WEBVTT

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[music]

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If a healthy woman dies
in childbirth in Britain,

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it would be a disaster. Tonight,
we report from an African hospital

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where it can be a daily event. But where
promises to help are being broken.

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Five years ago world leaders signed up to targets
known as the Millennium Development Goals,

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targets for helping the world\'s poor, including
women die in childbirth and pregnancy.

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Our story shows how we\'re falling behind,

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and also takes us across the
world to find reasons for hope.

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[music]

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It is the story of one African woman\'s fight
to stop women dying because they\'re pregnant.

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Grace Kodindo is an obstetrician
in the main hospital in N\'djamena,

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the capital of Chad in central Africa.
We spent a week with her,

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filming disasters and triumphs.

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She\'s three kilos 100 not so small.

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[sil.]

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Triumphs that include presiding over the
delivery of a baby every 45 minutes.

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Most of them quite safe.

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[sil.]

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The first crisis, helping a
woman over a miscarriage.

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Miscarriages happen in Britain too.
But not like this.

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Pregnant for the eighth time. Eighth time?
Yes. Seven children,

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uh… four have died. That also shows
a very high infantile mortality.

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Like Britain, Chad has both
state and private healthcare.

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Grace\'s hospital is the
showcase of the state system,

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but Chad\'s NHS is not free at the point of delivery.
Patients have to pay for just about everything.

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Antiseptic, £1.

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The drip, £1.50. The needle, 25 pence.
Not much to us,

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but here many earn 50 pence a day or less.

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The woman\'s family haven\'t bought all
she needs. She has only paid one bottle

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of IV fluids and it\'s not enough.

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The hospital\'s supposed to provide some basics
itself, but often they aren\'t there either.

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You know everything is lacking here, normally we
should be having clean sheets to properly cover her,

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and we should also be having some oxygen.
Grace is on the front line of the battle

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to save women at risk in pregnancy and
childbirth. But the odds are against her.

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This is not an environment to
decrease the rate of maternal deaths.

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Today even the light anaesthetic

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they normally use in this kind of operation
has run out. We would have done anaesthetisia

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to prevent the pain. But
we don\'t have that.

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Despite everything success. The
patient\'s over the crisis.

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J\'ai fini. One emergency over, and
some basic harsh truths established.

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But the day\'s toughest
cases are still to come.

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Few pregnant women in Chad
give birth in hospital.

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So the women who come here,

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local mums or those who\'ve made it from the
countryside, are in some ways the lucky ones.

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In Chad, the lifetime chance of a woman dying
in pregnancy or childbirth is one in 11.

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In Britain, it\'s over one in 5,000.

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[sil.]

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The heart of the maternity
ward is the birthing room.

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Two women are lying next to each other.

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In one bed is Fatime Izadine. She\'s 16.

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She is having her baby. One of
over 11,000 born here every year.

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The baby\'s fine.

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And Fatime\'s okay too, at the moment.
Lucky to be alive and healthy? Yes.

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[sil.]

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But in the next bed there\'s a problem.

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A woman and a baby very much at risk.
This is a very risky case.

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Batoul is bleeding internally,

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she may die, and her baby
too before it\'s born.

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She urgently needs a caesarean,
which could happen in Britain.

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But in Britain your family wouldn\'t
be asked to go looking for blood.

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We\'ve sent her relatives to go for the blood. Most
of the time in the blood bank there is no blood,

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so the relatives should give blood.
In the hospital\'s blood bank,

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just 15 bags. Today none
in Batoul\'s blood group.

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The message has gone out to her
family for urgent donations.

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Rushing round relatives for blood during
an emergency is quite normal here.

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But as ever it takes time. And time is running
out. Now there\'s concern about the baby.

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[non-English narration]

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Grace listens for the baby\'s heartbeat.
In vain.

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The baby is already dead.

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Now Batoul could die too.
She needs the operation.

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Her bleeding needs to be stopped
and the dead baby removed.

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But still the relatives haven\'t
returned with any blood.

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We\'re waiting for the blood. You\'re waiting for the blood?
Yeah, it\'s more than one hour they haven\'t come back.

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In the next bed there\'s more
trouble, Fatime\'s baby is fine

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but she is having eclampsia, a fitting
attack that can lead to coma and death.

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With the right treatment
and some simple drugs,

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it can almost always be prevented. But
while they\'re giving her some drugs

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they\'re not the ones Grace would have chosen.
Normally we would give her Magnesium Sulphate.

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Do you have Magnesium Sulphate? We don\'t
have it here in the whole country.

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There is no Magnesium Sulphate in the whole country? In the…
in the whole country, we don\'t have it. We don\'t have it.

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And this is known as the most
effective drug against eclampsia.

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And this really helps to save live, and this would
really help to reduce the maternal mortality.

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[sil.]

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By about one o\'clock Grace
is getting worried,

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Batoul\'s been here since about nine.

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I think she\'s now dehydrated, she\'s asking
for water, this is not a good sign.

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[sil.]

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The family comes back from their search.

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As well as trying to find blood, they\'ve had
to go looking for drugs in local pharmacies.

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What on that list have you not got?
He did not find the normal saline.

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He bought the antibiotics,
he bought the syringe,

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he also bought the folic catheter.

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He bought everything. Everything he has
(inaudible)… He\'s done really well, hasn\'t he?

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Yeah. That\'s good. So far the bill\'s come
to about £30 and they\'ll have to buy more.

