1. OUR
TOP 5 HEALTH INITIATIVES
SUPPORTING
MOTHERS
WORLDWIDE AND HOW YOU
CAN HELP p2
HIGH
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other
IMPACT
M ay Philanthropy
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WWW.DIRECTRELIEF.ORG
THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST

2. DANIEL ROTHENBERG PHOTOASIA.ORG, DAN SMITH, JODIE WILLARD, BRETT WILLIAMS
KRISTIN BROWN
COVER IMAGES: KRISTIN BROWN, LOS ANGELES FREE CLINIC, LINDSY POLLACZEK,
TOP 5 HEALTH INITIATIVES
DIRECT RELIEF’S
Supporting Mothers
Worldwide
Why we moms. Aside from the obvious—no one would exist without someone having become
a mom—mothers are the cornerstones of families, communities, economies, and societies
worldwide. That’s why it’s staggering that the World Health Organization estimates that a woman
dies each minute from complications during pregnancy and childbirth—more than 500,000 each
year worldwide. Pregnancy is often a time of joy and trepidation, but in developing countries,
pregnancy is a life-threatening condition, as pregnancy and childbirth are the second leading
cause of death among women of reproductive age.
Many of the risks for pregnant women and children in developing countries are related to
general conditions of poverty, nutrition, and severely limited health resources and access that
affect everyone. Direct Relief’s core activities have long been aimed at expanding the quality,
us
fe p ry
Help regnancy availability, and access to health services for all people. But a principal focus of this effort is on
re sa e a
ensu & deliv d create maternal and child health and, more specifically, interventions that directly address the specific
e an our mom
nlin or y
ate o f
threats to women during pregnancy through childbirth.
Don ute page 7-8
Np
trib R EO G MO .OR
CTR
ELIEF As Mother’s Day arrives, here are the five high-impact initiatives Direct Relief is pursuing to
DIRE
support mothers worldwide.
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3. TOP 5 Health Initiatives Supporting Mothers Worldwide
EXPANDING ACCESS TO CARE
When women have adequate access to care, their chance of having a healthy pregnancy
and delivery goes up exponentially. The World Health Organization reports that a woman’s
lifetime risk of dying from complications in childbirth or pregnancy is about 1 in 7 in Niger
and 1 in 48,000 in Ireland.
Many factors limit women’s access to care. Scarcity of resources—human, financial,
technological, and medical material—and limited access to education and physical
proximity to care are among the many challenges. For 60 years, Direct Relief has worked
to infuse essential medical resources into in-country systems so more people can receive
better quality care. In recent years, these efforts have focused more intensely on
----------
expanding and enhancing health services for women and children, including prenatal care,
safe delivery, care for low-birthweight babies, and access to basic medicines and supplies.
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----
----
In sub-Saharan Africa, only 40% of women are attended
by a health professional during childbirth. In building
DANIEL ROTHENBERG, PHOTOASIA.ORG
access for essential care, Direct Relief has financed and
equipped 4 surgical theaters costing up to $50,000 each in
Malawi, Tanzania, and Zimbabwe to enable safe C-section
deliveries (which reduce the risk of HIV transmission in
childbirth) and other surgeries.
--------
------------------
In 2005, Direct Relief formed a strategic partnership with MARIE STOPES
INTERNATIONAL (MSI), a leading reproductive health service nonprofit organization
with facilities serving five million people around the world. Direct Relief now supplies
MSI clinics and outreach programs in 15 countries, assisting women and children in
Africa, Asia, Latin America, and the Middle East.
Financial support from individuals and organizations has joined with support from
corporate partners seeking to improve the health and lives of women and children. THE
BRETT WILLIAMS
ABBOTT FUND and Direct Relief ’s partnership to support the ANGKOR HOSPITAL ----
FOR CHILDREN in Cambodia, where 45 percent of children are malnourished, provides
nutritional products essential for patients and also to establish an on-site garden and -----
demonstration kitchen where families learn to grow, prepare, and eat nutritious foods to
avoid preventable malnutrition. The company also has provided major support through
Direct Relief for the AFGHAN INSTITUTE OF LEARNING, a dynamic, women-run
----
organization which provides education and care for women and children at its four clinics
throughout Afghanistan. ----------------------------------------
----- Ghana, BD has joined with Direct Relief and committed financial support,
In
----------------------------------------
laboratory and other medical equipment and supplies, and technical assistance and
training by employee volunteer teams. The collaboration has boosted the capacity and
quality of services provided by the MARANATHA HEALTH SERVICES, a 30-bed facility
in Kumasi, Ghana, serving 300 patients a month. The clinic offers prenatal exams,
nutritional counseling for pregnant women, labor and delivery services, post-natal
RANDY OLSEN, COURTESY OF BD
care, and treatment of common illnesses affecting children. The clinic also emphasizes
preventive health and health education, including child-care classes for new mothers.
