu, Medical Director of UNFPA Malawi, this was very helpful since it is critical that the patients have food, but it is often difficult to have a sufficient stock when the fistula patients stay a long time in the hospital and come from very far, rural areas.

The report also noted that the incontinence pads provided were a big relief and comfort to the patients, who remarked being very happy they had this extra support during their recovery.

Women who live with obstetric fistula often live lives of isolation and suffering. Fistula repair gives them an opportunity to regain their sense of dignity and self-respect, and allows them to return to their communities as healthy and hopeful individuals.

UNFPA Malawi is looking forward to the next camp scheduled for this fall and has requested Direct Relief’s assistance in providing medicines and supplies. Dr. Chipungu commented, “We just want to appreciate the speed in which you were able to send the supplies to us after we signed our partnership agreement.  We are very grateful.”

Direct Relief looks forward to partnering again with UNFPA Malawi and Queen Elizabeth Central Hospital to ensure women in need have access to timely fistula treatment.

The post Women in Malawi Receive Life-Restoring Fistula Treatment appeared first on Direct Relief.

For more than ten years, Direct Relief has supported fistula repair centers throughout Africa and Asia with donations of essential medical supplies to enable fistula-repair surgeries and, in partnership with the United Nations Population Fund (UNFPA) and The Fistula Foundation, created the Global Fistula Map to consolidate and publish information on fistula treatment capacity and activity worldwide and help direct resources.

Obstetric fistula is a hole in the birth canal that is caused by prolonged and obstructed labor. If untreated, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces. In addition to physical injuries, many women with fistula suffer humiliation, isolation, and stigma as a result of the smell and constant leakage. And in most cases of obstructed labor in which a fistula develops, the baby is stillborn.

Fistula was once common throughout the world, but over the last century has been virtually eradicated in Europe and North America through improved medical care.  In the United States the last fistula hospital, now the site of the Waldorf Astoria Hotel in New York, closed in 1895 because of diminishing cases.

“Two million women living with this disabling and often isolating  condition after having suffered the loss of a child is an enormous human tragedy that is hidden in plain sight because the nature of the condition and where the women live,” said Lindsey Pollaczek, Senior Program Manager for Direct Relief. “Because fistula has been virtually eliminated in the developed world for more than a century, we know it can be done everywhere, and we are working to make that a reality for all women no matter their economic situation.”

Surgical and medical supplies are a critical component of fistula care and can be expensive and difficult to obtain in areas of high need. To ensure health providers have a reliable flow of supplies to improve access to treatment, Direct Relief maintains a robust inventory of surgical and medical supplies to meet the diverse needs of fistula care providers across the world.

Having helped launch the world’s first Global Fistula Map, Direct Relief is expanding support to fistula repair centers in 15 countries based on the information gathered.  The incidence of new fistula cases and

the prevalence of the condition has traditionally been very elusive due to the stigmatizing nature of the condition itself and because it typically occurs in areas lacking basic health services and related public-health reporting.

Global data from 42 countries released on the Global Fistula Map reflects a grim future for most of the estimated two million women living with obstetric fistula worldwide and more than 50,000 women who suffer the devastating birth injury and stigmatizing physical condition each year.

The Global Fistula Map is an evolving collaborative effort developed by Direct Relief and can be found at www.GlobalFistulaMap.org. While the reported availability of surgical treatment for obstetric fistula is growing, the current capacity of most fistula treatment facilities remains limited.  Less than 10 percent of health facilities treat more than 200 women per year and nearly half of all facilities have only one or no surgeons permanently on-site. To learn more about Direct Relief’s efforts to address fistula and help spread the word, visit directrelief.org/fistula.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

The post First-Ever Day to End Fistula Brings Attention to Progress, Challenges appeared first on Direct Relief.

The Global Fistula Map was launched last year by Direct Relief, the Fistula Foundation, and the United Nations Population Fund (UNFPA) to consolidate and publish information on fistula treatment capacity and activity worldwide and help direct resources.  The incidence of new fistula cases and the prevalence of the condition has traditionally been very elusive due to the stigmatizing nature of the condition itself and because it typically occurs in areas lacking basic health services and related public health reporting.

For 2011, the number of women reported to have received fistula-repair surgery was 15,465, an increase of 6.1 percent from the totals reported for 2010, but far fewer than what would be required to address the estimated number of new cases occurring each year, let alone existing cases.