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This is why some of them do not want to
go to the hospital and they stay home

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until they become completely out of it
and they are brought, they just die.

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Grace is full of praise for the family\'s efforts.
They\'ve been on a desperate shopping trip,

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like some macabre reality show, that has as
its prize, the life of the woman they love.

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It is not easy but you know, they
have tried to really help each other.

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[sil.]

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Five hours after Batoul came to hospital,

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she is taken to the theatre, along
with the drugs her family has bought.

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Her baby\'s already dead, now the
surgeons will try to save her life.

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But they\'re going ahead with just one bag of blood.
It\'s all the family have managed to provide so far.

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They\'ll need more.

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Grace stands by ready to help.
Then, a shock.

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Batoul\'s womb has ruptured.

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Grace reckons it happened some time ago.
[But nobody had realized.

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She has ruptured her uterus here apparently,
since she has been here since 9 am.

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We hope that she will have enough of
blood and antibiotics she will survive,

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but the baby has died from the ruptured
uterus. So it was a very high price.

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Now there\'s an even graver emergency.

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The blood still hasn\'t arrived.
Her blood pressure\'s dropping.

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It should be higher that… It should be higher. It
should be higher. What she needs is more blood,

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one bag is not enough
because she has bled a lot.

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Outside, while some relatives give blood, her
husband and the rest of the family wait anxiously.

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The blood finally arrives.
They\'ve brought more blood.

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The family have succeeded in
bringing three more bag of blood.

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That really is a good thing, I mean, it
will really decrease the risk of dying.

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A life saved, as many can
be when trained help

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and the right basic drugs are available.

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But the crisis isn\'t over yet.

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A relative rushes off
with a new prescription.

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You know, as… as I was telling you,

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she is still having fits
again, that one… Yeah.

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Back in the birthing room, Fatime
is having another eclamptic fit.

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[sil.]

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Well, into the evening the temperature\'s
still over 30 centigrade.

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Through the night, lives hang in the balance.
Over half a million women die in childbirth

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and pregnancy every year,
almost all in poor countries.

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Saving three quarters
of those lives by 2015

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is Number Five of the eight
Millennium Development Goals.

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The Millennium Development Goals were
signed in New York five years ago

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by 189 world leaders. For the first time,

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leaders of the rich and poor countries taking
collective responsibility for the world\'s poor.

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They set targets for education, health,
empowering women, and cutting poverty.

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And they set deadlines. But no budgets
or legal obligation to meet the goals.

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There\'s a world summit on the MDGs in September,
and the UN\'s preparing a progress report.

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This week its author gave us a preview.

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Maternal mortality is the goal which most countries are
most seriously off track, the countries that account

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for the bulk of this problem in particular, most
of them are either sticking roughly where they are

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or in many cases they are moving backwards. Now unless we can
change that picture very dramatically over the next few years,

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there\'s really no chance at all of the world
meeting the target of reducing maternal mortality

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by three-quarters by the year 2015. This is a story
which isn\'t a story of women and children first,

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it\'s women and children last.

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[sil.]

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It\'s the second day of the week
we spent with Grace in Chad.

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It starts quite normally. For the whole
24 hours, we have had 41 deliveries

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and one case of maternal death.

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Lots of babies born. Yes. Forty one,

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isn\'t that something, 41 in one day.

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Grace leads the ward round.

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Batoul is okay. She says she\'s fine.
Thanks God!

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Fatime is doing all right too.

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Then Grace spots a woman clearly in pain,

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and something her midwives haven\'t noticed.

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Oh My God. Very serious case.

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We will have to open her… open her abdomen.
It… She… It must be pus,

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infection that has already spread in the whole abdomen.
And she\'s… she\'s not quickly, properly managed

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that also can cause her death.

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This is from the illegal abortion.

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She has now a septic abortion.
Abortion is illegal in Chad -

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as it is in most sub Saharan African countries. It\'s estimated that about
a fifth of maternal deaths are from illegal abortions that go wrong,

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very much part of the
target of lives to be saved

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under the Millennium Development Goal.
The doctors and nurses are stunned

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at what\'s happened on their watch.

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Grace demands action.

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This is an emergency case,
that can be fatal for her.

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It\'s almost midday. The girl will
need an operation this afternoon.

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[sil.]

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In the theatre, dealing with a
septic abortion is serious enough,

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the question now whether there
could be more complications.

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Earlier the girl told Grace a local
nurse whose identity she didn\'t reveal,

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had performed the abortion at his house. The state
she\'s been left in is about to become clear.

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Oh My God, very bad.

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Uterus is completely perforated.

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The surgeons are now trying
to remove her uterus

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just to save her life. She
is going to lose her uterus

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but she will be alive. All
this could have been prevented

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if only she has been using
contraceptive method.

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It\'s ignorance and lack of money, the
two, you know, uh… bring to this.

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So another life saved. While
elsewhere in the maternity wards,

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one more death that wouldn\'t
have happened in the rich world.

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But for all its daily death toll, the
hospital is a sanctuary where mums give birth

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with trained midwifes and
emergency care if needed.

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And that\'s unusual in Chad.

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[music]

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So what\'s having a baby like for
women without any medical help?

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Grace took us into the barren landscape
outside N\'Djamena to find out.

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In the world\'s poor countries
almost one woman in two gives birth

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without help from a qualified doctor or
midwife, that\'s over sixty million births.

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They happen in places like Chawa.

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The only help available
here is what are called

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traditional birth attendants, or TBAs.