Since 2004, Direct Relief has provided Maranatha Maternity Clinic with more than
$800,000 (wholesale) in medical material aid.
Sometimes small interventions make a big difference. Prenatal vitamins—which
cost $13 for one year’s supply—help prevent gestational hypertension and eclampsia
(caused by a lack of calcium and magnesium) and severe iron-deficiency anemia, which
kills 100,000 women each year. Direct Relief provides these basic items to partner
organizations and is seeking new partnerships with vitamin manufacturers to expand
availability of these low-cost, high-impact supplements.
More than 130 of Direct Relief ’s international partners provide a broad range of preventive
and curative services for women. We hope to support them all more expansively in the years to come.
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4. TOP 5 Health Initiatives Supporting Mothers Worldwide
SAFE DELIVERY
MIDWIFE TRAINING & KITS
Pregnancy and childbirth are the leading causes of death
and disability among women in developing countries.
Having a skilled attendant present during delivery is
considered the single most critical intervention for
ensuring safe motherhood.
Direct Relief is deeply committed to reducing
maternal and infant mortality. It supports facilities and
organizations that train midwives so that more women
have access to prenatal and obstetric care, and more babies are properly
cared for during their critical first hours and days. It also helps equip birth
attendants with necessary supplies to make use of their life-saving skills.
--------------- Midwife Training -------------------------------
-------------------------------------------------------
----------------
------
Direct Relief supports midwife training programs in 12 countries, including Afghanistan
and India. Afghanistan has one of the highest maternal mortality rates in the world, but
the AFGHAN INSTITUTE OF LEARNING (AIL) is working to reverse that statistic.
Founded by Sakena Yacoobi in 1995, AIL provides healthcare services, preschool through
university-level education, and training to women and girls at four sites in Afghanistan.
With support from the Abbott Fund and Direct Relief, AIL has operated a successful
-
nurse-midwife training course since 2005. To date, 46 women have completed their
training, with most now employed in clinics and hospitals. An additional 25 women are
currently enrolled and will graduate in August 2009, with a second group of 25 students
expected to graduate in 2010.
Trainees study a comprehensive curriculum of medical subjects during the 18-month
WILLIAM VAZQUEZ
program and after graduation are able to treat an estimated 11,000 patients a year. Because
it is culturally preferred that Afghan women receive health care from a female provider,
highly skilled nurse-midwives represent greater access to care and are highly sought after.
The Abbott Fund has funded nurse-midwife training programs since 2005; together,
Equipped and Ready Direct Relief and the Abbott Fund have provided AIL with more than $7 million in cash
grants and medical material assistance.
Training and equipping midwives saves lives and significantly increases and In Maharashtra State, India, PRASAD CHIKITSA provides medical care to a largely
improves the chance for safe delivery. Based on input from partners in the field, tribal population marginalized by caste and poverty. Midwifery skills traditionally
Direct Relief created medical kits to equip midwives. The kits come in two have been passed down through generations, with a midwife, or dai, learning from her
versions: one for traditional birth attendants (TBAs) working at the village level grandmother and mother. With Direct Relief ’s support, PRASAD Chikitsa is providing
and another for graduates of formal midwife training programs, or skilled birth a two-year training program for dais to improve and expand their skill base. Thanks to
attendants (SBAs). funding from the Abbott Fund, 40 women are receiving training through the program.