Obstetric fistula is one of the most devastating childbirth injuries and typically occurs when a woman without access to a skilled birth attendant or emergency medical care encounters prolonged, obstructed labor.  The extended pressure destroys internal tissue, creating an opening between the birth canal and bladder or rectum.  The prolonged, obstructed labour also often results in the tragic loss of the baby’s life, with the devastation compounded by the woman being left incontinent and unable to control her bladder and/or bowels for the rest of her life if the problem is not addressed surgically.

Often abandoned by their husbands and families, women with obstetric fistula find themselves ostracized from society. Girls drop out of school, women cannot work, and simple things—like getting on a bus—become an ordeal because of the way the sufferer smells.  Known as “the backyard disease,” fistula is a little-known social affliction which is extremely stigmatized within society.

Fistula was once common throughout the world, but over the last century has been virtually eradicated in Europe and North America through improved medical care.  In the United States, the last fistula hospital, now the site of the Waldorf Astoria Hotel in New York, closed in 1895 because of diminishing cases.

“Tragically, there are unacceptably high numbers of fistula cases, yet we see from the map data gathered so far that treatment currently only reaches a fraction of patients annually—not counting the significant backlog of cases,” said Gillian Slinger, UNFPA Coordinator of the Campaign to End Fistula. “Documenting where treatment is available is critical to providing care, raising resources and restoring the health and dignity of women and girls living with fistula.  If we know where service gaps are, we can then better steer activities forward, to get help to all those who need it.”

The Global Fistula Map is an evolving collaborative effort developed by Direct Relief and can be found at www.GlobalFistulaMap.org. The new edition reports on 238 health facilities providing 17,878 fistula repairs in 42 countries across Africa, Southeast Asia, and the Middle East, displaying data from the most recent year for which a health facility submitted the Global Fistula Map Survey. Data is therefore either shown for services provided in 2010 or 2011. While the reported availability of surgical treatment for obstetric fistula is growing, the current capacity of most fistula treatment facilities remains limited.  Less than 10 percent of health facilities treat more than 200 women per year and nearly half of all facilities have only one or no surgeons permanently on-site.

“The latest survey numbers, while disheartening, only push us to work harder to help repair the physical and emotional wounds of the women living with fistula,” said Lindsey Pollaczek, Senior Program Manager at Direct Relief.  “For Direct Relief, the Global Fistula Map enables the organization to know where fistula surgery is available, allowing us to increase our support of medical and surgical supplies to those treatment facilities, a critical component in helping sustain and expand their ability to provide care to women in need.”

Some of the new features of the Global Fistula Map include: new facilities reporting data; data on rehabilitation and reintegration services; stories of women who have received surgical repairs; and sources of financial support for fistula repair services.  The map will be continuously updated with information provided by experts and practitioners around the globe about facilities providing fistula repair and rehabilitation services.

“The Global Fistula Map is a crucial step forward in the field of fistula treatment. It is a dynamic and powerful tool that can help target scarce resources where they are most needed to treat women with obstetric fistula,” said Kate Grant, CEO of the Fistula Foundation.

Explore and share the map: www.GlobalFistulaMap.org

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

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A year after the launch of the first-ever Global Fistula Map, the largest and most comprehensive map of available services for women living with obstetric fistula, Direct Relief is pleased to release an updated version representing 17,878 patients at 238 sites in 42 countries with more data and new features.

The map was created by Direct Relief in partnership with The Fistula Foundation and the United Nations Population Fund (UNFPA), and represents a major step forward in understanding the landscape of worldwide treatment capacity for obstetric fistula.

Since last year, the map has helped improve coordination and allocation of resources to facilities while also raising awareness of the condition, which is little known in the developed world. According to currently accepted estimates, there are some 50,000-100,000 new cases of fistula every year.

Obstetric fistula, one of the most devastating childbirth injuries, is a hole in the birth canal caused by prolonged, obstructed labor when a woman goes hours or days without prompt medical attention. It is a highly stigmatizing condition, though in most cases is treatable through reconstructive surgery.

Having the right medical and surgical supplies is a critical component for helping women access fistula repair surgery. The Global Fistula Map enables Direct Relief to know where fistula repair surgery is available and increase the flow of medical and surgical supplies to those facilities, helping sustain and expand their ability to provide treatment to women in need.

