All posts by Melissa Pracht

DR Rasha

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Dr. Rasha Khoury is an obstetrician-gynecologist based in New York City. Dr Khoury worked in a Doctors Without Borders/Médecins Sans Frontières (MSF) trauma facility in April and May 2017.

Disclaimer: The location of the project has been withheld to protect MSF patients and staff. Although abortion for medical reasons is legal in the country where the project operates, it is still a very sensitive issue.

My handheld radio crackled under my long dress. “Cars are leaving in 10 minutes.” I cursed under my breath. I needed to stabilize this patient before we left. I radioed back, “Can we hold the departure time?” The field coordinator finally texted, Ok, but keep me posted. Delaying the Doctors Without Borders/Médecins Sans Frontières (MSF) medical convoy inside the city was always a risk. Ongoing fighting meant that we had to leave the hospital by late afternoon each day. Our local colleagues remained overnight to keep medical activities functioning 24 hours a day.

I was waiting for the patient to deliver. She was anemic and bleeding heavily. We were transfusing her as fast as possible with blood from our blood bank but I anticipated further hemorrhage after she delivered. I sent our ambulance to local hospitals—which were still only partially operational because of the conflict—to look for fresh frozen plasma (FFP). I took a breath and noticed the patient’s mother pacing. The patient was crying in pain and squeezing the midwife’s hand; my colleague was calm and soothing. I refocused to place a second IV cannula and provide more fluid for resuscitation. Someone ran over from the operating theater with a medication that helps to control bleeding. Time was moving in slow motion, but every second was critical. My clothes were drenched in sweat.

Out of the corner of my eye I saw the field coordinator in the hallway, then heard the radio, “Convoy on hold for medical emergency.” I felt relief. Minutes later the patient delivered. It took an hour to stabilize her with all the medications we had available to make the uterus contract back to its usual size, four units of blood, two units of FFP, many liters of normal saline, a urine catheter, and continuous uterine massage. The midwife smiled proudly as the patient’s mother kissed her hand. We were able to save her life and avoid performing a hysterectomy—two outcomes that are rare for patients in her condition.

The patient had risked her life to reach MSF’s trauma center. She was pregnant but unsure how far along the pregnancy was. When we examined her, she complained of shortness of breath and her belly was unusually ballooned. She had not felt fetal movement for several days. We performed an ultrasound and determined that she was around seven months along. We also saw that the amniotic fluid level inside her uterus was too high—a medical condition often associated fetal abnormalities. The dangerously high level of fluid was likely worsening her shortness of breath.

The fetus had heart activity but lacked brain structures. This condition is called anencephaly—a fatal fetal abnormality that causes death in utero or almost immediately after delivery. The condition is directly linked to folic acid deficiency. Conflict makes this anomaly—a rare deficiency in countries like the United States (US)—considerably more common when people cannot access folic acid fortified foods and supplementation, family planning, early pregnancy diagnosis and treatment, and affordable health care services. During my time in the trauma unit, I saw pregnancies affected by anencephaly multiple times a week but in my 10 years of training and practicing obstetrics in the US, I have only seen this condition a handful of times.

It is dangerous for women carrying a fetus with anencephaly to go into labor while at home, especially in times of instability and conflict. anencephaly puts the mother at high risk of hemorrhage both before and after delivery—a preventable complication, but one of top five causes of maternal mortality each year. Our patient had travelled several days to reach our facility. If I had sent her home without inducing her labor, it is unlikely she would have made it to a functioning health facility in time to receive the care she needed to survive.

Explaining the diagnosis to the patient was not easy; the accumulation of suffering was visible everywhere on her face. Her husband and three of her five children were killed in the fighting. But knowing the risk she faced if we sent her home, and knowing her fetus would not survive, we offered to induce her labor to end the pregnancy safely in our facility. Here I could attend her delivery and she would have access to an operating room and blood bank should she need those services. This care would be free of charge; in keeping with our principles, MSF provides free care to everyone regardless of race, religion, or political status.

Safe abortion care plays a vital role in reducing maternal morbidity and mortality. MSF is committed to offering safe abortion care services if needed. How we provide these services depends on the specific context and is tailored to keep patients and staff safe.