-----
The TBA kits are targeted to areas where more than 70 percent of
-----------------------------------------
---------------------------------------------------------
---
deliveries occur at home and where providers have completed basic birth-
attendant training programs. The program started in 2006, and, with support ---- In Afghanistan, where only 14% of births are attended
from the STEINMETZ FOUNDATION, 694 TBA kits have been provided to by a skilled healthcare worker and the literacy rate is
midwives in Sumba, Indonesia, and 13 other countries. just 13% for women, Direct Relief and the Abbott Fund
---
---- SBA kits contain the same contents as TBA kits but include higher-level
have teamed up for 5 years to support the critical
-------------------------
equipment such as stethoscopes, blood pressure cuffs, and instruments
appropriate for either births at home or in a health or maternity center. work of the Afghan Institute of Learning in training
MILTEX, INC., a division of Integra LifeSciences Corporation, provided critical midwives and educating women and children.
elements to complete the kits. A total of 30 SBA kits were produced and sent to
partners in 2008. Kits targeted to partners’ needs have helped increase capacity
SUMBA FOUNDATION
for safe delivery in several regions around the world:
AFRICA – Cameroon, Ethiopia, Ghana, Uganda
ASIA – Afghanistan, China (Tibet), India, Indonesia, Laos, Philippines
LATIN AMERICA AND THE CARIBBEAN – El Salvador, Haiti, Honduras
PACIFIC – Fiji
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The $50 kit is designed to handle 100
-----------
deliveries, with equipment that is
sterilized after each use and supplies
that can be restocked by Direct Relief.
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5. SHALEECE HAAS
------------------------------
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DIRECT RELIEF
ADDRESSING
----
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COMPLICATIONS
EMERGENCY OBSTETRIC CARE
In about 15 percent of deliveries worldwide, an unpredictable
complication occurs. That’s when emergency obstetric care
RESTORING
HEALTH & HOPE
(EMOC), such as a cesarean section, becomes necessary.
But for women in developing countries, access to EMOC is
very limited, and without access, a woman who experiences
complications during delivery will likely suffer debilitating
OBSTETRIC FISTULA
injuries like obstetric fistula or even death. The disability or PREVENTION & CARE
loss of a mother reduces the survival rates of her other children
Every year, more than half a million women die
and affects not just her family but the community at large.
because of largely preventable complications of
In partnership with African Medical Research and
pregnancy and childbirth. This tragedy is most
Education Foundation (AMREF), Direct Relief has started
significant in the poorest countries where the risk of death is many hundred times
a pilot program in Uganda to fight maternal mortality by
greater than it is in the developed world. For every woman who dies in labor, many
equipping health facilities and providers so they can offer
more will suffer serious injury if proper obstetrics care is not available in time.
quality EMOC services.
Obstetric fistula is most commonly caused by a prolonged labor that obstructs the
PRINCESS DIANA HEALTH CENTER is one of several health birth canal and renders the woman incontinent. Because of the obstruction, obstetric
facilities in Uganda’s large district of Soroti—population 1.6 million. fistula almost always results in stillbirth. Worldwide, more than 2 million women are
---
Princess Diana, a primary health center for residents of Soroti town, is living with obstetric fistula, 80 percent of whom live in sub-Saharan Africa. An estimated
the EMOC center for the district and a referral center for surrounding
50,000 new cases are reported each year, though the number is likely much higher.
areas. High-risk patients are sent to Princess Diana in advance of
delivery so they can receive surgical intervention immediately if an Obstetric fistula is preventable. When women have access to quality emergency
emergency arises during labor. Nearby, SOROTI DISTRICT HOSPITAL obstetric care, the incidence of maternal death and disability drops significantly.
handles all surgical referrals, from road accidents to C-sections. Several Obstetric fistula repair surgery is a relatively simple one, and the success rate of repair
hundred EMOC interventions are performed there each month, but on the first attempt can be as high as 90 percent. Direct Relief supports several obstetric
women must travel long distances
and wait for long periods before
fistula repair and prevention programs in Africa, from Ethiopia to Liberia.
TOP 5 Health Initiatives Supporting Mothers Worldwide
surgery. Delayed EMOC is often fatal --------------------------------------
--
for unborn babies and their mothers.