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Three traditional birth attendants were
waiting to see us. Okay. Can I say hello?

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Should I (inaudible)… They told us how
they try to help with emergencies

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like, a retained placenta.

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When the baby is coming out I help it. When the placenta
is stuck inside I put my hand in to take it out.

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They have no other way to remove the placenta.
They\'re only using their hands, and they try.

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If they remove, and they cut
out… they move the whole piece,

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sometimes there are remaining
pieces, and the woman die.

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And they have many, many, many cases of maternal mortality
here. The birth attendants don\'t have drugs or equipment.

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They\'re untrained, and they know it.

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The only way to reduce maternal
mortality is to have a qualified nurse.

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We need to be trained and to have equipment.
They know that as they… as they are now.

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They know nothing to save a woman\'s life. This is a traditional way
of doing things. And it\'s not helping to… to… to save a woman\'s life.

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[sil.]

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Chawa does have a small
clinic built with big hopes.

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It has targets set by the government
for medically attended births.

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Last year the target was
299 and this year 307.

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In reality, we were told, there were
no medically attended births at all.

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Women won\'t come here because there are
no specially trained attendants or drugs.

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So women give birth at home.

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When we asked how often they die,
we were told there were no records.

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We were directed instead to a
village close by. In a family hut,

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women had gathered for the funeral of a heavily
pregnant woman who\'d died just two days earlier.

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She was called Fatime. She left a
two year old daughter, Mariam,

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now being looked after by her grandmother.
Fatime had been 18.

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She was complaining of fever,

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headache, pain in her throat and
chest and she could hardly drink.

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[sil.]

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Deaths like Fatime\'s are
effectively off the medical map,

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no treatment, no record. Relatives
showed us Fatime\'s grave.

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There are thousands of graves like
this in the world\'s poor countries.

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Their obscurity makes progress on
the Millennium Development Goal

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almost impossible to measure. It
always goes like that, unnoticed.

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Especially for rural women, very far from hospitals. They\'re
always… always dying like that without being noticed.

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So how are the millennium
development goal is going to be,

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you know, reach? I don\'t know.

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[sil.]

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It\'s not… I mean, it\'s unjust for an 18
year old guy… girl… woman to die like that.

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It\'s very, very unjust. What
will happen to the grave?

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Well, when it rains, when it… it
may even become completely flat,

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so nobody will… will never even
notice that there is a grave here.

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It will become flat, you know,
few years and then that\'s all.

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[music]

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Grace is a Protestant and takes
inspiration from her religion.

00:20:30.000 --> 00:20:34.999
As does her daughter, Halima.

00:20:35.000 --> 00:20:39.999
Most of the time. Grace adopted Halima after
finding her abandoned in the hospital.

00:20:40.000 --> 00:20:44.999
I decided to adopt her because
I wanted to give her…

00:20:45.000 --> 00:20:49.999
you know… something, a chance in her life,
because apparently I mean she… she…

00:20:50.000 --> 00:20:54.999
she has no luck. She was just abandoned
like that. It did something to me.

00:20:55.000 --> 00:20:59.999
And now? And now, well, we are
both happy with each other.

00:21:00.000 --> 00:21:04.999
I love her, she loves me and
that\'s… that\'s wonderful.

00:21:05.000 --> 00:21:10.000
But even Grace\'s commitment can be
affected by what happens in the hospital.

00:21:20.000 --> 00:21:24.999
There\'s already been one
death today, now another.

00:21:25.000 --> 00:21:29.999
We… we just have a second
maternal death now.

00:21:30.000 --> 00:21:34.999
The woman\'s died from eclampsia. She\'s one of about
100 who die from eclampsia ever year in this hospital

00:21:35.000 --> 00:21:39.999
compared to just four or five
in the whole of Britain.

00:21:40.000 --> 00:21:44.999
It\'s another preventable death.

00:21:45.000 --> 00:21:49.999
We had one death on Saturday, Sunday and Monday
this morning. Well, this morning we… we had two.

00:21:50.000 --> 00:21:54.999
[sil.]

00:21:55.000 --> 00:21:59.999
How many would there have been in the West?

00:22:00.000 --> 00:22:04.999
None. None in the west.

00:22:05.000 --> 00:22:09.999
How does it affect you personally?

00:22:10.000 --> 00:22:14.999
Well, personally, you know, it is removing all my enthusiasm and
then I don\'t know. I mean, I ask myself what am I doing here,

00:22:15.000 --> 00:22:19.999
I mean, this kind of environment, you know, where I
cannot even use my knowledge to save people life.

00:22:20.000 --> 00:22:24.999
[sil.]

00:22:25.000 --> 00:22:29.999
So uh… I feel depressed

00:22:30.000 --> 00:22:34.999
But life in the hospital is
an emotional rollercoaster.

00:22:35.000 --> 00:22:39.999
Grace is told by a midwife that a mother
she\'s helped has named her baby after her.

00:22:40.000 --> 00:22:44.999
Congratulations.

00:22:45.000 --> 00:22:49.999
She is named Grace. Dr. Grace.

00:22:50.000 --> 00:22:54.999
How many babies have you had named
after you? Oh my God, so many.

00:22:55.000 --> 00:23:03.000
[sil.]

00:23:05.000 --> 00:23:09.999
But then, the most shocking case so far. One that
will make Grace not only depressed but angry.

00:23:10.000 --> 00:23:14.999
There\'s a new patient, only 12 years old.