Since the map launched, Direct Relief  has increased its network of fistula care provider partners by more than 50 percent, and now provides support to 18 hospitals in thirteen countries in Africa and Asia. In next 12 months, Direct Relief aims to enable 5,000 fistula repair surgeries.

The map has also been used by public health researchers to investigate the gap between demand and service provision for fistula repair as well as by foundations seeking to efficiently target funds to increase the number of women receiving treatment.

Additionally, the map was cited in the U.N. Secretary-General Report “Supporting Efforts to End Obstetric Fistula,” last fall as a significant step to streamline information on fistula-related activities – data that has been scarce, scattered, incomplete and difficult to obtain in the past.

Going forward, the Global Fistula Map will be continually updated, further refining our understanding of where treatment exists in order to strengthen collective efforts to help all women suffering from this condition.

New Features of the 2013 Global Fistula Map:

• 64 new facilities reporting data, including facility data from Chad and the Central African Republic, two countries not represented on the map in 2012.
• New data for rehabilitation and reintegration services.
• New “From the Field” feature to highlight the stories of the women that have received this life-restoring treatment as well as the dedicated surgeons and health providers that have committed themselves to this cause.
• New data on facilities’ source of financial support for fistula repair services
• New information about membership in the International Society of Obstetric Fistula Surgeons (ISOFS)

Key Findings:

• • Capacity for fistula treatment remains limited: Less than 10% of health facilities treat over 200 women per year and nearly half of all facilities have only one or no surgeons permanently on-site.
  • About 20% of facilities report that they only provide fistula repair services periodically. These facilities treated a total of 1,379 women in 2011. Lack of permanent and consistent services suggests that there are likely women in those regions who otherwise might have received care.
  • Overall, there was a slight decrease in the average number of women that received fistula surgery at hospitals that submitted data for 2010 and 2011. However, there appear to be significant regional differences and this finding warrants further investigation to understand if the decrease might be influenced by changes in funding, human resource availability, or other specific factors.  Nonetheless, it does suggest that overall capacity for fistula treatment has not increased significantly from 2010 to 2011, despite the alarming number of women that continue to suffer from the condition.
  • Just under half (48%) of all hospitals responding offer any type of rehabilitation or reintegration services following fistula repair surgery—including physical therapy, psychosocial support, or income-generating activities. 37% of hospitals provide physical therapy while only 33% of hospitals provide psychosocial support or counseling services.
  • The majority of facilities (76%) receive financial support from non-governmental organizations to fund fistula treatment services. 14% of hospitals take payment from the fistula patient or her family (self-pay) to cover the cost of fistula repair surgery, which can be a significant burden to the family and barrier for accessing treatment.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

The post Updated Global Fistula Map Strengthens Efforts to End Fistula appeared first on Direct Relief.

Earlier this month, Direct Relief provided a $50,000 grant to support essential obstetric fistula repair surgeries for women who are living with this devastating and debilitating condition in Somalia’s capital, Mogadishu.

Direct Relief again partnered with the Women and Health Alliance International (WAHA), an international nonprofit organization committed to improving maternal and neonatal health in disadvantaged communities throughout Africa, to help carry out the goals of the grant on the ground in Somalia, where only 1/3 of all births are attended by skilled personnel.

WAHA aims to improve maternity care to reduce the extremely high rates of maternal mortality and provide fistula repair services for women in the capital city of Mogadishu by training local health providers; establishing an ambulance service; upgrading the quality of equipment within the biggest child and maternity hospital in Somalia, Benadir Hospital; creating a midwifery school; and creating a 60-bed facility dedicated to fistula repair.

To fulfill this three-year project, WAHA is also working closely with Somali Ministry of Health, the United Nations Population Fund (UNFPA), and The Fistula Foundation.

These quality maternal and neonatal health services, including obstetric fistula treatment, are essential for host and internally displaced populations in Mogadishu. Since 2007, more than 2.2 million people have been displaced from their homes as a result of a raging insurgency combined with extreme food shortages because of an extensive drought and high rates of inflation.