BRETT WILLIAMS
In Ethiopia, Direct Relief provides support to the ADDIS
LINDSEY POLLACZEK
EMOC is part of a care
ABABA FISTULA HOSPITAL, the only medical center in the
--------------------------------
continuum. Adequate prenatal
care supporting the mother and her world dedicated exclusively to fistula repair. The hospital is
the model institution for obstetric fistula repair and training
----
unborn baby is paired with careful
monitoring before and throughout delivery. At minimum, a midwife is in Africa. The Addis Ababa Fistula Hospital provides free
-------------------------------
------------------------
present during delivery. Proper training enables a midwife to provide repair services for approximately 2,200 women every year and
interventions when complications arise, or to know when to refer a long-term care for 35 women whose obstetric fistula cannot be ---------
repaired.
--
woman on to an EMOC facility. AMREF trains midwives and clinical
officers, and Direct Relief sees that these health professionals have the In Somaliland, EDNA ADAN MATERNITY AND TEACHING
tools they need to support such critical decision making. HOSPITAL is the region’s main referral center for obstetric emergencies. The traditional practice
As part of the pilot program, AMREF is improving training and of female genital mutilation, common in Somaliland, can lead to complications in childbirth
capacity at all facilities in Soroti district to ensure adequate local maternity and increase the likelihood of maternal injury or death. Edna Adan Maternity and Teaching
services. Direct Relief supports AMREF by supplying materials, Hospital places a high priority on training nurses, midwives, and community health workers to
> continued on next page
pharmaceuticals, and equipment. A large consignment of supplies and
equipment—including an anesthetic machine, oxygen concentrators, and
------
an ultrasound machine—will enable the trained staff at Princess Diana to ---------- Since inception in 1974, the Addis Ababa Fistula
inaugurate EMOC service in the new health center. Direct Relief has also Hospital has treated 30,000 Ethiopian women
donated nine motorcycles and several computers to AMREF in Soroti to for fistula repair.
assist in service delivery and evaluation of the project.
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6. CRAIG BENDER
TOP 5 Health Initiatives Supporting Mothers Worldwide
RESTORING
HEALTH & HOPE
CRAIG BENDER
------
OBSTETRIC FISTULA
---------------------------------------------------------------------------------------
.
nt
PREVENTION & CARE
co
LINDSEY POLLACZEK
-----
---------------------------------------------------------------------------
-------------------------------------------
Prevention
of Mother to
Child
> continued from previous page
prevent maternal death and disabilities like obstetric fistula. Transmission
To promote quality obstetric surgery in Somaliland, Direct
Relief has helped equip the hospital’s operating room with
all the components required for a fully functional surgical
of HIV
theater. ---------------------------- Every 48 seconds, a child is infected with HIV, the virus that
--
The JFK MEDICAL CENTRE in Monrovia, Liberia, has causes AIDS. This is a profound human tragedy, the primary
a ward and operating theater dedicated to fistula repair.
cause of which is preventable. Without medical intervention, the
The center’s multifaceted program focuses on prevention,
repair, and rehabilitation/reintegration for fistula patients. chance that a mother will pass along the virus to her child during birth is as high
The project was launched in 2007, and in the first year and a as 30 percent, but with proper testing and therapy, this chance can be nearly
half, more than 330 women received fistula repair surgeries.--- eliminated.
--------------
Nurses and midwives have been trained to provide quality In 2007, Direct Relief began distributing free, HIV rapid test kits. Sixty-nine
emergency obstetric care, including safe delivery, and doctors
have been trained in management of common obstetric
developing countries are eligible for the program, including all countries in Africa,
emergency techniques, including cesarean section. where the burden of HIV is heaviest. Direct Relief is working to eliminate the
barriers to the testing of pregnant women for HIV in countries where mothers and
--------------------------------------- their children face the greatest threat.