Unsafe abortion is one of the five main causes of maternal mortality worldwide, together with hemorrhage, eclampsia, sepsis, and obstructed labor. Unsafe abortion accounts for 13 percent of maternal deaths around the world, according to the World Health Organization. MSF’s priority is preventing the consequences of unwanted pregnancy and unsafe abortions.

Wherever MSF works, we must navigate different value and belief systems, taking social norms and laws into account without allowing them to inflict further suffering on vulnerable groups. MSF stands behind safe abortion care as a medical necessity and argues for it from a humanitarian and evidence based perspective.

Had we not been able to provide this care to the patient, it is quite possible she would have died from the obstetric hemorrhage at home, or in another medical facility that may not have had all the resources she needed. She remained hospitalized overnight for observation; most women insist on going home within hours of delivery. The following day I found her waiting for our MSF convoy to arrive so she could say her goodbyes. We talked with her about what she had just been through and provided her with contraception, iron, and a high dose folic acid supplementation to prevent this happening again if she were to unexpectedly become pregnant in the future.

When we think of insecure environments and conflict, we often think of direct injury and death, food and shelter shortages, or perhaps we think of the spread of diseases. The countless people with indirect injuries leading to death or near-death experiences, like this patient, remain mostly invisible.

  #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

In War Zones, Mothers Need a Safe Alternative to Breast Milk

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A nurse examines a malnourished 6-month-old girl in MSF’s Qayyarah Hospital in Mosul, Iraq. Photo by SUHAIB SALEM/REUTERS

  “It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” wrote Manuel Lannaud, MSF’s country director for the organization’s projects in Iraq. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

The writer Gayle Tzemach Lemmon reports on the complex problem of providing for babies in wartime in “Don’t Make Babies Rely on Breast Milk in War Zones” on

It’s a problem MSF field workers are grappling with as large numbers of malnourished babies arrive at hospitals and clinics around Mosul and other conflict zones. The tiny patients are often brought by mothers stressed or traumatized by trying to survive and keep their children alive in the midst of deadly violence.

While MSF agrees that breastfeeding is best, aid workers on the front lines say there needs to be flexibility in how humanitarian organizations respond to malnutrition, especially in conflict zones. Read the article on

MSF has treated more than 300 babies for malnutrition in Qayyara, Iraq, since March, most of them under 6 months old. Many of these sick infants arrived with families fleeing the besieged part of western Mosul. Their mothers have often been unable to breastfeed due to the trauma and living conditions they’ve endured, and in western Mosul there is little access to formula or health care.

Read Iraq: Babies Suffering from Severe Malnutrition in Mosul Region

  #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

Sexual Violence Should Be Recognized as a Public Health Issue in Haiti

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Giselle*, 20, a survivor of sexual violence, in Port-au-Prince. Photo by Benedicte Kurzen/NOOR [*Name has been changed]

Recently, staff from MSF’s Pran Men’m clinic for sexual and gender-based violence (SGBV) survivors in Port-au-Prince held a powerful Facebook Live where they talked about the patients they see every day.

Watch it here:

MSF is pushing for Haiti to recognize SGBV as a public health problem, and calling for coordinated, comprehensive care to be made available for all survivors.

A lack and need of such services is not unique to Haiti, but numbers from the Pran Men’m clinic (Haitian creole for “take my hand”) have pushed the organization to launch a public campaign.

Over two years MSF teams have treated 1,300 patients at Pran Men’m; 77% have been under 25 years old and 53% were under 18. This high rate of minors who’ve experienced sexual violence is particularly worrisome.

Some additional numbers:

  • 4 out of 5 minors treated at the clinic knew their attacker
  • Most attackers were family acquaintances and 11% were household members
  • 71% percent of children under 10 were abused in places where they should feel safe
  • 1 in 5 minors who came to the clinic after they were sexually abused was previously exposed to SGBV

  • This photo story combines haunting photographs from Haiti with the findings of MSF’s report, “Against Their Will”.

    “Against Their Will” stresses that comprehensive care is needed for survivors, which includes both medical and psychological services. Survivors need to know that they can and should receive treatment for sexual violence, and that they should come for treatment within 72 hours of the attack so they can receive effective prophylaxis for STDs and unwanted pregnancy. There is also a dire scarcity of safe shelter for those who fear continued abuse if they go home. MSF reports that longer-term shelter for these survivors is one of the biggest needs that must be addressed. Read more.

    Subscribe for updates to the Because Tomorrow Needs Her project!

