Aminata and Baby Boy

by Emily Scott

Written Friday March 6

On the day Abass died, I was on my way back to Freetown where I have been assigned to work at the holding center for pregnant women for the rest of my time here. Let me explain what that means:

With limited resources, it isn’t feasible to have Ebola Treatment Units in every town in Sierra Leone. Ebola Holding Units are used to isolate and treat suspected patients until their Ebola status can be confirmed. EHUs are peppered around the country, and patients with a wide variety of maladies show up there to be triaged to see if they fit the case definition for Ebola. If they do not, they will either be sent home or referred to a government hospital for further care. If they do show symptoms that make clinicians suspect they have Ebola, they are admitted to the holding unit and cared for until their Ebola blood test (called a PCR) comes back. Depending on the center, a PCR result can take anywhere from several hours to several days. The patients whose results come back positive are then transferred to a full Ebola Treatment Unit for care.

The holding unit where I now work is specifically for pregnant women, and it is the only one in the country. Even before Ebola, the state of obstetric care in Sierra Leone was abysmal. In 2010, one in every eighty-three women died in childbirth (that’s forty times higher than in the US). Since the outbreak, pregnant women have been completely abandoned.

The problem is that labor and common complications of pregnancy can look frighteningly like Ebola. If a pregnant woman showed up to triage in America complaining of abdominal pain, weakness, and nausea, we would assume she was in labor. But here, among healthcare workers who have watched their colleagues die, everyone sees Ebola. They also know that the mortality rate among pregnant woman with Ebola is nearly 100%, and with limited resources, a case can be made that time and medicine would be better spent on someone who has a chance of surviving. Add to that the fact that the viral load in the fetus, placenta, and amniotic fluid is very high (and even a normal labor is a very messy processs involving a LOT of bodily fluids), and suddenly a woman in labor looks like a bomb about to go off.

As a result, many pregnant woman have been isolated and essentially left to die since the outbreak began. Princess Christian Maternity Hospital (PCMH) is the only hospital for pregnant women in the entire country, and descriptions of it during the height of the outbreak are horrifying. A New Yorker article from last October makes it sound like hell on earth: “Inside the ward, a woman writhed and groaned on the floor in a pool of bleach and bloody diarrhea, a full body bag lying next to her. Staff entered and exited without properly donning protective gear. There was a shortage of numerous supplies, and used equipment was being discarded in a hole dug outside. A woman wandered between rooms, holding her dead infant.”

Since then, the situation at PCMH has improved, although it is still by no means ideal. On the compound that PCMH shares with the children’s hospital, PIH staff now help run a holding unit to care for pregnant women who would otherwise be turned away. The main hospital now cares only for pregnant women who are clearly Ebola negative; the others come to us.

Our unit is housed in what used to be the radiology building. Like Maforki ETU, the nurses station and donning and doffing areas have been added on to the original structure with tarps and wood. We have enough beds for nine women in three rooms, plus two little rooms with a bed in each designated for deliveries. There are six international PIH staff, and plenty of national nurses. Our family practice doctor leaves tomorrow, so for now we nurses will run the show.

In our small unit next door to the full hospital, we do the best we can to keep these women alive until they can receive proper care. Because we can’t be sure which patients are having common labor complications and which have Ebola, we do all of our care (and if necessary, deliveries) in full PPE. Although some of our patients do turn up positive (one this week and two the week before), we see many more complicated labors than we do Ebola. Unfortunately, the only way to distinguish between the two is to do a PCR blood test. A lab run by the Dutch has recently arrived on-site that can process our samples in several hours, but before that it could take days. On my third day at the holding unit, the Dutch lab’s generator was broken so no tests were being processed.

Unfortunately, the time it takes to get Ebola test results is the difference between life and death for many moms and their babies. If a woman shows up at triage hemorrhaging, for example, in America she would have an emergency cesarean section to save the lives of her and her baby. Here, bleeding is a sign of Ebola, so she must first come to our holding unit. No one will perform a c-section on a woman suspected of having Ebola. It would be too risky for the staff, and if she did have Ebola she would likely bleed to death during the surgery anyway. But for those woman who arrive likely bleeding because of a placenta previa or a uterine rupture, we hope we can keep them stable long enough to prove they are Ebola negative and get them to the operating room.

To make the situation worse, prenatal care has halted along with the rest of the country’s health systems since the outbreak began. Aminata* is a perfect example of this. She was the first patient I cared for at PCMH holding unit, and when I first saw her she was lying on the ground next to her bed, barely conscious. She had arrived at the hospital eclamptic – a condition of pregnancy in which high blood pressure causes seizures (for reference, I usually tell people that eclampsia is what Sybil died of in Downton Abbey, which, it’s worth noting, was 100 years ago). I have never seen an eclamptic patient in America. Because our moms get consistent prenatal care, the warning signs are identified early and I often see pregnant woman with PRE-eclampsia (essentially, we have caught them before the condition is serious enough to cause a seizure). In Sierra Leone, no one is caught at the pre-eclampsia stage.

