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Dr. Harshad Sanghvi
Vice President & Medical Director, Jhpiego
The 2009 Award for Best Practices in Global Health
Thank you Joy, and thank you Global Health Council for doing me this immense honor.
Good evening, friends. It is a huge privilege for me to receive this award on behalf of Jhpiego and on behalf of all those amazing midwives in developing nations who have to live with and face the harsh reality of maternal death every day. It is also a huge honor for me to receive this award in the presence of so many accomplished health professionals who pursue the achievement for health for all with passion and energy.
I am especially pleased to receive this honor in the presence of Prof. Japheth Mati, who as professor and chair of the Department of Obstetrics and Gynecology at the University of Nairobi in Kenya, was my teacher, my mentor and my guide and who taught me that taking care to hundreds of women in the community was so much more rewarding than providing care to them in my clinic one at a time.
One common theme for many in this room is that we are in the business of creating change.
We create change because the current situation regarding the very high mortality and morbidity in developing nations, combined with the inequity in access to health care between poor and rich people is just not acceptable in civilized nations.
More important, we create change because we already possess and have possessed for quite a while, the scientific evidence and the technology for major interventions that can save millions of lives today. But most of all, we create change because we care. We care for women and their families.
We care for women and their families wherever they may be, and whether they are poor or rich, rural or urban and whether they are able to or not able to reach our health care facilities. We care.
Allow me to quote Barry Jones, politician and author, 1932–
I quote:
“ If you have the same idea as everybody else, but have them one week earlier than everyone else, then you will be hailed as a visionary. But if you have them five years earlier you will be named a lunatic”
So ladies and gentlemen, I had this notion a week before everyone else, the notion that we could solve the problem of maternal mortality by attacking in a systematic, aggressive and sustained manner, one or at most two of the leading causes of death, a notion that was substantially at odds with the wisdom with which the Safe Motherhood initiative was crafted.
But the lunatic in this case, the lunatic who had thought this through many years earlier was Noel McIntosh, former president of Jhpiego and my other mentor and I thank him for providing me with so many opportunities and ideas to pursue.
I also thank Molly Gingerich, then at USAID/Indonesia for allowing Jhpiego to pursue the introduction of Active Management of Third stage of Labor in midwifery education, and than fought many battles that I know of and several others that I do not know of, so as to permit us to test community based distribution of the drug misoprostol. A drug that women could keep and use immediately after childbirth to protect themselves from hemorrhage in case a skilled provider was not available. [A]Sort of Plan B.
A turning point in creating change, came when together with Patricia Stephenson, of USAID we were able to get the two leading global professional associations dealing with health care for women, the International Confederation of Midwives and the International Federations of Obstetricians and Gynecologists to come together for the very first time to issue a joint statement: midwives and doctors working together to address PPH. That was in 2003. It was fitting that this catalytic and historic event occurred in Ottawa, in a building that was formerly the chapel of the order of “Sister Adorers of Precious Blood.”
It has been such a pleasure working with community volunteers in Kenya, in Indonesia, in Nepal, in Afghanistan. These volunteers are able to identify pregnant women in their communities, provide them sufficient information about PPH and distribute the medication misoprostol when women are 8 months pregnant and visit mothers after birth. These volunteers have the capability of reaching everyone, and overcome that first and second delay that is the major cause of maternal death and disability; something that facility based services can never hope to do. And these volunteers work for no fees but are motivated by the creativity of their leaders in the community. In Indonesia for example, the district elders provide two young men to help the each CHW prepare her paddy for rice planting so that she can go house to house to help pregnant women. In Afghanistan the district Shura will supply free power to the CHW, from the community power generator in gratitude for her community service. The most important lesson I have learned is to never to allow illiteracy to be confused or thought of as a lack of intelligence.
While I am pleased that some countries have made much progress in adopting such life saving innovations, many others remain behind. I am particularly concerned that such innovations take so long to become a reality in Africa. And there are a number of proven inexpensive, evidence based innovations that are languishing, such as calcium supplementation that could halve the mortality from the second biggest killer of women in childbirth, preeclampsia. I do wish that each of these effective interventions for which evidence has existed for more than 10 years can find some champions here and in all the countries we serve.
I wanted to take this opportunity to thank my dear wife Bharti, who sacrificed her career as a teacher so that I could pursue my dreams, and my two children Anjali and Shimal who are such a joy.
Let me end by thanking you once again for this great honor. It truly belongs to the thousands who work to save lives everyday.
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