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    Preventing Cervical Cancer in Zimbabwe

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    Tendai Chigurah a nurse mentor, visits, Florence at home in a remote village near Chimombe Hospital in Gutu district. Photo by Melanie Wenger/COSMOS

    Tendai Chigurah a nurse mentor, visits, Florence at home in a remote village near Chimombe Hospital in Gutu district. Photo by Melanie Wenger/COSMOS

    Cervical cancer is the leading cause of cancer-related death in Zimbabwe.

    Doctors Without Borders/Médecins Sans Frontières (MSF) has been working with the ministry of health in Masvingo, a rural province in southeastern Zimbabwe, to provide a range of simple but effective cervical cancer prevention strategies. Here are some of the women who have gotten help through the project.

    Ngonidzashe and her husband Hastings.  Photo by Melanie Wenger/COSMOS

    Ngonidzashe and her husband Hastings. Photo by Melanie Wenger/COSMOS

    “I live in Mahachi village with my husband, an electrician. We have three children, a small field with tomatoes, and a few hens. Both my husband and I are HIV-positive, but thankfully our children aren’t.

    Despite being HIV-positive, I was in good health. When I heard about the test to screen for cervical cancer at Gutu rural hospital, I volunteered, even though I wasn’t feeling any pain. I was excited when I heard that this test could save lives.

    I listened to all the information before the test and the nurse explained every step during the screening. When they finished, they told me I had cervical lesions covering 75 percent of my womb.

    They said I was supposed to go to Harare, the capital, to get treatment and have LEEP [a procedure that removes the lesions] because it wasn’t possible to have it done in Gutu. We didn’t have the money to go and I was very scared.

    In February 2016, I got a call from MSF, who offered to cover all the costs. The MSF car picked me up and took me to Newlands clinic in Harare, where I had the procedure done. I was home by the evening. They told me I didn’t have cancer and I was just so happy.

    In February this year, I went for a repeat screening and it was negative, meaning I have no lesions anymore. I will now go every year for the screening.”

    —Ngonidzashe, 28, Gutu, Zimbabwe, March 2017

    Portrait of Magaret.  Photo by Melanie Wenger/COSMOS

    Portrait of Magaret.
    Photo by Melanie Wenger/COSMOS

    “My eldest daughter died of cervical cancer and we found out too late because she didn’t tell us.

    In February 2016, I heard about the screenings from the nurses at Chimombe rural hospital. Even though I’ve been divorced for eight years and had no symptoms, I decided to have the screening because they explained I was still at risk.

    On the day of the hospital appointment, I walked for two hours to get there. After the screening, I learned that I had lesions on my cervix. The medical staff asked if they could perform cryotherapy straight away, which treats lesions with the freezing method. At first, it was difficult to accept, because I thought I had cancer, but the nurses reassured and counseled me.

    The cryotherapy was a little bit uncomfortable, but I was determined to have it done. After the treatment, I walked for two hours to get home. I wasn’t in pain or sick from the procedure.

    In August 2016, I came back for a follow-up appointment to see if the cryotherapy was successful. They told me I had no lesions anymore. I also had an HIV test, which came back negative, so I don’t have to come back for my next screening for another three years.

    I’ve tried convincing my two daughters to have the screening, but they saw their sister die of cervical cancer and are still too scared. They say, ’I’d rather die undiagnosed than screen for cancer.’

    But I was happy to learn I had these lesions, because it was an opportunity for me to get treatment and be cured.”

    —Magaret, 58, Gutu, Zimbabwe, March 2017

    Faceme discusses her medical report with MSF nurse mentor Sister Tendai Chigurg. Photo by Melanie Wenger/COSMOS

    Faceme discusses her medical report with MSF nurse mentor Sister Tendai Chigurg. Photo by Melanie Wenger/COSMOS

    Portrait of Faceme.  Photo by Melanie Wenger/COSMOS

    Portrait of Faceme.
    Photo by Melanie Wenger/COSMOS

    “When my husband died in 2001, he left no pension. I own three goats and I’m lucky that a nearby family asked me to work for them as a housekeeper, which helps me pay for [my two children’s] school fees and upkeep.

    In September 2015, I had malaria and went to Chimombe hospital to get treatment. It was the very same day that the [cervical cancer] screenings started there. When I heard the nurses giving education about it, I decided to have the screening. I was the very first patient in the hospital to be screened.

