By Elaine Jarvik
Deseret Morning News
The little medical kit is deceptively, heartbreakingly simple: a sterile razor blade, three baby blankets, some pills, a fingernail brush, a tiny hat. It’s not much — but it’s helping reduce the mother and infant death rate in Tibet, thanks to a Salt Lake nurse and the nonprofit organization she started several years ago.
When Arlene Samen first went to Tibet in the late 1990s as part of a team that did cleft-palate surgery on children, she discovered that in remote areas of the country women were delivering babies in medieval conditions.
Typically, says Samen, a rural Tibetan woman about to give birth goes out to the barn, where she lies down in hay covered with yak dung and stoically waits. Because Tibetans believe that the blood of childbirth is polluted, the woman will generally go through labor alone, although sometimes the father or mother-in-law will be on hand to cut the umbilical cord with a dirty knife. The barn is often cold and wet; in the winter, newborns are often simply laid on the frozen ground.
No wonder one out of 10 newborns in rural Tibet die, usually from causes that easily could have been treated or prevented. The majority of women have lost one or more babies in their lifetime; and most villagers know at least one woman who has died from hemorrhage following childbirth.
Samen started One H.E.A.R.T. (a punctuation-laden name that stands for Health, Education And Research in Tibet) in 1998. Originally associated with the University of Utah’s Department of Obstetrics, where Samen was a high-risk OB nurse, the nonprofit is now an independent charitable organization. Offices are in the Tibetan capital, Lhasa, and in a converted old church on 300 West in Salt Lake City.
The U.S. health professionals who travel to Tibet to educate mothers and doctors come face to face not only with yak dung but also childbirthing superstitions. A woman in prolonged labor will often put on a piece of her husband’s clothing, tying it in front instead of in the back, because it’s believed that will speed up delivery. Or she’ll jump over a rabbit’s head 100 times. Often a woman will go for months without knowing she’s pregnant, or at least without acknowledging it, in the hopes of warding off the envy of other women, thus preventing a miscarriage.
So, the little medical kits are a tangible start to improve conditions, but by themselves are not enough. One H.E.A.R.T. doctors, nurses and midwives also teach expectant mothers about nutrition and train local doctors in safe childbirthing practices.
With a grant from the Centers for Disease Control, One H.E.A.R.T. assessed the typical diet of rural Tibetan women, sending food samples to Beijing to be analyzed. The diet — heavy on dough balls, butter and yak — was found to be deficient in micronutrients. Studies in other countries have shown that if maternal diets are improved, fewer babies and moms die during pregnancy and birth, says Dr. Bernhard Fassl, a pediatrician with Primary Children’s Medical Center, who travels to Tibet twice a year with the group. One H.E.A.R.T. is now introducing the women to a wider variety of locally grown vegetables. The next step, Fassl says, is to apply for a second grant to build greenhouses.
One H.E.A.R.T. CEO Samen travels to Tibet three times a year, and for eight months of the year, she says, at least one U.S. health professional is there doing training. The team also includes two doctors from the U.’s department of maternal-fetal medicine — Dr. Michael Draper and Dr. Michael Varner — plus three out-of-state doctors and a midwife. The Americans train Tibetan health workers in basic life-saving skills: how to stimulate and dry a newborn, how to perform basic resuscitation, how to do uterine massage to prevent postpartum hemorrhaging. Local doctors are also learning to identify women who may have high-risk pregnancies.
In February, One H.E.A.R.T. signed a three-year contract with the Foreign Affairs Office of the Tibet Autonomous Region, which is a part of China. According to Samen, fewer than 10 agencies worldwide have permission to work in Tibet, and only one other works in maternal and child health.
One H.E.A.R.T.’s work is already having an impact. Last year, 97 percent of the women in Medro Gonkar County had at least three prenatal visits and one postpartum visit from a village or county doctor, 86 percent of the births in the county were attended by someone trained in the program and 36 percent of the women delivered at a hospital. One H.E.A.R.T. is now expanding into a second county, with health workers from the first county helping to train those in the second.
“I would love to see the program become a government policy so it could be implemented everywhere,” says Samen, who was selected in 2001 as one of 50 “Unsung Heroes for Acts of Compassion” by the Grace Family Foundation.
The nonprofit also teaches doctors who practice at hospitals in Lhasa, who in turn train rural doctors. And in 2003, through a U.S. State Department grant, six Lhasa physicians were brought to the University of Utah to be trained in obstetrics and newborn care.
“If we can provide effective maternal health programs on the Tibetan plateau, one of the poorest and most isolated regions in the world, with an illiterate population, few resources and no history of skilled birth attendants,” says Samen, “these programs can be used effectively anywhere in the developing world.”
If money were no object, Samen would like to take One H.E.A.R.T. into Africa and South America.
In One H.E.A.R.T.’s first Tibetan county, only one woman died during childbirth last year, and the infant mortality rate has fallen 50 percent. Samen expects the numbers of newborn deaths will continue to fall as more birth attendants learn to use the resuscitation equipment the nonprofit is now donating. Each mask-and-bag unit costs just $1 but, like the $50 childbirth kits, may be enough to save a tiny life.
How to help
Tax-deductible donations can be made to One H.E.A.R.T., 740 S. 300 West, Suite 301, Salt Lake City, UT 84101.
E-mail: jarvik@desnews.com