00:23:15.000 --> 00:23:19.999
She has attempted an
abortion, she\'s 12 year old.

00:23:20.000 --> 00:23:24.999
She has succeeded in aborting but now she is in pain
and bleeding. She will need a lot of antibiotics now.

00:23:25.000 --> 00:23:29.999
Have you got them? Well, she…
she bought some but she didn\'t…

00:23:30.000 --> 00:23:34.999
but her mother has no money to buy
the other one, so her aunt went home

00:23:35.000 --> 00:23:39.999
to look for more money. She is only a kid?
She is a kid.

00:23:40.000 --> 00:23:44.999
What did she do to herself? She
received some injection to abort,

00:23:45.000 --> 00:23:50.000
but they will never tell you the
truth what they have really done.

00:23:55.000 --> 00:23:59.999
Next morning the 12 year old
girl\'s had an operation.

00:24:00.000 --> 00:24:04.999
They have removed pus, they\'ve
cleaned it and now she is on…

00:24:05.000 --> 00:24:09.999
she\'s on IV fluids and antibiotic.

00:24:10.000 --> 00:24:14.999
She\'s still fighting for her life. But
whatever happens, her future may be grim.

00:24:15.000 --> 00:24:19.999
But the future may be infertility, she may
become sterile and she may have, you know,

00:24:20.000 --> 00:24:24.999
some chronic uh… pelvic, abdominal pain.
You know, chronic pain.

00:24:25.000 --> 00:24:29.999
The girl\'s mother tells us
they live 35 kilometers away.

00:24:30.000 --> 00:24:34.999
And had come here in a taxi. A
taxi they could only afford

00:24:35.000 --> 00:24:39.999
by sharing with other people. She couldn\'t pay
for a taxi would have taken them directly here,

00:24:40.000 --> 00:24:44.999
so they has to use the cab… the taxi

00:24:45.000 --> 00:24:49.999
where other people are also driving in the same,
so the taxi has to drop everyone off this people

00:24:50.000 --> 00:24:54.999
before taking her here in the hospital. Didn\'t
anybody say hey we\'ve got a sick girl here,

00:24:55.000 --> 00:24:59.999
we\'ve got to go to hospital first?
Nobody. Nobody. Because?

00:25:00.000 --> 00:25:04.999
They think that\'s… they have paid the
same fare, they have the same right,

00:25:05.000 --> 00:25:09.999
and then they don\'t, you know,
have any compassion for her.

00:25:10.000 --> 00:25:14.999
[non-English narration]

00:25:15.000 --> 00:25:19.999
What can I say, there are no words.
All I can think about

00:25:20.000 --> 00:25:24.999
is how to find the money to
save my daughter\'s life.

00:25:25.000 --> 00:25:29.999
A few days later her daughter died.

00:25:30.000 --> 00:25:34.999
One of over half a million such
deaths in the world\'s poor countries.

00:25:35.000 --> 00:25:39.999
But is such high maternal
mortality inevitable?

00:25:40.000 --> 00:25:44.999
There\'s now remarkable research that suggests it\'s
not that poor countries can save more mothers lives.

00:25:45.000 --> 00:25:49.999
It\'s by one of the top authorities on the politics
of maternal mortality in the developing world.

00:25:50.000 --> 00:25:54.999
I do not want to discount resources,

00:25:55.000 --> 00:25:59.999
I do not want to discount poverty, I do not want
to discount donor AID, all of that is critical.

00:26:00.000 --> 00:26:04.999
However, poor countries can surmount
maternal mortality problems.

00:26:05.000 --> 00:26:09.999
There are reasons for optimism.
I\'ve looked at several countries

00:26:10.000 --> 00:26:14.999
where individuals and groups of
individuals have managed to mobilize

00:26:15.000 --> 00:26:19.999
the political system to push political leaders to
make maternal mortality reduction a policy priority

00:26:20.000 --> 00:26:24.999
and actually to have achieved documented
success in reducing maternal mortality.

00:26:25.000 --> 00:26:29.999
Individuals persuading governments
to save more mothers lives.

00:26:30.000 --> 00:26:34.999
It sounded like a dream to Grace until
she read Doctor Shiffman\'s work.

00:26:35.000 --> 00:26:39.999
His model, a little known civil
servant called Doctor Cipriano Ochoa.

00:26:40.000 --> 00:26:44.999
An unsung hero from Honduras,

00:26:45.000 --> 00:26:49.999
one of the poorest countries in
Central America. Grace fascinated.

00:26:50.000 --> 00:26:54.999
I\'d really like to get you to talk to Dr Ochoa. I really would
like to, yeah. I am wondering if there is some way we can do that,

00:26:55.000 --> 00:26:59.999
whether we could get him on the
phone… …Or a email. Yes. Or email…

00:27:00.000 --> 00:27:04.999
Or emails. I can let you my emails. Or we
could bring back the video with the phone.

00:27:05.000 --> 00:27:09.999
Exactly yeah. I\'m… I\'m… I would
really like to know how he did it.

00:27:10.000 --> 00:27:14.999
Or we could take… or we could take
you with us! Why not? Why not?

00:27:15.000 --> 00:27:19.999
I would really like to know how he did it.
(inaudible). You know, he did it.

00:27:20.000 --> 00:27:28.000
[music]

00:27:30.000 --> 00:27:34.999
A week later we met Grace in Honduras. Hi.

