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We know how to save their lives, yet 800 women die every day from pregnancy-related causes. We know how to ease their suffering, yet many victims of sexual violence go without any medical or psychological care. Millions of newborns die in the first weeks of life from preventable causes. And while we know how to keep HIV-positive mothers from passing the virus to their babies, every day 700 children come into the world with HIV.

There are challenges keeping women in developing countries from getting the care they need, the services that should be easily accessible to them. It is urgent that they be addressed—and Doctors Without Borders/Médecins Sans Frontières (MSF) has seen from our own work that it can be done. Because Tomorrow Needs Her explores these challenges through the experiences of MSF field workers: doctors, midwives, nurses and counsellors.

In seven chapters, each focused on a specific issue, and one journal that documents six months working in an MSF maternity hospital in Sierra Leone, these field workers share stories of especially memorable patients and describe how field teams have often managed to overcome difficult issues, times when they haven’t, and what still needs to be done.

In first-hand testimonies, patients and patients’ relatives also share the challenges they face in getting care. And through striking photo stories and videos, we see what those challenges mean for individual women.

What You Can Do

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The Print Book

Because Tomorrow Needs Her is available as a print book. Order it online at www.doctorswithoutborders.org/book.
You can also click here to download a pdf of the entire print book.
Send any questions to womenshealth@msf.org.

The Contributors

Martina Bacigalupo was born in 1978 in Genoa, Italy. After studying literature and philosophy in Italy, she studied photography at the London College of Communication. In 2007 she moved to Burundi, East Africa, where she continues to work as a freelance photographer, often in collaboration with international NGOs [among others: Human Rights Watch, Amnesty International, Doctors Without Borders/Médecins Sans Frontières (MSF), and Handicap International]. Her work has been published on the New York Times, Sunday Times Magazine, Le Monde, Vanity Fair, Esquire, Liberation, Internazionale, and has been shown in several international venues, including PARIS PHOTO 2013, UNSEEN, Amsterdam 2014, and AIPAD New York 2014. She won the Canon Female Photojournalist Award in 2010 and the Fnac Award for photographic creation in 2011. She is member of AGENCE VU in Paris and is represented by Grimaldi Gavin Gallery in London.

Dr. Helen Bygrave trained at Cambridge University and University College London School of Medicine, qualifying as a general practitioner in 1995. Since 2005, she has worked for MSF, supporting HIV/TB programs across Africa and Asia. She currently works as one of MSF’s HIV/TB advisors in the Southern Africa Medical Unit. One of her major focuses has been supporting the field implementation of Prevention of Mother to Child HIV Transmission (PMTCT) programs, including operationalizing PMTCT B+.

Eva de Plecker is a midwife. She completed the International Course on Planning and Management of Reproductive Health Programs at Prince Leopold Institute of Tropical Medicine in Antwerp in 2008. She began working for MSF in 2004 in Rwanda, Ethiopia, Papua (Indonesia), Zimbabwe, Democratic Republic of Congo, and Haiti. From 2010 to 2011 she worked as sexual and reproductive health referrent and currently is an advisor for sexual and reproductive health at MSF-Belgium.

Dr. Séverine Caluwaerts qualified as a gynecologist-obstetrician in 2007 in Belgium, her home country. During her residency she spent one year in South Africa where she cared for a large population of HIV-positive women. After finishing her specialization, she did a six-month tropical medicine course and in 2008 went to work with MSF in Sierra Leone, to which she has returned several times. She has also worked in Democratic Republic of Congo, Niger, Burundi, Pakistan, and Afghanistan in MSF’s maternal health projects. When she is not on mission, she works with HIV-positive pregnant women in Belgium and is involved in teaching medical students and midwives. She is also one of the referent gynecologists for MSF.

Joanne Cyr, Psy.D., is a clinical health psychologist and advisor on patient support, education & counselling (PSEC) for MSF-Switzerland. She also works for MSF as a flying specialist/PSEC implementer, travelling to different MSF projects to aid in strategic planning, evaluation of program activities, and training and coaching teams to strengthen a patient-centered approach to care in health structures and communities. She has worked with MSF since 2010, involved in training, mentoring and implementation of activities to support Prevention of Mother to Child HIV Transmission (PMTCT), adherence counselling by HIV/TB expert patients, and community models of sensitization, testing and counseling on HIV and TB.