    I was told that I didn’t have any lesions, but because I have HIV, I had to come back the following year. I had my second screening in September 2016 and am still negative.

    I stay healthy by eating well, sticking to my antiretroviral treatment [for HIV] and not overworking. I want to continue having cervical cancer screenings every year.”

    —Faceme, 43, Gutu, Zimbabwe, March 2017

    Portrait of Beauty and her husband at home. Photo by Melanie Wenger/COSMOS

    Portrait of Beauty and her husband at home. Photo by Melanie Wenger/COSMOS

    “When I met Charles six years ago, I told him I was living with HIV and had three children, but he still wanted to marry me. We desperately wanted to have a child together.

    Seven years ago, I lost my older sister to cervical cancer, and was worried it might happen to me as well. We only found out that she had cancer when it was too late and she had come home to die.

    In September 2015, I had pain in my abdomen. I heard from a friend about the screening at Gutu rural hospital, so I went. The test results showed I had lesions that couldn’t be treated at the local clinic. MSF took me to Newlands clinic in Harare and paid for the procedure. The nurses told me the results, which recommended that I have my uterus removed, but I found out I was pregnant.

    We both wanted [a child], but my husband was torn because he didn’t want to lose me. Throughout my pregnancy I had regular check-ups, and the doctor booked me for an elective Caesarean to prevent any risks.

    Our baby is two weeks old now and we are both so happy. I’ve been advised to have another test for cervical cancer six weeks after my delivery. Now that we have a child, I’m fine with any course of treatment, even a hysterectomy.

    My strong message is that every woman should get screened, there’s no shame in it. I would have stayed in the dark if I hadn’t been screened.”

    —Beauty, 36, Gutu, Zimbabwe, March 2017

    “It wasn’t an easy decision, but we decided to have the baby, knowing the risks. I was still very worried. The nursing staff were very surprised that I went with her every time, and said we were a very loving couple. Men should encourage each and every program that is supportive of women’s health. We benefit from these programs, too, because they save the lives of our families.”

    —Charles, Gutu, Zimbabwe, March 2017

    Read more about MSF’s cervical cancer prevention project in Zimbabwe.

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    Is the Global Gag Rule Truly Pro-Life?

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    Is the Global Gag Rule Truly Pro-Life?
    By Aerlyn Pfeil
    Midwife and member of the MSF-USA board of directors

    I remember coaching a young woman as she pushed her first baby out of her womb following nine months of nightmares. She had been raped and abortion was restricted in Papua New Guinea. At eight weeks of pregnancy, she had arrived at a Doctors Without Borders/Médecins Sans Frontières (MSF) clinic, shaking, fearful, and sobbing, asking if I could help.

    We discussed her fears, her desires for the future, and the physical, emotional, and legal risks of terminating her pregnancy, as well as the risks of continuing it. Ultimately it wasn’t safe for her to have an abortion. But it was extremely important for her emotional well-being and her capacity to mother her yet-to-be-born child that she receive informed, unbiased, and comprehensive care.

    The Mexico City Policy, also known as the Global Gag Rule (GGR), will prevent midwives all over the world from providing these vital services.

    The GGR is a United States government executive order prohibiting non-governmental organizations (NGOs) that receive U.S. government funding from providing or discussing with patients the option of safe termination of pregnancy. While the U.S. has not allowed government funding for most abortion services overseas since the 1973 Helms Amendment, this executive order further restricts women’s ability to receive complete reproductive care by withholding all funding if abortion is even mentioned during patient consultations. That means no patient counseling, no public education, and no referrals related to safe abortion services.

    MSF does not receive any U.S. government funding, so we’re protected from the GGR, but we are the exception. I am fearful of the far-reaching negative impact the GGR will have on women’s health worldwide.

    I’m going to be upfront: discussing abortion has never been easy for me. I’ve seen that when it comes to our moral convictions, evidence does little to sway people one way or another. But I’d like to share, anyway.

    Since I started attending births in 2001, I’ve provided informed care to thousands of women, regardless of my faith or personal convictions. I have witnessed girls become mothers. I have held slippery newborns as they take their first breath, and, in some cases, their only breath.

    I have witnessed time and time again the strength and suffering of women. I’d like to believe my experience makes me actively, acutely, truly, pro-life. I also believe women have the right to make informed decisions about their reproductive health, about their bodies and families. Being a midwife means I am with and for women and yes, sometimes that means I terminate a pregnancy.