00:27:35.000 --> 00:27:39.999
It\'s wonderful to see you. Yeah, me also.
What we hoped to find out,

00:27:40.000 --> 00:27:44.999
how poor countries could still cut maternal mortality
in time to reach the Millennium Development Goal

00:27:45.000 --> 00:27:49.999
and save hundreds of
thousand of women\'s lives.

00:27:50.000 --> 00:27:54.999
[music]

00:27:55.000 --> 00:27:59.999
What Doctor Ochoa and his colleagues had done was galvanize
their country into taking mothers lives more seriously.

00:28:00.000 --> 00:28:04.999
We met the modest Doctor Ochoa

00:28:05.000 --> 00:28:09.999
in the town of Marcala at one of the simple birthing
clinics he\'d helped persuade the government

00:28:10.000 --> 00:28:14.999
to build across the whole country.
This is Senor Ochoa? Si How do you do?

00:28:15.000 --> 00:28:19.999
This is Grace Pleased to meet you also.

00:28:20.000 --> 00:28:24.999
He made it clear right away. He thought other
poor countries can do what Honduras has done.

00:28:25.000 --> 00:28:29.999
Do you believe that the
millennium development goals

00:28:30.000 --> 00:28:34.999
cutting maternal maternity death
three quarters can be achieved?

00:28:35.000 --> 00:28:39.999
Yes, I am almost sure we can achieve
that goal, probably before 2015.

00:28:40.000 --> 00:28:44.999
In the clinic women waited
for antenatal check-ups.

00:28:45.000 --> 00:28:49.999
Back in the \'90s Doctor
Ochoa, then a civil servant,

00:28:50.000 --> 00:28:54.999
wondered how many women like these
were actually dying while pregnant.

00:28:55.000 --> 00:28:59.999
He and his colleagues conducted a survey, and found the
results far worse than their own government had estimated.

00:29:00.000 --> 00:29:04.999
Mothers, they told both government and
international donors, urgently needed help.

00:29:05.000 --> 00:29:09.999
And with a program including simple
clinics like this they got it.

00:29:10.000 --> 00:29:14.999
The result, a dramatic 40% drop in
maternal mortality in seven years.

00:29:15.000 --> 00:29:19.999
[non-English narration]

00:29:20.000 --> 00:29:24.999
In the labor room, the nurse in charge

00:29:25.000 --> 00:29:29.999
showed us how the course of every
pregnancy is recorded moment by moment.

00:29:30.000 --> 00:29:34.999
The partogram helps doctors\' spot problems.
Grace said her hospital used to do the same

00:29:35.000 --> 00:29:39.999
until United Nations funding dried up.
You remember the woman we saw

00:29:40.000 --> 00:29:44.999
who had the ruptured uterus in the hospital? If she
had been properly followed up by a partograph,

00:29:45.000 --> 00:29:49.999
they would not have come to that. So that could have been
prevented with this kind of system. Exactly, yeah. Exactly.

00:29:50.000 --> 00:29:54.999
Grace spots something else they
don\'t have in her hospital in Chad.

00:29:55.000 --> 00:29:59.999
You see, they have… they have
oxygen in the labor room.

00:30:00.000 --> 00:30:04.999
For the mother and baby sick, that\'s very
important, that\'s a very big difference.

00:30:05.000 --> 00:30:09.999
Salaries here are paid by the government.
Women are charged a standard 80 pence fee

00:30:10.000 --> 00:30:14.999
and additional funds are raised
voluntarily in local communities.

00:30:15.000 --> 00:30:19.999
The buildings often paid
for by foreign donors.

00:30:20.000 --> 00:30:24.999
Then, a simple device to revive dying babies.
Again, nothing like it back in Grace\'s hospital.

00:30:25.000 --> 00:30:29.999
Do you know the cost? Forty dollars.

00:30:30.000 --> 00:30:34.999
Forty-dollar. That would be really helpful
in Chad, to help to save a baby\'s life.

00:30:35.000 --> 00:30:39.999
And it\'s… it\'s almost cheap. The few
simple things needed to deliver

00:30:40.000 --> 00:30:44.999
most babies safely, ready and waiting.
I really feel envious. I… I feel envy.

00:30:45.000 --> 00:30:49.999
I mean, they have what is really needed,
you know, to help to save life.

00:30:50.000 --> 00:30:54.999
[music]

00:30:55.000 --> 00:30:59.999
Honduras has been helped in saving mothers lives
by a relatively stable political environment,

00:31:00.000 --> 00:31:04.999
by a culture that\'s come to
take women more seriously,

00:31:05.000 --> 00:31:09.999
by a good long term relationship with aid
donors and by the quiet determination

00:31:10.000 --> 00:31:14.999
of Dr. Ochoa and his colleagues.
He is a good man.

00:31:15.000 --> 00:31:19.999
Really I like him, and he is
humble, he\'s simple, you know.

00:31:20.000 --> 00:31:24.999
He is also very realistic. I would have
loved to work in this environment.

00:31:25.000 --> 00:31:29.999
It… it would make me even more efficient,

00:31:30.000 --> 00:31:34.999
you know, in my work, to help to
save the women\'s and babies lives.

00:31:35.000 --> 00:31:39.999
Really I would have loved to
work here in this condition.

00:31:40.000 --> 00:31:44.999
[music]

00:31:45.000 --> 00:31:49.999
So most mums much safer.

00:31:50.000 --> 00:31:54.999
But what about women who live
far away from the new clinics?

00:31:55.000 --> 00:31:59.999
In remote mountain villages like San Isidro, really poor women
often have trouble even raising the bus fare to a clinic.