-----------
------------------- --------------------------------
----
--------------
The Abbott-donated Determine® test is quick—results take 15 minutes—and requires no
CRAIG BENDER
electricity or water, making it ideal for areas that may lack steady access to either resource. If a
pregnant woman tests positive for HIV, the healthcare provider can take the necessary steps to
--
help prevent the baby from being infected with the virus. ------------------------------------
h
watJcK Medwicoaml en
m F
Between 2002 and 2008, Abbott donated more than 11.2 million rapid HIV tests to
prevention programs throughout the developing world. Through 2007, over 7.7 million pregnant
--
o fro t the
vide and mee has been ic women have been tested and 855,000 of those women tested positive for HIV. Two million
tre lt h tetr
Cen hose hea ugh obs spouses and children of the pregnant women tested were also screened.
w hro pair.
red t re s/ In many developing countries, Direct Relief works closely with ministries of health and
resto fistula rfocu
rg/ou la.aspx other major healthcare networks running prevention of mother-to-child transmission (PMTCT) ---
lief.o cfistu
----------------
ctRe i programs to distribute the test kits. The RWANDAN MINISTRY OF HEALTH, one of the first to
Dire /obstetr
m ch subscribe to the program, has already tested 750,000 pregnant women. In Kenya, where UNAIDS
estimates 8.3 percent of adult females are HIV positive and 117,000 children under the age of 14
are infected, Direct Relief partner ELIZABETH GLASER PEDIATRIC AIDS FOUNDATION has
lear
more abo n
tested 117,000 expectant mothers, 8,600 of whom were HIV-positive.
ut mothe
rs
--------------------------------------------------
and child
------
ren living
healthier
lives at --- This program, along with Direct Relief’s antiretroviral therapy
D I R E CT R
ELIEF.O drug program which began last year, represents a huge leap
RG
forward in helping local health providers identify and combat
HIV across the globe.
6 WWW.DIRECTRELIEF.ORG PAID ADVERTISEMENT SPRING 2009 THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST

7. ...
USA
YOUR
Maternal SUPPORT
...
AND
Child Health
AT
HOME
HELPS PROVIDE A RANGE OF ITEMS
CRITICAL TO THE HEALTH OF
MOTHERS AND BABIES AROUND
THE WORLD.
FOR EXAMPLE…
$25
According to August 2008 U.S. Census data, nearly 46 million Americans A one-year supply of prenatal supplements
lack health insurance. The uninsured have few options to receive quality, for two women
affordable health care. Nonprofit clinics and community health centers
bridge this gap by providing a broad range of healthcare services for
$50
millions of people. Direct Relief USA supports more than 1,200 of these
A basic midwife kit for a Traditional
valuable clinic resources for the medically underserved in all 50 states. Birth Attendant to serve at 100 births
Direct Relief USA has provided nonprofit clinics across the country with
$250
more than six million prescriptions, plus other medicines and supplies One supplemental midwife kit for a
valued at $150 million (wholesale), and $5 million in cash grants. While Skilled Birth Attendant
TOP 5 HEALTH INITIATIVES
these providers often cover a comprehensive set of primary care services,
DIRECT RELIEF’S a key focus of care is maternal and child health.
$300
Obstetric fistula surgery for
ST. CHARLES COMMUNITY HEALTH CENTER (SCCHC) in Kenner and Luling,
one woman
Louisiana, has provided quality, accessible primary healthcare services to the
Supporting Mothers
uninsured and underinsured since 2002. In the aftermath of Hurricanes Katrina
$6,000
and Rita, SCCHC provided urgent medical care to more than 20,000 evacuees. In An obstetric ultrasound machine,
addition to supplying emergency and ongoing medical material support, Direct
including printer and extra paper
Worldwide
Relief provided a cash grant of $75,000 to help the center initiate a Maternal and
Child Health Services program in 2007.
Prenatal care for the uninsured and
Funding for the Afghan Institute of
KATIE LEWIS
$20,000
underinsured population in the greater New
Orleans area has become extremely difficult Learning’s new Maladon clinic in
Afghanistan for a year
to access due to the post-Katrina reduction exist without someone having become a
Why we moms. Aside from the obvious—no one would
in capacity and closings of previously
mom—mothers are the cornerstones of Latino women are
available providers. families, communities, economies, and societies worldwide. That’s
100% OF
why it’s staggering that the particular Health Organization estimates that a woman dies each minute from
in World need of care, as many are
----------------------------------------
ineligible for government-sponsored health
complications during pregnancy and have difficulty accessing care 500,000 each year worldwide. Pregnancy is
programs, and childbirth—more than
due to language and cultural barriers.
often a time of joy and trepidation, but in developing countries, pregnancy is a life-threatening condition,
To address this need, SCCHC has
as pregnancy and childbirth are thethe Centering Pregnancy CONTRIBUTIONS
implemented second leading cause of death among women of reproductive age.