    The GGR is not saving lives; it plays politics with women’s lives.

    If we are against abortion in any and all cases and believe every pregnancy should be continued, regardless of the circumstances, the GGR seems to make sense. Yet, like life, the policy isn’t black and white. The GGR will actually hurt women and their children. In short, it will force NGOs to choose.

    NGOs can continue to counsel women on safe reproductive care options and lose funding for a range of life-saving services, from safe deliveries to contraception, from treatment for malnutrition and HIV, to care for Ebola, malaria, and the Zika virus, all of which uniquely impact pregnant women. Or they can withhold vitally important health information, a clear violation of medical ethics. Either way, patients—adults and children—will pay the price.

    There is abundant evidence supporting the fact that highly restrictive abortion laws do not prevent the termination of pregnancy1. And there is no evidence showing the GGR has in the past, or would in the future, reduce the number of abortions. Data shows that the number of abortions actually go up when the GGR has been in place2. The truth is that defunding organizations that provide safe, informed reproductive health services increases the risk of a life lost. Denying a woman access to health care puts her life and the lives of the children she feeds at risk.

    Some 81 percent of unintended pregnancies worldwide are a result of unmet contraceptive needs3. The GGR defunds programs that provide access to much needed contraception. We know that when women have no safe options, many of them will risk their lives to end an unwanted pregnancy. Unsafe abortion is one of the leading causes of maternal mortality, killing 68,000 women every year4.

    The vast majority of these deaths occurs in developing countries, where the NGOs that the GGR will further restrict are often the sole providers of health care.

    Almost all these deaths are preventable.

    I remember two young girls who travelled across three country borders to seek contraception in South Sudan. They walked for over a month before arriving at the MSF hospital. I remember worrying about who and what they encountered along that journey. The girls, not more than 16, were alone and scared, without money or food.

    I remember informing one of them that she was already pregnant. She slept under the hospital bed, hidden by sheets and blankets. I remember holding the hands of these girls while they cried. I remember sitting next to their brave, stoic bodies, their grim, unsmiling faces.

    These girls needed counseling, education, the ability to make informed choices. If we want women and girls around the world to have healthy, meaningful lives, they must be given opportunities for safe, complete, and informed reproductive health care. They must not be used as political pawns.

    Aerlyn Pfeil is also a contributor to Because Tomorrow Needs Her.

    1Guttmacher Institute, “Fact Sheet: Induced Abortion Worldwide.” May 2016.
    2E. Bendavid, P. Avila, and G. Miller, “United States aid policy and induced abortion in sub-Saharan Africa.” Bull World Health Organ. December 2011
    3Guttmacher Institute, “Fact Sheet: Induced Abortion Worldwide.” May 2016.
    4Lisa B. Haddad and Nawal M Nour, “Unsafe Abortion: Unnecessary Maternal Mortality.” Reviews in Obstetrics and Gynecology. 2009, Spring.

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    MSF-USA Issues Press Release Responding to Trump’s Gag Rule Reinstatement

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    January 25, 2017—Today, MSF-USA released a statement on the new administration’s reimplementation and expansion of the so-called global gag rule that withholds U.S. foreign aid to groups working in other countries who discuss abortion as an option for women. Also known as the Mexico City policy, it was first implemented by President Reagan in 1984 after it was announced at a UN population conference in Mexico City.

    Although this rule does not directly affect MSF, which takes no money from the U.S. government, it will certainly affect women and girls, families, and communities in developing countries, as it has before when it was implemented by previous U.S. administrations.

    An excerpt from the press release:

    Research over the past decade has shown that policies that ban medical providers from educating women about abortion and their family planning options—including birth control and condoms—actually lead to more unwanted pregnancies, more unsafe abortions and death, and higher rates of sexually transmitted diseases, such as HIV. People need reproductive health services, including access to contraceptives and safe abortion care. This access has decreased in the past when the Mexico City Policy was in place.

    Read the New York Times article: “Trump Revives Ban on Foreign Aid to Groups That Give Abortion Counseling”

    It is MSF’s policy to provide access to abortion services to women who request it, or to direct them to services that are already available and accessible. Read about MSF’s policy and our reasons for this initiating this in 2004 here.