00:32:00.000 --> 00:32:04.999
As in Chad they still have to rely
on traditional birth attendants.

00:32:05.000 --> 00:32:09.999
Eugenia\'s been a TBA for two decades.

00:32:10.000 --> 00:32:14.999
Grace watched her at work with Maria, five
months pregnant with her fourth child.

00:32:15.000 --> 00:32:19.999
You have to eat lots of vegetables.
You must feed yourself better.

00:32:20.000 --> 00:32:24.999
You\'re not eating enough. The baby
isn\'t growing, it\'s very small.

00:32:25.000 --> 00:32:29.999
But here\'s the difference with Chad.

00:32:30.000 --> 00:32:34.999
If things go wrong, Eugenia has been trained
to refer women like Maria to a clinic.

00:32:35.000 --> 00:32:39.999
Grace was curious.

00:32:40.000 --> 00:32:44.999
If they tell you to go to hospital,
would you go to hospital?

00:32:45.000 --> 00:32:49.999
If there are no problems, I\'ll
have it here at home with Eugenia.

00:32:50.000 --> 00:32:54.999
But if there are complications,
I\'ll go to the hospital.

00:32:55.000 --> 00:32:59.999
In Chad, Grace had despaired of
the traditional birth attendants,

00:33:00.000 --> 00:33:04.999
untrained and self-appointed. But
here most are now state-trained.

00:33:05.000 --> 00:33:09.999
And for Grace, it worked. How do they compare
to the traditional birth attendants in Chad?

00:33:10.000 --> 00:33:14.999
I mean, this is… they are completely different. I
mean, not only they have… they have been trained

00:33:15.000 --> 00:33:19.999
to diagnose complication, but
they\'re even given equipment.

00:33:20.000 --> 00:33:24.999
I have never seen that in Chad.
It\'s wonderful.

00:33:25.000 --> 00:33:29.999
[sil.]

00:33:30.000 --> 00:33:34.999
It\'s true that Honduras is a little wealthier than
Chad, but out here in San Isidro you wouldn\'t know it.

00:33:35.000 --> 00:33:39.999
[sil.]

00:33:40.000 --> 00:33:44.999
The next day Maria\'s husband Santos showed us
his larder. More colorful than well-stocked.

00:33:45.000 --> 00:33:49.999
He grows enough corn and beans to
feed his family, but only just.

00:33:50.000 --> 00:33:54.999
After all, his wife had been told she
wasn\'t eating enough for the baby.

00:33:55.000 --> 00:33:59.999
When he has a little extra he sells it,
making a cash income of about £40 a year.

00:34:00.000 --> 00:34:04.999
For Grace, it all seemed very familiar.
In many, you know, in Africa

00:34:05.000 --> 00:34:09.999
we have… we have the same problem, you
know, that this is extreme poverty.

00:34:10.000 --> 00:34:14.999
So new clinics and trained
birth attendants,

00:34:15.000 --> 00:34:19.999
what about real emergencies?
Suyapa\'s 15, heavily pregnant

00:34:20.000 --> 00:34:24.999
and she\'s had a miscarriage already.

00:34:25.000 --> 00:34:29.999
Today, she\'s off up a mountainside
with her mother in law, an hour\'s slog

00:34:30.000 --> 00:34:34.999
before she can reach any sign of civilization.
And she tells us she may be due inside a week.

00:34:35.000 --> 00:34:39.999
Cases like this can still turn out badly.

00:34:40.000 --> 00:34:44.999
Pregnant women in Honduras still over
seven times as like to die as in Britain.

00:34:45.000 --> 00:34:49.999
But Suyapa\'s lucky. Her
local town is Esperanza.

00:34:50.000 --> 00:34:54.999
And it\'s home to one of the big regional hospitals
which do treat mums with real emergencies.

00:34:55.000 --> 00:34:59.999
She\'s given the all-clear.

00:35:00.000 --> 00:35:04.999
You could almost kid yourself it\'s the NHS.
Or almost, there\'s a nominal fee.

00:35:05.000 --> 00:35:09.999
In the delivery room, another safe birth.
They handle up to 10 deliveries a day.

00:35:10.000 --> 00:35:14.999
There were just two deaths last year, again
one after insisting on delivering at home.

00:35:15.000 --> 00:35:19.999
How do you say congratulations in Spanish?

00:35:20.000 --> 00:35:24.999
Felicidad. I want to tell her felicidad.

00:35:25.000 --> 00:35:29.999
In a poor country,

00:35:30.000 --> 00:35:34.999
it\'s a standard of equipment and
care close to rich world standards.

00:35:35.000 --> 00:35:39.999
Do you need to be a rich country
to be able to afford all these?

00:35:40.000 --> 00:35:44.999
I\'m not sure. I think there\'s
a lot of poverty here.

00:35:45.000 --> 00:35:49.999
But I think what there has
been are some good decisions

00:35:50.000 --> 00:35:54.999
to put what little money has been
borrowed or donated where it\'s needed.

00:35:55.000 --> 00:35:59.999
These are examples of that,

00:36:00.000 --> 00:36:04.999
so not only are we a country with
poverty, debts and corruption,

00:36:05.000 --> 00:36:09.999
but we\'re also a country
that takes good decisions.

00:36:10.000 --> 00:36:14.999
Yeah. It\'s the political will, I mean, to
do things, even… even with fewer resource.