Patrick Farrell has been a photographer with The Miami Herald since 1987. He is the recipient of the 2009 Pulitzer Prize for Breaking News Photography—awarded for his photographs of the devastation in Haiti caused by a particularly brutal hurricane season. Farrell has documented three decades of major news events, both locally and abroad, including the 1989 race riots in Miami’s Overtown neighborhood, political and civil unrest in Haiti during the country’s 1994 military rule, Hurricane Andrew’s 1992 path of destruction in South Florida, the 1999 earthquake in Turkey, the Columbine High School massacre, and childhood poverty in the Americas. He has won numerous awards for his coverage of Haiti, including a Feature Photography Award in 2008 from the Overseas Press Club, two first place awards from Pictures of the Year International (also in 2008), and the first place 2009 National Headliner Award for Photo Essay. Farrell has been named Region Six Photographer of the Year twice by the National Press Photographers Association. He is an adjunct professor of photography at Florida International University, where he is helping develop a photojournalism program for the FIU School of Journalism and Mass Communications. Born in Miami, he graduated from the University of Miami in 1981. Farrell is married to Miami-based journalist Jodi Mailander Farrell and they have two young daughters.

Kate Geraghty started work as a photographer in 1997 and has been a staff photographer with the Sydney Morning Herald since 2001. In that time she has covered the 2002 Bali bombings, the 2003 invasion of Iraq, South Asian Tsunami, 2006 war in Lebanon, humanitarian crisis in the DRC, South Sudan’s historical referendum vote for independence, Gaza flotilla attack in 2010, Afghanistan and Papua New Guinea in 2013. In 2014, Kate covered life under sanctions in Iran, the Crimea crisis, the war in East Ukraine including the MH17 downing, and has just returned from covering the war against ISIS in Iraq. She was recently awarded 2013 Nikon Walkley Press Photographer of the Year, Australia.

Olivia Hill is a reproductive and sexual health referent in the medical department of MSF-Spain. She is a nurse and midwife with a specialization in tropical diseases and holds a masters degree in Sexual and Reproductive Health Research from the London School of Hygiene & Tropical Medicine. She began working with Action Against Hunger in 1998, traveling to Afghanistan, Sudan, and Cambodia, and joined MSF in 2000 where she supported sexual and reproductive health activities in Eritrea, Sierra Leone, Somalia and Colombia. She has contributed to MSF’s field research through evaluations of rapid diagnostic tests for malaria in Colombia, investigating the gap between the use of antenatal and delivery services in northern Uganda, and documenting the sexual and reproductive health consequences for victims of trafficking in Morocco. In addition, she represents MSF as an active member of the Interagency Working group (IAWG) on reproductive health in crisis and is a contributing author to the 2010 IAWG field manual.

Kristin Hooper is a registered nurse who has worked in a variety of health care settings. Starting out working in an adult cardiac intensive care unit (ICU), she discovered pediatrics by chance. Over the last eight years, she has worked in a neonatal ICU, a pediatric ICU, in pediatric oncology, and in several adult and pediatric emergency rooms at home in the United States and abroad. She worked with MSF for five months in Aweil, South Sudan, with a focus on pediatrics. Currently, Hooper works as a pediatric flight nurse at Oregon Health and Science University and is finishing a graduate degree in Family Practice Nursing.

Dr. Michiel Lekkerkerker qualified as a MD in 1983, and received additional training in emergency surgery, obstetrics, radiology, and family medicine in Holland, the Netherlands Antilles, and South Africa. Between 1985 and 1995 he worked mainly in Africa as a district health manager with heavy clinical duties. He has vast experience in war surgery and emergency obstetrics in resource-poor settings. After a brief stint as general practitioner in Holland, he started working for MSF-Holland in 1999 as a health advisor supporting MSF projects in various countries. He has been the surgical advisor for MSF-Holland for eight years. He is also a reproductive health advisor and a member of MSF´s intersectional working group on sexual and reproductive health. He has a particular interest in the issue of obstetric fistula and he introduced a model of care for women living with fistulas in MSF-Holland.

Meinie Nicolai first worked with MSF in 1992, as a supervising nurse in Liberia. She has since gained a decade of field experience in Angola, the Democratic Republic of the Congo, Ethiopia, Rwanda, Somalia and South Sudan. Nicolai then returned to her native Netherlands to coordinate national network on sexual and reproductive health and AIDS between 2002 and 2003, but her involvement with MSF continued and she became a board member of the Belgian association. In 2004, she became director of operations in the Brussels office until October 2010 when she was elected president of both MSF-Belgium and MSF’s operational directorate in Brussels.

