The Rotary Club of Fulton, Missouri, USA, with its partners, proposes to improve the quality of and accessibility to ante- and post-natal healthcare for Maasai mothers and babies, thereby decreasing rates of mother and infant mortality. Using an integrated, culturally sensitive approach, this project will create an innovative, sustainable healthcare delivery model that will dramatically improve maternal and infant survival rates and overall health in target areas. Critically, the project will incorporate modern technology and traditional practices, maximizing the strengths and minimizing the weaknesses of each.
 

This Humanitarian – Maternal/Child Health project will be piloted in two remote clinics in Northern Tanzania using an integrated approach that provides each clinic with: a) solar power, b) a basic laboratory for diagnosing/confirming diseases, c) training for clinic staff and traditional birth attendants (TBAs - unskilled midwives), d) mobile phones with solar chargers to link TBAs with clinics, e) Basic-Utility-Vehicles to transport patients to the clinics, f) safe birthing kits, and g) maternity waiting homes for high-risk pregnant women. Further, following the completion of the project, the resulting service delivery model can be replicated and scaled up in other remote and indigenous communities demonstrating similar needs and context, including a series of training videos developed for the targeted area.

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This project is a collaborative effort between:

 

• Babati Rotary Club of Tanzania

• Rotary Clubs of District 6080 (Missouri) and other Midwestern Rotary districts

• Three Maasai grassroots organizations

• Maasai Women’s Development Organization

• Loibor Siret Educational Forum

• Maasai Visions Organization

• Humanity for Children, a USA-based international humanitarian organization, and

• The Ministry of Health of Tanzania (Simanjiro District)

Note: Global health physicians at the University of Washington (Seattle) and University of Wisconsin

(Madison) medical schools are interested in partnering with us, but no firm decision has been made

on their involvement at this time. They would offer expertise in the use of mobile technology and the

training of unskilled traditional birth attendants.

The involvement and support of multi-level stakeholders is essential to the success and sustainability of this project. In addition to the aforementioned groups, local leaders, village healthcare providers and the communities themselves have also pledged their full support.

 

To effectively address the community identified  needs, this project will:

 

1. Enhance each clinic’s electrical power supply by providing more modern and reliable solar collectors, charge controllers, inverters, and storage units.  This power will enable the clinic to have lighting, laboratory equipment, and, in the future, computers.

2. Provide a Solar Suitcase to each clinic.  The Solar Suitcase (see appendix) was recently developed by Dr. Laura Stachel and a team of engineers as they responded to the challenges of delivering babies and conducting other emergency operations in remote clinics without reliable power.  The suitcase provides a mobile solar collector, a battery storage unit, two LED high efficiency medical task lights and a fetal doppler.  (http://wecaresolar.org/)

3. Establish a basic laboratory at each clinic.  The laboratory equipment will include microscopes, centrifuges, blood and glucose testing equipment, and other basic testing supplies.  The establishment of a basic laboratory will allow for the diagnosis and confirmation of diseases.

4. Develop “Level II Birth Attendants” role by identifying, training, supervising, and evaluating high performing TBAs. This training will improve skills, increase knowledge, and promote stronger relationships with the local clinics.  Training should result in earlier and more frequent prenatal visits to the clinic, earlier detection of complicated pregnancies that should be handled at a medical facility, fewer instances of sepsis (infection) that often lead to infant death within the first few weeks, and reduced incidents of HIV transmission from mothers to babies and from mothers to TBAs.

5. Equip Level II Birth Attendants with mobile phones and solar chargers to ensure they can readily communicate with healthcare staff when complicated or dangerous deliveries present.  Portable solar charging units will also serve as an income source since Level II TBAs will receive a small payment from other villagers when they charge their phones.  In Phase 2, the mobile phones will be equipped with applications that allow for direct recording of patient information, access to health information and protocols, and the ability to reserve clinic appointment dates and times.