00:36:15.000 --> 00:36:19.999
If the government really wants to attack the problem and
take good decisions, as you said, they will succeed.

00:36:20.000 --> 00:36:24.999
[sil.]

00:36:25.000 --> 00:36:29.999
When 189 countries including
Chad and Honduras,

00:36:30.000 --> 00:36:34.999
signed up to the Millennium Development Goals, part
of the deal was rich countries increasing aid,

00:36:35.000 --> 00:36:39.999
plus action on trade and debt relief. In
return, poor countries committed themselves

00:36:40.000 --> 00:36:44.999
to better governance, spending
money honestly and effectively.

00:36:45.000 --> 00:36:49.999
The aim, a global partnership for
development enshrined as Goal Eight.

00:36:50.000 --> 00:36:54.999
And here, it\'s worked.

00:36:55.000 --> 00:36:59.999
[sil.]

00:37:00.000 --> 00:37:04.999
Oh! This is combined oral pill. Honduras doing everything its
government believes is right to try and save mothers lives,

00:37:05.000 --> 00:37:09.999
hospitals in a Catholic country
even giving away contraceptives.

00:37:10.000 --> 00:37:14.999
So they\'ve got condoms and contraceptive
pills here in the pharmacy.

00:37:15.000 --> 00:37:19.999
Back in N\'djamena you have what?
We have none. None of them.

00:37:20.000 --> 00:37:24.999
How important is that for preventing
maternal mortality? It\'s really important

00:37:25.000 --> 00:37:29.999
because if we prevent
uh… unwanted pregnancy

00:37:30.000 --> 00:37:34.999
that most frequently led to criminal abortion, you know,
it will decrease the maternal deaths from abortion.

00:37:35.000 --> 00:37:39.999
Grace had begun her
journey feeling defeated.

00:37:40.000 --> 00:37:44.999
So how did she feel now in Esperanza,
the town whose name translates as Hope?

00:37:45.000 --> 00:37:49.999
Are you as pessimistic as you were before
coming here about cutting maternal mortality?

00:37:50.000 --> 00:37:54.999
No. No. Because I mean, can
see that even a country

00:37:55.000 --> 00:37:59.999
not very rich like Honduras, when
they are really aware of the problem

00:38:00.000 --> 00:38:04.999
and they want to fight it with their
small means they can do something.

00:38:05.000 --> 00:38:09.999
And that really gives… gives me hope, that
Millennium Development Goal can be met

00:38:10.000 --> 00:38:14.999
if people you have… you have… people
are really responsible enough

00:38:15.000 --> 00:38:19.999
to take the right intervention to work for
it. So you\'re still feeling as depressed

00:38:20.000 --> 00:38:24.999
as you were when we last filmed a ward
round in Chad? No. Less than that

00:38:25.000 --> 00:38:29.999
because I know that, I mean, is it possible
to do something if there is a will to do it.

00:38:30.000 --> 00:38:34.999
[sil.]

00:38:35.000 --> 00:38:39.999
We told the man writing a progress report on
the Millennium Development Goals about Grace.

00:38:40.000 --> 00:38:44.999
And we asked him whether her newfound optimism was
justified. Grace\'s optimism is completely justified,

00:38:45.000 --> 00:38:49.999
we… we know from the evidence from a large group of
countries that it\'s possible to get maternal mortality rate

00:38:50.000 --> 00:38:54.999
and child death rates down very quickly,
countries like Malaysia, Sri Lanka,

00:38:55.000 --> 00:38:59.999
Egypt and Honduras have all shown that. We
also know that it would cost very little.

00:39:00.000 --> 00:39:04.999
We\'re talking around $6 billion a year to cut these
maternal mortality rates and child death rates

00:39:05.000 --> 00:39:09.999
at the level needed to achieve the millennium
development goals, that… that\'s equivalent to roughly

00:39:10.000 --> 00:39:14.999
one weeks worth of what rich countries
currently waste on subsidizing agriculture.

00:39:15.000 --> 00:39:19.999
The real problem is not the lack of financial
resources, it\'s not the technologies,

00:39:20.000 --> 00:39:24.999
it\'s not the policies, it\'s the
political resolve to make them happen.

00:39:25.000 --> 00:39:29.999
Back in Chad, time to celebrate.

00:39:30.000 --> 00:39:34.999
At least for this high society couple.

00:39:35.000 --> 00:39:39.999
Suddenly there seems to be money to spare.
Look more closely and it\'s recycled.

00:39:40.000 --> 00:39:48.000
[music]

00:39:50.000 --> 00:39:54.999
Still the few western haunts
in Chad seem to be booming.

00:39:55.000 --> 00:39:59.999
[music]

00:40:00.000 --> 00:40:04.999
Chad does have something to celebrate, oil, a
billion barrels discovered under its desert sands.

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Petrol has long been something

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you find here in old bottles.
Now Chad\'s own reserves are set

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to boost government revenues.

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But will more money really
help Chad\'s mothers?

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[sil.]

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In hospital, Grace encounters attitudes
that money alone won\'t change.

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Fanne is 15. She has just had her second
child at home close to the hospital.

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But it\'s gone wrong, and now she\'s here
with a potentially serious complication.

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The baby has come out but
the placenta did not come.

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Should normally follow the delivery of the baby, it
hasn\'t happened in this case. Is that dangerous?

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Yes, because she may have hemorrhage, lot of bleeding,
and this is one of the cause of maternal death.

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Husband Hassan has gone to buy some drugs.