Program at the Kenner facility, which has strengthened the provision of maternal
ARE DEVOTED
Many of the risks for pregnant women and children in developing countries are related to general
and child health services in the New Orleans area. Today, women can rely on
SCCHC for complete obstetric andnutrition, care, including family planning
TO OUR PROGRAMS.
conditions of poverty, gynecologic and severely limited health resources and access that affect everyone.
services. Nutrition counseling, pap smears, breast exams, and prenatal and
Direct Relief ’s core activities have long been aimed at expanding the quality, availability, (non-program) to
postnatal care, including treatment for postpartum depression, are all provided by All overhead and access expenses are covered by
health services for all people. But a principal focus of this effort is on maternal and child health and, more
SCCHC. Pediatric care—vision and hearing tests, allergy and asthma treatment, a generous bequest.
dental services, sick-child visits, routine check-ups, and immunizations—is available
specifically, interventions that directly address the specific threats to women during pregnancy through
at little to no cost. I N M EMORIAM
childbirth.
Maria Rivas was one of the first patients to go through St. Charles Community
Gordon Allen
Health Center’s Pregnancy Program. She and her daughter turn to SCCHC for 1924-2009
As Mothers Day arrives, here are the five high-impact initiatives Direct Relief is pursuing to support
------
their primary care, and Rivas advocates on behalf of SCCHC among the area’s
We note with sadness the loss of Gordon Allen, former Direct Relief
mothers worldwide.
growing Hispanic community. director and longtime supporter whose generosity, kindness, and
--------------------------- energy will be greatly missed.
WWW.DIRECTRELIEF.ORG PAID ADVERTISEMENT SPRING 2009 THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST 7

8. MAY IS FOR MOMS!
THIS MOTHER’S DAY, honor the moms in your life with a personal
tribute page. You’ll support Direct Relief’s programs that help
women around the world have safer pregnancies and
deliveries––and help children thrive.
Find out more at dri.convio.net/MothersDayTributes
JAY FARBMAN
For a suggested $25 donation,
Direct Relief will send a beautiful card to
A WOMAN YOU WANT TO
HONOR THIS MOTHER’S DAY.
Call (805) 964-4767 or visit DIRECTRELIEF.ORG
NONPROFIT ORGANIZATION
U.S. POSTAGE PAID
SANTA BARBARA, CA
PERMIT #756
27 S. LA PATERA LANE
SANTA BARBARA, CA 93117
TEL: 805.964.4767 TOLL FREE: 800.676.1638
FAX: 805.681.4838
www.DirectRelief.org
BOARD OF DIRECTORS
CHAIRMAN Stanley C. Hatch
VICE CHAIRMAN Dorothy F. Largay, Ph.D.
SECRETARY Ayesha Shaikh, M.D.
TREASURER James A. Shattuck
Bruce N. Anticouni • Frederick Beckett • Frederick P. Burrows • Jon E. Clark
Kenneth J. Coates • Thomas J. Cusack • Killick Datta • Ernest H. Drew, Ph.D.
Gary Finefrock • Richard Godfrey • Bert Green, M.D. • Raye Haskell
Priscilla Higgins, Ph.D. • Brett Hodges • Tara Holbrook
Ellen K. Johnson • Donald J. Lewis • Alixe G. Mattingly
Robert C. Nakasone • Natalie Orfalea • Carmen Elena Palomo • John Romo
James H. Selbert • Ashley Parker Snider • Richard Steckel, M.D.
Gary R. Tobey • Paul H. Turpin • Sherry Villanueva
INTERNATIONAL ADVISORY BOARD
CHAIRMAN Frank N. Magid
Lawrence R. Glenn • E. Carmack Holmes, M.D.
S. Roger Horchow • Stanley S. Hubbard • Jon B. Lovelace
Hon. John D. Macomber • Donald E. Petersen • Richard L. Schall
John W. Sweetland
PRESIDENT & CEO Thomas Tighe
HONORARY BOARD
PRESIDENT EMERITUS Sylvia Karczag
CHAIR EMERITUS Jean Hay
DIRECTOR EMERITUS Dorothy Adams
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