    For a deeper read, see “Why Médecins Sans Frontières (MSF) provides safe abortion care and what that involves“, published on BioMed Central website, and authored by BTNH contributor and advisor and the head of MSF’s sexual and reproductive health working group, Catrin Schulte-Hillen.

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    The Day We Created Life in Aweil, South Sudan

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    A new mother and baby rest in Aweil State Hospital. Photo by Yann Libessart/MSF

    A new mother and baby rest in Aweil State Hospital. Photo by Yann Libessart/MSF

    By Neil Murphy, MSF OBGYN in Aweil State Hospital, South Sudan

    In labor and delivery suites around the world, we usually don’t create life. Rather we try to assist in the smoothest landing possible for the incoming baby; until I worked in Aweil, South Sudan, at the MSF maternity project, that is.

    One day, an exhausted patient came in from an outlying clinic after being in labor for five days. It clearly had been a hard five days of labor, plus she then had to get to our facility. The patient was near her due date, but at some point in this five-day process the umbilical cord had prolapsed, or slipped out below the baby’s head.

    When the umbilical cord gets compressed it stops giving blood to the baby within minutes, so the baby had died prior to arrival at our facility. This was especially sad because the patient’s last delivery had been of a set of twins who were both stillborn.

    Our chief midwife was on duty that day, and feeling compassion toward the patient’s struggles, he hoped this patient could just get past this ordeal so she could start feeling better. He moved to expedite the delivery of the dead baby with the assistance of a vacuum device which allowed him to pull gently on the baby’s head in order to assist the patient’s own efforts while pushing.

    Prior to the expedited delivery, we had performed a brief bedside ultrasound which confirmed that the fetus had no heart beat. But it also showed what might have been a previously undiagnosed second fetus, which also appeared to have died. This looked like a repeat of her last sad delivery. Rather than taking more time for further extensive evaluation, the midwife moved to make the patient more comfortable.

    The delivery went quickly with his assistance, but there was one hitch.

    As soon as the baby was delivered, he took a gasp of air. Then another gasp. And another.

    The team quickly rallied around the infant boy and provided basic respiratory support. Within a short time the baby was breathing well on his own.

    We all watched as the he grew and thrived. The staff throughout the whole facility referred to him as our “miracle baby”, right up until his normal discharge.

    The rest of the story. The patient still had a prolapsed cord after delivery of our miracle baby. It now became clear that this was the unusual scenario of an upper twin’s membranes rupturing and prolapsing a cord past the lower twin.

    The mother was finally able to get cleaned up and rest that day. When it was time for her to go, she was quite happy to leave the hospital with a live baby who she never knew existed.

    One could say that the health care system should have diagnosed a twin pregnancy much sooner than at delivery, but the clinics outside Aweil do not have well trained midwives or ultrasound. Given the context and our daily challenges in Aweil, we prefer to just think of this as the one single day we created life.

    Read more blog posts from MSF field staff.

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    South Sudan: The tragedy of being female

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    The delivery room at Aweil State Hospital. Photo by Lisa Lepine

    The delivery room at Aweil State Hospital. Photo by Lisa Lepine


    “I am here to help. But I feel helpless.”

    By Lisa Lepine, MSF OBGYN in Aweil State Hospital, South Sudan

    I was on call for the maternity ward last night but it was a relatively quiet night, and so I got some sleep. I can’t imagine what this day would be like with no sleep on top of it.

    After I rounded in the hospital wards this morning, I was called to the OT (operating theatre or operating room) to evaluate a young girl. Her mother said she had come home with blood running down her legs. On examining her, it was obvious to me that she had been repeatedly raped on a number of occasions based on new and old wounds. She had lacerations along both sides of the vagina all the way up to the cervix, as well as lacerations on the perineum down to the anus. It took a long time to repair them all.

    The girl would not say what had happened. I am sure she is scared and might feel she needs to protect the identity of the perpetrator.

    After the surgery I spoke to her mother, explaining what I saw and did and instructing her in post-op care. She told me through the translator “Thank you for saving my daughter’s life.” As I walked back from the hospital that morning I felt overwhelmed and started crying, knowing I didn’t save her life and I can’t save her life. I am sad that she will not have the kind of life I would like for her, the kind of life she deserves.