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Grace tells Fanne they\'ll
help pull her through.

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So it will help to contract the
uterus and detach the placenta,

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so it will come back easily now. But Grace is
furious, Hassan let Fanne deliver at home.

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When she starts to have pain labor she told
her husband, I want to go to the hospital,

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her husband say, \"Wait, I have
some business to attend in town.\"

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It tell us about the low status of woman in this country.
Woman are… I mean, have a very, very, very low status.

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She goes to find Hassan.

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He says Fanne didn\'t tell him
she was about to give birth.

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Still Grace decides to
issue a stern warning.

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[non-English narration]

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Whoever\'s in the wrong, the incident
raises a crucial issue for Grace.

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We need people to change, their way of
thinking, especially about the woman status.

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Woman is not something that we
buy, we keep, she produce baby,

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she die and you buy another woman.
But… but they… they think like that.

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You know, I buy her, she make children, she die,
I mean, I will buy another woman, that\'s all.

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It stinks that you can
buy, keep, that\'s all.

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So as Chad\'s oil money starts rolling in,

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will it seize the chance to save mothers
lives? Or do cultural attitudes to women

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in countries like Chad mean that even if they find
the means to help, they still don\'t have the will?

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Aziza Baroud is Chad\'s health minister.

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She\'s also an economist who co-ordinates how
to spend the country\'s new oil revenues.

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We asked to meet in the hospital.
Grace wanted to show her around.

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She\'s promised to increase
spending on maternal health,

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though there are few signs of it so far. Just
explain to me why the oil is already flowing out

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and we\'re getting the benefit of it, but the syringes,
the drugs as we see here are not yet coming in.

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So you have to understand one thing also,

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it is not because the day you have the money
that the day you will change everything

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because you have your system of management,
you have all those manager that you have to…

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Well, there\'s always management and stuff but
somehow the oil is going to the West. Absolutely.

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But the drugs and the syringes aren\'t coming in here. Yeah.
This is much more a matter of organization inside the hospital,

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inside the services… If the drugs
and syringes aren\'t yet coming in

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some people are gonna say, \"Look,\"
(inaudible) some people will say,

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you know, African corruption and incompetence.
It is not a matter of corruption

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and here, you know, again I would like to… to maybe
to put their emphasize here in… in what I\'m saying

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that it is a problem of management,
it is not a question of corruption.

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So corruption not a relevant issue she
claims, although management competence is.

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But what about cultural attitudes and caring? Do you think countries
like Chad care enough about mothers, care enough about women?

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If it… Culture and attitudes you
can change through communications,

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through information and that\'s it. What
some people are saying at the moment,

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at the time of the G8 is, \"Hey,
you get your act together first.

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Change your attitudes, change culture,
spend the money with more efficiency,

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and then we\'ll think about giving you some
more.\" Ah, spend the money with more efficiency,

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I agree with them. Change your culture, this
is very difficult because we are human being

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and you don\'t have any computer
that you put our mind inside

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and change as you want. This is a problem.

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We went to visit a 16-year-old girl
called Dana who had eclampsia.

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[sil.]

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She is 16-year-old, and she… Yeah,
she\'s a… she had her first pregnancy

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and she was admitted for
high blood pressure.

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She was another patient Grace
had been unable to treat

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with the cheap effective drugs that might save her
life. What do you think when… when you see that?

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I feel very sad. I feel very sad.

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Grace took the chance to tell the minister about what she\'d learnt in
Honduras and about the need for a national strategy on maternal mortality.

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The problem in Chad is that we should
have a strategy for maternal death,

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that\'s (inaudible) And they have… you know, they have found
out that the maternal… maternal deaths was very high,

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so they have tried to put down a committee

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who have worked on the strategy. It is
okay that someone moved in Honduras

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and we need someone to move
here but I don\'t believe that

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we have to go in Honduras and copy what is going there. But while you\'re waiting…
while you\'re waiting there\'s a woman… Who is saying that we are waiting?

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Who is saying that we are waiting? Well, there\'s a woman waiting there
behind the shutters for the right drugs. How come that… No, okay,

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because you take one case and you say
that people are sleeping in their houses.

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But this woman is… this woman is waiting. She\'s waiting behind
these… behind those shutters. Okay. Okay… She\'s waiting now.

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…but you want today because of
this woman that Chad could change,

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okay, thank you for the lesson.

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Back inside Dana was being
looked after by her family.

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She\'d developed eclampsia
after having a caesarean.

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It had been her first pregnancy.
A couple of hours later,

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Dana was passing into a coma.

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We went back later to find out
what had happened to Dana.

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Grace what… what happened to Dana?

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Well, she died. She died.

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[sil.]

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Oh, I mean, this is… this is…
this is a preventable death,

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you know, she could have
received the proper drugs,

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to cut the convulsion, to
cut the blood pressure,

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probably remission and she… she would have
survived. Sixteen-year-old, one baby,

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it\'s very sad. Again, a useless death.

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It could have been prevented. I
mean, despite this you keep going,

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your optimism is that
putting it too strong?

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Well, I don\'t know how long I am going
to keep going like this, you know,

00:47:55.000 --> 00:47:59.999
really I… I really don\'t know. I may just stop because
I mean, again I\'m… it is working on my nerves also.

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So I don\'t know how long I can go on this.

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[sil.]

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Okay.

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Two weeks since we filmed with Grace,

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she\'s still trying to stop mothers dying.
She\'s not given up yet.

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[music]

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[sil.]