Aminata had come to traige unconscious, and because she was living in a home that was quarantined due to contact with an Ebola case, no one at the main hospital would touch her. She was admitted to our holding center, and the national nurses reported that they had delivered her baby vaginally overnight, while she was still unconscious. Her first PCR had come back negative, but because she had come from a quarantined home, protocol required that she have another test three days later before the main hospital would take her or her baby.

When I found Aminata lying on the floor, her little baby boy was wrapped in a lapa on her mattress a few feet away from her. She was not aware enough to know that he’d been born. My colleague and I lifted her onto the mattress and began to clean her up when I saw her eyes roll back into her head and her eyelids begin to flutter. I knew what was happening only from books, and it took me a moment to process that I was seeing my first eclamptic seizure. A second later her arms began to twitch, and her whole body followed. I turned her onto her side while my colleague shouted out to the Green Zone for medications. A minute passed, maybe two. Aminata continued to seize while we waited for medications to be drawn up and handed in to us. I felt like I was in a nightmare.

Aminata’s seizure spontaneously resolved just before her medications arrived. Among other things, we treated her with intramuscular injections of magnesium sulfate, though in the US she would have been on an IV drip under constant supervision. In an Ebola holding unit, where the heat often drives us out of our suits and away from our patients in under an hour, there is no way to continuously monitor an extremely ill woman. There are also no IV pumps to make sure the exact dose is administered, and no lab testing to check the level of magnesium in her blood.

Despite all this, Aminata has come around. One of the PIH-ers who has been working at PCMH for weeks told me that they often see good outcomes in eclamptic mothers, despite their shockingly late arrival for treatment. When I visited Aminata yesterday she was lethargic but completely conscious, a huge improvement from the day before. I unwrapped her baby and put him on her bare chest, and she stared down at him in wonder.

Unfortunately these two are not out of the woods yet. The little boy is small (to the naked eye, anyway; we don’t have an infant scale) and not interested in breastfeeding. We have been feeding him formula while we encourage Aminata to keep trying, but it’s not a viable long-term solution for a woman who can’t afford the formula, let alone clean water to mix it with. But soon their fate will be out of our hands. Aminata’s second Ebola test came back negative, so we cannot keep her in our unit any longer. The day before, the woman in the bed next to her turned out to be Ebola positive. Every minute Aminata spends in our holding unit puts her and her baby at risk for catching Ebola from someone else. Aminata is no longer ill enough to be admitted to the main maternity hospital, so she’ll go home with her family tonight. In America, I would refer her to a lactation specialist to make sure her baby eats and gains enough weight. Here, there’s no such thing.

The sad truth about this job is that I can take on my own small role, and nothing more. I wish I had the time and resources to follow up on Aminata, but in reality I barely have a moment to chart on the care I gave her, before some other issue falls at my feet. Yesterday one of the lab personnel saw a pregnant woman wandering around alone in the hospital compound, vomiting. Without touching her, she guided her to our holding unit, where the 17-year-old told our nurses that her mother, father, sister, and brother had died of Ebola. She said she had come to the hospital when she started to have vomiting and diarrhea, and had been turned away at triage. For the past three days, she had been sleeping in the hospital compound, being sick in the lab stairwell.

After a fair amount of horror at the idea that an Ebola-positive young woman had been wandering around the compound spreading infectious fluids everywhere, we got to the bottom of her story. Her family had actually passed away three months ago, longer than the incubation period, so she hadn’t really had Ebola contact. If she was going to catch Ebola from her relatives, she would have gotten sick in the first 21 days. The nurses at triage confirmed that they had seen her and turned her away since she didn’t meet case definition: Her vital signs were fine, no fever, just a pregnant woman with morning sickness. She’d told them that the person she was staying with since her family died had kicked her out of the house, and she had essentially turned up at the hospital out of desperation.

We all breathed a little easier knowing that, based on her history, it was unlikely that she had Ebola. Her blood test came back later that day and confirmed that she was negative. Like Aminata, this young woman now poses a problem that we aren’t equipped to solve. She insists that she has no place to go and no one to turn to now that we must discharge her. With no social worker and no idea what options we have, we PIH-ers turned to the national staff to help us come up with a solution for her. The last I heard before I head to leave for the day was that the staff was collecting some money for her. She’ll get her discharge package from us (clothes, medicines, and a certificate saying she tested negative for Ebola) and presumably they’ll send her on her way.

As the Ebola outbreak gets under control and the Sierra Leonean government attempts to return to normal healthcare, the issue of pregnant women will continue to be a problem. No one quite knows what to do with them. Over dinner tonight we got a call asking us to admit a woman in labor coming from a quarantined home. My colleague asked the usual questions, trying to get a sense of how likely it was that the woman had Ebola. As she untangled the story, it turned out that this woman was not in fact in labor – just very pregnant, and looking like she was about to pop. She had no symptoms of Ebola, no fever, no indication that she was sick at all. But she was hours away in Port Loko district in a quarantined home, looking like she might go into labor at any moment and making everyone very nervous. Couldn’t we just hold on to her until she went into labor?