The $50,000 grant from Direct Relief will help enable WAHA to carry out this vital work and will be used for the following essential interventions:

• $22,000—train nine Somali fistula care staff to fully take over the fistula repair operations at Benadir Hospital. This includes: two obstetrician-gynecologists, two anesthetist technicians, one operating theater nurse, two nurses, two social support/reintegration officers
• $18,000—perform 24 fistula repair operations for women who would otherwise be unable to pay for the procedure
• $10,000—repair and refurbishment of the 60 bed fistula treatment department including fixing holes in the roof, replacing electrical circuits and plumbing, rebuilding the sanitation facilities

Obstetric fistula is caused by prolonged and obstructed labor and creates a hole in the birth canal that, if left untreated, can cause chronic incontinence and bodily fluid leakage. Often the baby is lost and the hole that is created in the birth canal creates a severely debilitating and tragically ostracizing condition for each woman with the condition.

Roughly two million women in the developing world women suffer with this devastating – but fixable – problem and an estimated 50,000 to 100,000 cases develop each year, far surpassing the global capacity for treatment. The condition primarily results from a lack of quality maternity care services.

Together, Direct Relief and Women and Health Alliance will be able to reduce the number of women suffering from obstetric fistula in Mogadishu.

The post Restoring Health and Hope for Women with Fistula in Somalia appeared first on Direct Relief.

In the midst of Hurricane Sandy activity last week, it was nice to see the Global Fistula Map—published by Direct Relief, the Fistula Foundation, and the United Nations Population Fund (UNFPA)—cited in the U.N. Secretary-General Report, “Supporting Efforts to End Obstetric Fistula,”  presented by UNFPA Deputy Executive Director, Anne-Birgitte Albrectsen, at the United Nations.

As the report notes, obstetric fistula is often a severely debilitating and tragically ostracizing condition for each woman with the condition, and a deeply compelling humanitarian objective exists to provide necessary care that enables women with fistula to regain their lives. The condition results from broader causes including poverty and severely limited access to either information or appropriate care during pregnancy and delivery.

The fistula map is really not about mapping, but rather about knowing and understanding the many dimensions related to obstetric fistula so we can mobilize the right charitable resources and direct them to the right people in the right places in a thoughtful, focused way that addresses a problem appropriately. The map and the information that lies beneath it is a good example how modern geographic information system (GIS) tools and mapping technology can be useful in humanitarian health work.

Among other things, these tools enable us (and anyone else) to see at the same time both the “big picture” public-health context of a situation and very specific localized information needed to take action. For fistula, the big picture includes the global incidence of the condition, the root causes, general awareness of the condition and its causes, the availability of access to a skilled birth attendant, and moving the large gears and prioritizing big funding pools of government and international organizations.

Understanding this big picture is every bit as essential for Direct Relief and the terrific colleague organizations we work with, such as One by One and The Fistula Foundation, even though our respective day-to-day efforts tend to be focused more narrowly. These organizations do excellent advocacy and educational work, yet, they (like Direct Relief) focus primarily on providing direct support and resources to expand and improve access to both surgical care and the supporting services for women living with fistula. It’s important to see how individual efforts fit into and affect the larger issue.

But so too is the specific information about the actual places, facilities, patients, conditions, and experts that are doing the frontline work actually providing the care for women. They need resources and support to do more of their essential work. Dr. Hillary Mabeya—who with his wife founded and run Gynocare, a fistula hospital and support program in Kenya—for example, is exactly the type of person and program of which more are needed to help women with fistula that Direct Relief supports. In the conversation about the big, global issue of obstetric fistula, Dr. Mabeya needs to be “on the map” since it is he and his many colleagues, often working in relative isolation from each other, that are doing the actual work caring for women.

Driving with a map is better than driving without one. The general approach that led to the global fistula map also enables a much more focused and pragmatic use of charitable resources to “intensify resources to bridge the large gap” in treatment that exists, as the UN report states. In gathering information from all the various individual sites, for example, we learned that among the trained fistula surgeons who are providing this specific, life-restoring surgery,  a very particular type and size of suture is preferred. It is an expensive item, obviously far beyond the means of a destitute fistula patient and most often beyond those of the facilities and surgeons who are caring for the patients. In seeking either general charitable support for fistula or this and other particular items without which restorative surgery is impossible, it is essential to explain why it is needed, where it will be used, who will use it, and how many are needed.

That’s why it was good to see the Global Fistula Map highlighted in the UN report.  For similar reasons, but with respect to different issues, Direct Relief continues to push ahead and publish various maps, which also really aren’t just about mapping either. These maps, like any map, help us know where we are and where we’re going.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

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