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Mass. woman takes nursing talent to South Sudan

By Chris Curtis
The Recorder / April 7, 2012
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GREENFIELD, Mass.—Retiring in 2010 from Baystate Franklin Medical Center, Liza Ramlow decided to take her 30 years of experience as a nurse and midwife where her help was most needed.

Ramlow, a Gill resident, applied and was accepted to Medecins Sans Frontieres, better known in the Anglophone world as Doctors Without Borders, and has since volunteered more than a year in Africa, most recently serving refugees in South Sudan.

Ramlow described her two months in the newly autonomous country by phone from Wisconsin, where she is spending time with her elderly parents.

Ramlow was dispatched to Maban, South Sudan, as part of a MSF emergency response to the worsening refugee situation.

When she first heard of the Doro refugee camp in December, Ramlow said, the U.N. counted 8,000 refugees, a number that had jumped to 20,000 by the time she arrived a few days later.

The concentration of people in a barren section of country, where the dry season had wells nearly dry and goats trying to climb the trees for green vegetation by the time she left, required medical attention that was not available.

"In South Sudan there is an extreme shortage of medical personnel, after 25 years of civil war the population of trained people has pretty much fled, and they aren't doing any training right now, so our services were needed there, in some cases to provide medical care and in other cases to train others to provide care, and that's what I did," she said.

She and another MSF midwife, Carolina Methenge of Kenya, worked training the midwifes within the displaced communities, filling in where modern medicine was needed to supplement generations of experience.

"These women, traditional birth attendants, have been taking care of the women of their community for hundreds of years, and most babies are able to be born with little or no medical assistance," Ramlow said.

An important part of the training was in preventing and treating life-threatening delivery complications.

A primary focus was the problem of postpartum hemorrhage, severe blood loss after delivery, the leading cause of maternal death in developing regions according to the World Health Organization.

Ramlow helped train the local midwives to respond to and prevent hemorrhaging, and to identify women at risk. Women giving birth for the first time and experiencing prolonged labor, and women having their "sixth, seventh, eighth, ninth or twelfth" baby are especially at risk for internal damage, and can hemorrhage or develop fistulas, Ramlow said.

An obstetric fistula is a hole in the birth canal caused by obstructed labor and resulting in "constant incontinence, shame, social segregation and health problems," according to the WHO, and affecting 50,000 to 100,000 women worldwide, with an estimated 2 million young women living with untreated obstetric fistula in Asia and sub-Saharan Africa.

It is common for women to have many children in South Sudan, Ramlow said, where the population has been decimated by long years of war. "So it is important to them for the women to have many children, which puts some women at risk and actually puts the children at risk to some extent, because resources for caring for children are scarce and children in very large families don't do as well," Ramlow said. "Disease and malnutrition take their toll."

During her time at the camp, Ramlow said they saw 700 to 800 women in the prenatal ward, but initially saw relatively few births.

Most women still delivered in their homes, improvised shelters of mosquito netting and sticks, but the MSF team made some inroads.

In December they saw 11 births, she said, and in January 51, an increase Ramlow credited to the publicity efforts of the local staff.

Training the staff of 15 traditional birth attendants to work in the MSF clinic presented special challenges.

Most had never worked in a health care facility before, never administered an injection or even used a watch, she said, which complicated scheduling.

On top of the cultural difference, neither Ramlow nor Methenge spoke any of the variety of local languages, although Ramlow said Methenge was able to pick up some Arabic, a language spoken by refugees forced to flee to Ethiopia during an earlier conflict and only recently returned from exile.

Some of the staff and patients spoke some English, but much of the communication came down to common experience.

"The process of birth is something we had in common, and it made it easier for us to `talk' about it, even if we didn't have the words to use," she said, with sign language and demonstration figuring heavily.

Ramlow said she had always wanted to work internationally, and joined MSF because she felt the organization had the ability to place her where she would be most useful.

"There's also just a big part of me that wanted to have that experience, and I have really loved being a working part of other cultures," she said.

Also, she said the organization has a focus on maternal and child health she feels is important.

"When you save a mother's life you protect her children, and the other members of the community who rely on her," she said.

Ramlow has also worked in Nigeria and Zambia, for six and seven months respectively, on longer-term, non-emergency missions, and said she hopes to return to the field sometime this year.

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