Pamela A. Onango is a registered nurse-midwife from Kenya . Among other assignments, she has supervised mobile clinics and networked with traditional birth attendants in South Sudan, helped implement an Option B+ Prevention of Mother to Child HIV Transmission (PMTCT) pilot program in Swaziland, and set up a reproductive health department in an emergency project for internally displaced people in South Sudan. Before joining MSF in 2009, she worked with Kenya’s Ministry of Health for 14 years.

Dr. Nicolas Peyraud, MD, is a pediatrics specialist and serves as Pediatric Advisor for MSF-Switzerland. After completing his training in Switzerland he joined MSF in 2009 as a pediatrician, working at an MSF project in Niger. In 2010 he developed a training plan designed to improve the quality of medical care for malnutrition with a focus on high-level hospital care for malnourished children. He then implemented the training for MSF field staff in Zinder, Niger, and in Dadaab, Kenya. He joined the MSF-Australia Project Unit in 2011 as a pediatric advisor, focusing on hospital care for sick newborns and sick children. He provides supervision remotely and in the field for MSF projects in countries including South Sudan, Central African Republic (CAR), and Jordan.

Aerlyn Pfeil is a certified professional midwife from Portland, Oregon. In 2011, after working as a home birth midwife, she joined MSF and went on to work in South Sudan, Haiti, Senegal, the Somali region of Ethiopia, and Papua New Guinea. In addition to performing clinical maternal health work, she has trained midwives and community health workers and treated survivors of sexual violence. Pfeil has also trained MSF staff on gender issues and the delivery of medical and psychological care for sexual violence survivors. In 2014, she served as medical team leader for MSF’s treatment and training program for survivors of family and sexual violence in Papua New Guinea.

Debbie Price is a certified nurse-midwife and has been working with MSF since 1998. Her field experience includes serving as a medical coordinator in Democratic Republic of the Congo, Tajikistan, Pakistan, Sudan (Darfur), and Haiti. She has trained first-time medical coordinators and has been a member of the MSF emergency team. Price has also conducted program project evaluations for MSF in Cambodia and Russia (North Caucasus). She holds a Doctor of Public Health degree and her academic work has been focused on reproductive health in emergency settings. She is now based in the MSF-Holland office where she serves as the reproductive health specialist advisor for ten projects, and as coordinator of medical specialists for fifteen office staff.

Dr. Betty Raney earned her medical degree from Indiana University Medical School. She completed her residency in obstetrics and gynecology at Methodist Hospital in Indianapolis, Indiana in 1990, and has been actively practicing since that time. She spent six months as a practicing obstetrician and gynecologist with MSF in Gondama, Sierra Leone in 2012.

Nele Segers studied midwifery and tropical medicine and earned her Masters degree in Nursing and Midwifery Sciences as well as her teaching degree in Belgium. She joined MSF in 2007, working as a midwife first in Sierra Leone, then in Chad, Democratic Republic of Congo, Central African Republic, Afghanistan, Haiti, Ethiopia and South Sudan. In 2012 Segers started work for a year as a mentor for MSF midwives on their first assignment with MSF-Spain in Ethiopia, Yemen, and Syria, and other countries. After working for a short period at the University Hospital of Brussels, she returned to Central African Republic in 2014 as coordinator for an MSF maternity project. Segers was trained as a global ALSO (Advanced Life Support in Obstetrics) course instructor and has assisted in training staff in Denmark, Nairobi and India. She has also trained staff on treatment for sexual violence victims in Yemen and Nairobi.

Catrin Schulte-Hillen began working with MSF in 1989 as a midwife, going on to serve as a project coordinator and project manager in conflict and post-conflict contexts in Africa, Latin America, and the Balkans. Before becoming MSF’s reproductive health and sexual violence care working group leader, Schulte-Hillen was program director for MSF-USA and worked for several years as a health advisor and consultant on a number of specific assignments and evaluations for MSF and for other NGOs and the European Commission. As working group leader, Schulte-Hillen contributes to defining MSF’s vision, medical policies, and strategies, and to improve assistance in the areas of reproductive health and sexual violence care. She is a licensed midwife and holds a Masters of Public Health, a license in applied epidemiology and statistics, and a degree in business administration.

