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Maternal Health Among the Rural and Urban Poor

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Nidhi Ranpuriya, a nurse from Mumbai’s Hinduja Hospital, reports on her findings from interviews of recently-pregnant mothers to discover what they need for improved maternal health. Hi-Res Video>> and Lo-Res Video>> Introduced by Dan Oerther. Used with permission.

Daniel B. Oerther 1, Sarah E. Oerther 2 and Phalakshi Manjrekar 3

In a collaborative project created between Daniel B. and Sarah E. Oerther, the nursing staff at the Hinduja Hospital in Mumbai and the Nightingale Initiative for Global Health (NIGH) — nurses are learning how they are achieving United Nations Development Goals with their focus on maternal health for the rural and urban poor in India.

The UN ‘Millennium Development Goals’ (MDGs) are eight global targets aimed to be achieved by 2015 with the ultimate purpose of reducing global poverty, chronic disease, and stalled development. Identified by the United Nations General Assembly in 2000 and promoted by the UN since then, the MDGs focus on poverty and hunger, education, gender equality, child and maternal health, combating HIV/AIDS, protecting the environment and promoting global partnerships. One of the MDGs failing to meet its targets is MDG 5 — ‘Improve Maternal Health’ — where more than 280,000 women and girls are still dying every year in pregnancy and childbirth. ‘

But another of the targets related to the environment — MDG 7.C — “halve the proportion of people without suitable access to safe drinking water” — was achieved ahead of schedule, in 2012. In this first MDG achievement, Ban Ki-Moon, Secretary General of the UN, applauded the world’s efforts, and urged increased action to meet the remaining goals by 2015. One of the people who has helped humanity to achieve MDG 7.C is Daniel B. Oerther — the John A. and Susan Mathes Chair of Environmental Engineering at the Missouri University of Science and Technology — who has been working for nearly a decade to implement the MDGs in communities around the world. Dan focuses his collaborations with nurses to emphasize Florence Nightingale’s philosophy of raising the standards of care at home, hospitals, and in the community. In the autumn of 2011, Dan was inducted as an honorary lifetime member of Sigma Theta Tau the International Honor Society of Nursing — for service to global health through his international efforts to bring life-saving clean drinking water, sanitation and access to health care to more than 100,000 villagers in Guatemala, India, Kenya and Tanzania. He says, “I am grateful to the nurses with whom I've had the pleasure of collaborating during my career. Nurses are natural collaborators with engineers, and I'd like to see more…engage [ment of] nurses as partners in promoting sustainable health."

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Dan and Sarah Oerther and their children Barney and Emmalise beside Hinduja Hospital Director of Nurses and NIGH World Director, Phalakshi Manjekar (center). Photographer: Bhavna Nayak. Used with permission.

Through a collaborative effort, Dan is now working to address the importance of maternal health. In December 2012, Dan joined with the NIGH to recruit nurses from Hinduja Hospital to partner with him in this work. This collaboration was accomplished under the mentorship of Hinduja Hospital’s Director of Nurses and Member of NIGH World’s Board of Directors, Phalakshi Manjrekar. The primary objective of this ongoing study is to assess the attitudes and behaviors of mothers with regards to prenatal, labor and delivery and antenatal care. Their target populations include the working rural poor in the villages around Anand in the Indian state of Gujarat, as well as the urban poor in Mumbai in the state of Maharashtra.

To begin this project, Dan and his wife Sarah — also a nurse, President and Founder of Missouri EDGE, LLC and co-owner of PulaCloud, LLC — presented a workshop for a select group of 50 nurses on the staff of Hinduja Hospital in Mumbai. Entitled “Millennium Development Goals: Development, Application, and Future Needs,” the goal of this workshop was to empower Indian nurses to understand how they daily tackle the triple bottom line — of people, planet, and prosperity — from their nested perspective of the individual, the family, the community, the state, and internationally.

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Sarah Oerthner with workshop participants, nurses at the Hinduja Hospital in Mumbai, on December 18, 2012.
Photographer: Rahul Sukharia. Used with permission.

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Nidhi Ranpuriya (right) conducts a maternal home-health assessment in the village of Lingda, in collaboration with Dan Oerther from the Missouri University of Science and Technology. Photographer: Rahul Sukharia. Used with permission.
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At one of their research sites in Anand Gujarat. (left to right) Sarah Oerther, Bhavna Nayak, Dan Oerther & Nidhi Ranpuriya. Photographer: Rahul Sukharia. Used with permission.

Following this workshop and under the direction of Ms. Manjrekar, two of Hinduja’s nurses — Nidhi Ranpuriya and Bhavna Nayak — accompanied Dan and Sarah and their family to their first maternal health setting in rural villages surrounding Anand, Gujarat. Here they worked as students of the Oerthers to conduct home-health assessments of women who have recently given birth. The questionnaire covered a wide range of maternal and infant experiences, and maternal attitudes and behaviors before, during and shortly after pregnancy. The project’s aim is to collaborate with the nurses to better understand how the attitudes and behaviors of pregnant mothers actually impact upon their own health and the ultimate health of their infants.

Ultimately this will be used to assess the efficacy of an IT- based intervention wherein pregnant moms will register with an SMS text message thereafter receiving reminders about health, simple questions, and follow-up to improve health outcomes during and immediately following pregnancy. Already, this study is proving worthwhile. Sarah wrote to Phalakshi, “your nurses are angels! Nidhi and Bhavna are both doing an excellent job. I’ve been amazed to watch this group of students come together with enthusiasm, professionalism, a desire to help others, and a willingness to work hard and play hard. What a blessing to be one of the ‘teachers’ for this team. I use quotes because these students have done ALL THE WORK THEMSELVES!!! Its ‘easy’ to be a guide on the side when you are working with such gifted and motivated nurses and students.”

During their workshop with the nursing staff at Hinduja Hospital, Dan and Sarah noted that 2015 is now less than two years away and UN MDGs — such as Maternal Health — are still too far from their targets to be achieved by that year. However, longer global aims — from UN ‘Millennium Development’ to UN ‘Sustainability Goals’ — are now being identified in the international civil society campaign called ‘Beyond 2015.’ In coming years, the spirit of the UN MDGs will transition to the creation of community structures that sustain and continue to promote improvements in health, wealth, and the environment. At their Hinduja Hospital workshop, nursing participants identified how community health nursing —and its natural collaborative partners — will have a growing role and even necessary role to sustain the momentum created by working to attain the UN MDGs.

Powerful collaborations with organizations such as STTI and NIGH will continue to address the ultimate goals of eliminating poverty and improving lives as we, together, create and work to attain the United Nations Millennium Sustainability Goals.

1 Missouri University of Science and Technology, Rolla, Missouri, USA
2 Missouri EDGE, LLC, Rolla, Missouri, USA
3 Hinduja Hospital, Mumbai, India

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Visitors at the Mapparium in the Mary Baker Eddy Library in Boston, Massachusetts. This was the site to launch Dr. Jean Watson's Million Nurse Project—during the 2010 International Year of the Nurse—to radiate heart-centered Love, Caring and Compassion through individual and collective global meditations. Photo Courtesy of the Mary Baker Eddy Library.