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Two ObGyns, “MIA” in the developing world

The founders of Medicine in Action tell how they are working with volunteers and charitable support to improve health—especially for women—in two countries direly short on resources and caregivers

July 2009 · Vol. 21, No. 07


The authors received assistance from Angela Sykes in writing this manuscript.

There is—no surprise—a health divide between the industrialized world and the developing world, and that divide is greatest in maternal mortality (FIGURE 1). Of the more than one-half million women who die of a complication of pregnancy or childbirth each year, approximately 99% are in a developing country. (See “The great health divide: Maternal mortality” for a more detailed accounting of the problem.)

Hemorrhage, hypertensive disorders, obstructed or prolonged labor, and sepsis are the main causes of maternal death in developing countries. These manageable complications go untreated because the system in such places cannot provide skilled medical personnel, adequately equip medical facilities, or deliver electricity and clean water reliably.1

FIGURE 1 Regional variation in maternal deaths—2000

Source: World Health Organization.1

The great health divide: Maternal mortality

The lifetime risk of maternal death is approximately 1 in 76 in developing countries, compared with 1 in 8,000 in the developed world.1 In the poorest countries, a woman’s lifetime risk of dying during childbirth is 1 in 6; compare that to the United States, at about 1 in 4,800.2,3

In the past 20 years, the maternal mortality rate has fallen substantially in developed countries, yet rates in poorer regions have remained constant.3,4

In addition, women in the developing world have a disproportionately higher rate of morbidity than women in industrialized countries do. Each year, it’s estimated that 10 million women endure disability, infection, disease, or injury during childbirth that may cause lifelong suffering.1

Most of these deaths and disabilities are avoidable—and could be prevented if women had access to skilled health-care providers, emergency obstetric care, and basic medical supplies. In many developing countries, however, this is not the case—particularly for women in rural areas where, often, fewer than 50% of births are attended by skilled health-care personnel.1 In fact, millions of families have never seen a nurse or a physician, and women give birth at home with traditional birthing helpers. Women who do make it to a clinic sometimes find unreliable electricity, unclean water, and few nurses, doctors, or medicines.3

To make matters worse, maternal death has an enormous impact on children. Evidence shows that children whose mother dies within 6 weeks after giving birth are more likely to die before 2 years of age than those whose mother survives. And, in many instances, women who experience severe, lasting disability, such as obstetric fistula, are effectively removed from society and unable, therefore, to play an active role in their children’s health.1


1. United Nations Children’s Fund. Progress for Children: A Report Card on Maternal Mortality (No. 7). New York: UNICEF; September 2008. Available at: Accessed July 9, 2009.

2. Ronsmans C, Graham WJ. On behalf of The Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet. 2006;368:1189-1200.

3. Walt V. Death in birth. TIME. September 18, 2008. Available at:,9171,1842278,00.html. Accessed July 9, 2009.

4. Baskett TF. Epidemiology of obstetric critical care. Best Pract Res Clin Obstet Gyneacol. 2008;22:763-774.

We were moved to act

Our shared concern over the problem of shockingly high rates of maternal mortality led us to found Medicine in Action—simply, MIA—in 2005. This nonprofit, global organization provides medical and surgical care to people in developing countries, with a focus on women’s health.

MIA’s vision is that:

  • all people, from all countries, should have access to quality health care
  • every patient whom MIA sees is treated with the same level of quality and standard of care that patients in developed nations are guaranteed
  • young physicians and medical students in developed countries should be taught cultural sensitivity and should become globally minded
  • through education and an emphasis on good health, the organization works for the empowerment of women worldwide. MIA, with a growing number of volunteers, is making a difference in the lives of hundreds of patients and their families. Staff has treated approximately 3,000 patients, screened 533 women for cervical cancer, and performed more than 100 surgical procedures during eight medical missions. The impact of MIA’s missions reaches far beyond the patients treated, extending into the communities in which these patients live and allowing them to be healthy, productive members of society.

FIGURE 2 Meet the founders of MIA

Dr. Deborah Chong (center, in white top) with clinic staff and patients in Tanzania.

Dr. Karolynn Echols (left) and a patient at a clinic in Jamaica.

Where MIA makes a difference

MIA has performed seven medical missions in Jamaica, where the maternal mortality rate is 87 deaths for every 100,000 live births, and three in Tanzania, where matters are far worse—1,500 maternal deaths for every 100,000 live births.1

In urban and rural Jamaica. Through medical missions in Kingston, Jamaica, MIA has treated hundreds of patients at inner-city clinics in areas such as Trench Town (home of the late musician and composer Bob Marley). Some clinics are temporary and makeshift, held in church halls or homes; all provide much-needed medical care to women in the community. The medical teams also perform vital surgical procedures at local hospitals.

In addition, MIA volunteers travel to rural areas of St. Mary, a parish where basic gynecologic care isn’t easily available to many. There, staff works in public health clinics, where local providers appreciate the assistance of skilled professionals.

On these missions, MIA provides Pap screening for cervical cancer, performs major gynecologic surgery, and treats a variety of diseases, including diabetes, hypertension, infection, and gynecologic disorders. Staff has added an education component to their missions, counseling patients about breast self-examination, healthy diet, and exercise. A pediatric team was part of the most recent mission to Jamaica, for the first time.

Reaching out in Tanzania. MIA’s first mission to Tanzania was in May 2008. It included six volunteers (from California, Florida, and New York) who collaborated with another charitable organization, International Health Partners–Tanzania (IHP-TZ). Together, the teams’ members saw approximately 135 patients at a local clinic and performed nine gyn surgical procedures. Staff diagnosed many cases of HIV infection and other sexually transmitted infections. One of the volunteers held a women’s health educational evening at a local mosque.

In September 2008, MIA volunteers returned to Tanzania. Again, they partnered with IHP-TZ to treat many patients and continue the health education program begun in May. They helped train an operating room technician, giving her the necessary skills for employment so that she can provide for her family.

Members of the team also participated in fundraising for the hospital by making tablecloths and napkins from traditional Masai fabrics for sale at a local store.

MIA will return to Tanzania in September 2009 for a fourth mission and a fundraising climb of Mt. Kilimanjaro. The goal? To raise $60,000.

For us, and for MIA volunteers, satisfaction outlasts each mission

The medical missions conducted by MIA volunteers have an enduring impact not only on patients, but on volunteers, too. Here’s what volunteer Bhoomi Brahmbhatt, MD, told us last year:

The Jamaica experience was priceless. I got to see firsthand how much health care is in demand there. The clinics were busy and we worked in varying environments—from clinic trailers to churches. No matter how busy it was, the patients and volunteers always had smiles on their faces and were willing to wait. The surgical experience was incredibly gratifying. I felt a great sense of accomplishment in each of the seven cases we did; we literally brought all our supplies (including our anesthesiologist!) from the USA and were able to perform surgery that will improve these women’s lives forever.

Our message, and our summons, to ObGyns? Get involved!


1. AbouZahr C, Wardlow T. Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA. Geneva: World Health Organization; 2004. Available at: Accessed July 9, 2009.

Editor’s note: Medicine in Action (MIA) reports that physicians and other health-care professionals have several ways to contribute to, and get involved in, the international humanitarian aid that MIA provides in underdeveloped countries. These include cash donation (85% spent on care for patients); donation of medical supplies and equipment; and volunteering for a medical mission. Visit for information.

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