6. Provide Safe Birthing Kits to each TBA to ensure a more hygienic birthing experience if the birth takes place in a hut.  These kits provide:  a) an hygienic plastic sheet upon which the delivering mother can squat (traditional birthing position) instead of delivering on un-sanitized sheets or on bare ground; b) hygienic razors to cut the umbilical cord instead of used razors; c) hygienic umbilical cord clamps instead of the traditional use of fiber cut from the inner-bark of a local tree; d) gauze and other basic blood clotting supplies, e) rubber suction syringes/bulbs to remove mucous from newborn’s mouth and nose, f) rubber gloves and aprons for the TBAs to prevent the transmission of HIV from mother to TBAs, g) erythromycin medication for newborn’s eyes to prevent infection, and h) warming blankets for the newborn.   If, during the first year the Level II TBAs demonstrate high levels of practice and knowledge, misoprostol, a medication to treat postpartum hemorrhaging, will be included in their safe birthing kits.

7. Develop three training videos to be used in TBA training, educating women in traditional homesteads and in schools, and creating awareness among men on the benefits of supporting their wives and daughters to receive pre-natal services offered by the clinics.  Upon completion of this project, copies of these videos will be made available to government and private organizations engaged in healthcare initiatives in other indigenous areas.

8. Provide a Basic-Utility-Vehicle at each clinic which will transport patients living in distant homesteads to the clinic for pre/post-natal checkups and to bring women to the clinic for delivering their babies.

9. Provide trained project staff – community health educators (one per clinic) --to oversee project implementation and to train, supervise and evaluate all TBAs. These two workers will be temporary until the clinic staff can take over their responsibilities at the end of the project.

10. Establish a community-based “maternity waiting home” near each clinic where expecting mothers may come a week or more in advance of their projected delivery date.  This will ensure that these mothers are near healthcare providers who can handle complicated or dangerous deliveries.  This model will not solve the transportation challenge for all Maasai women who are preparing to deliver but it will increase the numbers who have easier access to the care provided by skilled nurses and clinical officers.  The communities will fund and construct these homes and provide volunteers who will support the women staying at one of these homes.   This project will fund the expenses for one year ($1 per day/mother) until the worth of the program is established, after which a small fee will be charged by the community to those staying at the home. 

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Who will benefit from this global grant?  

The Maasai people of East Africa (Tanzania and Kenya) are perhaps the best known tribe in all of Africa due

to their presence in the safari regions, their colorful dress, and pastoral way of life. Their reluctance to

participate in census-taking activities won’t allow for an estimated population; however, the Tanzanian government

estimates that 500,000 live in its northern region.

Traditionally, they moved their herds across vast stretches of Tanzania as they searched for green pastures for

their herds but their ability to freely move their cows, goats, sheep and donkeys has declined due to land-rights

issues. It is estimated that over 25,000 Maasai and other indigenous people living in Simanjiro District will

benefit from this grant. Direct beneficiaries include the approximately 300 mothers who will give birth each year in 

the project’s proposed area of responsibility (AOR) and the babies they deliver. Healthcare providers in the AOR

will also benefit directly as they will gain essential skills, knowledge and tools to provide improved medical

care. Maasai communities as a whole will benefit indirectly as access to improved services for women and

infants will enhance the overall health of communities. Further, communities presenting similar contexts and 

healthcare needs will also benefit indirectly as the project will result in a tested service delivery model that can be replicated.

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Where will the project take place?

Community: The two remote Maasai communities targeted for this project – Loibor Siret and Kimotorok -- are located in the Simanjiro District of Tanzania, near Tarangiri National Park. Both communities have government-supported clinics that, according to the Ministry of Health, are under-resourced and last on their list for improvements given their remote locations, lack of electrical power, and challenges of working with traditional pastoralists.

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What can I do to help?

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The best way to help is by making a monetary contribution to the project.  You can choose whatever amount is right for you...$100, $250, $500, or more.  For more information or to make a donation, you can contact Dr. Bob Hanson at bobhansenwc@gmail.com.  You can also make a donation by following this link.