Rebecca Singer is a doctorally prepared nurse with over a decade of experience in humanitarian response and development work. She spent nearly five years with MSF focusing on providing services to survivors of sexual and family violence in Liberia, Kenya, Chad, DRC, Zimbabwe and Papua New Guinea. She also worked with survivors of torture who had immigrated to the United States, ensuring that they had adequate health care services. Following her tenure with MSF, Rebecca has worked with several development organizations dedicated to improving the quality of life of coffee farmers. She is currently the executive director of Coffee Kids. Prior to becoming a nurse, Rebecca worked in community relations and as a communications manager for a membership organization. These experiences have shaped Rebecca’s philosophy that embraces both direct patient care and advocacy with a community approach.

Sydelle Willow Smith is a freelance photographer/filmmaker from Johannesburg, South Africa, now based in Cape Town. She is keenly interested in the subject of migration. Her 2014 public art project Soft Walls featured photos that sought to deal with convivial relationships between migrated African nationals and South Africans. Smith’s short film Vecinos (Neighbours), 2013, was completed as part of a residency at Jiwar, Creation and Society based in Gracia, Barcelona, funded by The Africa Centre and the Spanish Embassy of South Africa. Of this project, where she used video, documentary and participatory photography, Smith says: “I am intrigued by how people who are a minority, such as African ‘migrants’ in Barcelona, navigate the city. What is their experience of it? What happens after one survives the treacherous crossing by boat, or how has the experience changed after living here for twenty years…” Smith is currently completing her Masters of Science in African Studies at Oxford University through St. Antony’s College.

Ann Van Haver studied midwifery at Artevelde Hogeschool in Gent, Belgium, completing her internship in two Ugandan hospitals. After acquiring her undergraduate degree, she worked in a private hospital in Uganda, where she learned most of her technical skills. In 2006, she worked in the maternity and delivery room of a hospital in Brussels, where the majority of patients were immigrants, and took a course on tropical medicine for nurses and midwives in Antwerp. In 2007, Van Haver joined MSF, going on to work as a midwife in Liberia, South Sudan, Darfur, Central African Republic, Burundi, Pakistan and Afghanistan. She has also provided sexual and reproductive health (SRH) consultations, helped integrate Prevention of Mother to Child HIV Transmission (PMTCT) services into maternal care projects, assisted medical treatment for sexual violence, set up SRH activities, and, in Afghanistan, serving as a project’s medical referrent. Central in all of her field work with MSF has been the training and coaching of national staff. In 2013, Van Haver began working as a SRH mobile implementation officer for MSF-Belgium, supporting different MSF projects to offer quality SRH services, coaching field workers on their first assignments with MSF, and implementing new SRH activities.

Acknowledgements
This project could not have happened without the tireless contributions and overall support of Catrin Schulte-Hillen. Séverine Caluwaerts also contributed hugely to this project. Several other members of MSF’s Sexual and Reproductive Health Working Group provided invaluable guidance and contributions, including Eva Deplecker and Olivia Hill. Darin Portnoy and Greg Elder provided constructive reviews of all the material. Debbie Price and Meinie Nicolai provided particularly helpful contributions.
Phil Zabriskie and Stephanie Davies contributed editing support. Communications officers in MSF offices around the world contributed material, including Sandra Smiley, Laura McCullagh, Vivian Lee, Yann Libessart, and Eddy McCall. Countless field and headquarters staff reviewed the material and provided important information.
Alexandra Brown, Doris Burtscher, Francoise Duroch, Atif Fazari, Asia Kamble, Marjie Middleton, Raquel Rosenberg and Karen Stewart provided early contributions. Meg Sheahan conceived of the original idea. We are grateful to Expedia, Inc. for its financial contribution to this project.
All are warmly thanked.

Editor: Melissa Pracht
Designer: Renee Kim
Site developer: Mike Kim


CONTACT
Melissa Pracht, Editor
womenshealth@newyork.msf.org
Doctors Without Borders/MSF-USA
333 7th Avenue, New York, NY 10001-5004
T. (212) 679-6800


ABOUT MSF
Doctors Without Borders/Médecins Sans Frontières (MSF) is an international medical humanitarian aid organization that provides assistance to people in distress, to victims of natural or man-made disasters, and to victims of armed conflict, irrespective of race, religion, creed, or political convictions. Learn more about MSF-USA or about MSF International.
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