    After lunch, the ex-pat midwife on call was summoned to the hospital for a dead breech baby. The mother was 18 years old, having her first baby, and she had been in labor for 5 days. It was difficult for the midwife get the head out.

    Since this young woman is at risk for developing a fistula between her bladder and vagina due to the prolonged pressure from the long labor, a bladder catheter was inserted. The birth also resulted in a large vaginal laceration that I was asked to repair. I injected lidocaine before suturing, but she began to wail. I was informed by the translator that she was crying not from physical pain, but from grief. I understand. The baby was term—a full 3,400 grams—beautiful, perfect. It was obvious he had only died within the past 24 hours or so.

    At the end of the day, a young pregnant woman was brought to the maternity ward, unresponsive with cerebral malaria. Her blood sugar level was undetectable. Her husband had been traveling with her in that state all day because they lived far from the hospital and transport is very difficult around here. She was extremely dehydrated. After IV fluids and sugar, as well as IV antimalarial drugs, she became only slightly responsive. I hope she pulls through tonight because right about now I can’t take more tragic outcomes.

    Life in South Sudan is very hard. It is particularly difficult to be female in South Sudan. Girls are so vulnerable. Pregnancy is so dangerous. Childbirth, a life-giving event, is too often shadowed by death.

    I am here to help. But I feel helpless.

    Editor’s note: MSF international volunteers and employees experience situations that some people could not even imagine. It is not always easy. We do what we can to reduce the suffering of vulnerable people wherever we work, and we usually wish that we could do more. Although it is physically and mentally demanding, this work is also very rewarding on a personal level. The writer can be very proud of what she did on this day. Although it seems like small accomplishments to her, there are 3 young women who are still alive because of her efforts. This is what we do.

    Learn more about Lisa and read more blog posts from MSF field staff.

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    Video: Complications from Unsafe Abortions Are A Daily Emergency

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    “Somebody who’s got money and means and connections can always have a safe abortion in this world. Women who are in a vulnerable situation will be the ones who pay the price of their health or their life.” – Catrin Schulte-Hillen

    In developing countries, where Doctors Without Borders/Médecins Sans Frontières (MSF) works, unsafe abortions are a major problem. Not only is there usually a problem for many people to access health care in general, but there are also legal restrictions around termination of pregnancy. So often, women and girls who don’t have the money to access a safe abortion will risk their health and their life having an unsafe one.

    Every day at MSF hospitals and clinics around the world, women and girls come in with abortion-related complications. Some patients have severe wounds. Others have bought pills to end their pregnancy but were not instructed how to use them or what to expect so they are often experiencing bleeding and are frightened. The patients MSF sees and are able to help are the lucky ones.

    Many more women and girls will not seek medical care out of fear and will die at home alone. Unsafe abortion causes a significant amount of maternal deaths every year, the vast majority in developing countries.


      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

    Failing Displaced Women and Girls

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    A Burundian woman carries firewood in Nyarugusu camp in Tanzania. Photo by Luca Sola

    A Burundian woman carries firewood in Nyarugusu camp in Tanzania. Photo by Luca Sola

    “Women and girls are always disproportionately affected in times of conflict, so the prevention of and response to GBV should be central to any humanitarian response.” – Refugees International
    Yet it rarely is.

    The current political crisis in Burundi is pushing people out of their homes, across the border into camps in Tanzania. A report released by Refugees International reveals a sad example of how this knowledge of the necessity of prevention goes unheeded. According to the report, as of Fall 2015, hundreds of women and girls who survived the dangerous journey to find safety as a refugee, were then subjected to sexual violence inside Nyarugusu camp in Tanzania. The numbers have certainly continued to grow.

    The fact is that refugee camps are often set up with little regard for women’s safety. In Nyarugusu camp in Tanzania, as elsewhere, women must gather firewood in order to cook food. Women staying in Nyarugusu had to venture, alone sometimes, outside of the camp’s perimeter, where they can be and were followed and attacked. Latrines were not lighted and they did not lock from inside, making them traps at night. And the mass shelters where new arrivals were often placed to stay for several nights before they received tents had no privacy nor protection. These and other issues are outlined in the report.

    Apparently some changes have been made recently in the camp to help prevent some violence against women. But the real shame is that international agencies responsible for these camps know what measures they ought to take from the beginning to help prevent sexual violence; there have been studies on this and standards issued (like this one). But institutional knowledge doesn’t always result in action.

      #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.