The trouble with pregnant women in the setting of Ebola is that they’re all in a gray area. If this woman had not been pregnant, she would have remained quarantined in her home and only been brought to a holding center if she began to show symptoms. According to case defintion, she has no business being in a treatment center. But when she goes into labor, who will care for her? With no maternity care available in Port Loko, can we reasonably ask an untrained traditional birth attendant to do this delivery without PPE under the assumption that the mother is Ebola negative? If we tell her to come to our unit when she goes into labor, will she get here in time?

No matter what decision we make, it won’t affect just this one woman. We’re told there are actually ten women in quarantined homes in Port Loko in various stages of pregnancy. We can’t take them all at our holding unit. They would more than fill all of our beds, and we would have no space to care for the women from Freetown who continue to show up needing care. Much as we’d like to, we can’t take on all the pregnant women in Sierra Leone in day. We are at ground zero for rebuilding maternal care in this country, doing the best we can one day and one patient at at time.

*Names changed to protect privacy

Nurses for Edna: A Medical Mission to Hargesia, Somaliland

In August 2013, Wanda Chestnut, Kim Law and Kerra Plesko, three members of the Nurses for Edna team, left for Hargesia, Somaliland.  Due to a death in the family the last nurse, Sarah David, joined them two weeks later.

 Each member of the team had expressed a passion to improve women’s health around the world. For almost a year they had planned and worked.  They held fund raisers to augment the already generous grant awarded by Barco’s Nightingale Foundation for this mission. They sought free medical equipment and found ways to cover shipping costs and logistics. They sent out hundreds of appeals to friends and family to raise awareness of the plight of the Somaliland women. They did all this in an effort to make a difference in a country still struggling to recover from years of civil war. They traveled with little personal luggage so they might fill their baggage allowances with donations of medical equipment.  The trip took more than 24 hours; they arrived exhausted, but eager to begin work.

The Hospital director, Edna Adan requested they teach a First Aid course while they were in Hargesia. What they didn’t realize was how large the group would be – over 150 nurses, lab techs and public health students. Nor did they realize that some of their teaching would need to be done using pantomime and interpreters! 

Although each member of the team expressed that the teaching experience was both frustrating and somewhat overwhelming, they also expressed that one of the best things about the trip was the positive feedback that they got from their students. They can feel proud that they were instrumental in teaching more than 150 students the necessary skills needed to provide basic First Aid Care for the people of Somaliland.

“My happiest moment is a culmination of positive feedback from my students and from the university. Both have expressed gratitude for and positivity towards my teaching and indicated they would happily  have me teach again. Having never taught in a classroom setting before, and having experienced numerous frustrations throughout the course, the end response was very gratifying,” Kim Law.

Besides teaching and working at the Edna Adan Maternity Hospital the nurses also worked and taught in the

community at the Abdi Idan MCH Clinic. This free, government funded clinic provides multiple services including antenatal and postpartum care, low risk deliveries, a nutrition clinic, a pediatric health and immunization clinic, and lab services in one of the poorest neighborhoods in Hargesia.

While they were not able to spend as much time as they had hoped providing women’s health clinical care at the hospital, the nurses did both work, and provide supervision to student nurses, on the wards. Three of the nurses identified their biggest challenge, and saddest moments, came while resuscitating a newborn infant with no doctor to guide them.

“We tried to get one of the nursing students to go find a doctor, but she didn’t understand what we wanted. Finally, the nurse anesthetist came in and we were able to partially stabilize the baby and get it breathing. But, it was just a situation where no one in the room knew what to do and we couldn’t find anyone to help us, Kerra Plesko.

It was during incidents like this one, and other long neonatal resuscitations that the nurses felt pummeled with a moral and ethical dilemma.

 “My absolute worst experience here is the ethical dilemma I am now constantly thinking about. We've done a few, long neonatal resuscitations, and have been able to revive the babies, only to have them die a few days later. If they had lived they would have been severely disabled. Is it ethically responsible to do long resuscitations in resource poor countries where the risk for long term disability is high?” Kim Law

However, the nurses also expressed being positively impacted by their time in Somaliland, They came home with a greater appreciation for everything available to them at work and at home: medications, supplies and equipment.

“I now really appreciate being prepared at every delivery, having the necessary equipment ready, or

even having it at all, and having qualified trained people who know the importance of quick resuscitation and being efficient with what we are doing.  I appreciated it before, but I had never seen babies die from the lack of those things. I know we live in a rush- rush society and I do believe that we need time for slowdowns often, but I also value responding to a task quickly, and Africa has shown me how valuable that can be,” Kerra Plesko

They also came home with a greater appreciation for their knowledgeable, supportive team members at their respective work places.  Larger still, they returned with a sense of respect for the people of Somaliland and a reminder of the importance of humility.

“The people of Hargesia are so poor and despite being poor they are humble people. This experience reminded me to remain humble in all situations and circumstances,” Wanda Chestnut.

The nursing team also described moments of happiness along a difficult medical mission. Moments of showing support for each other; of early morning work -out sessions on the roof to decrease their stress; and spontaneous dancing in their rooms after working all day to the point of exhaustion. But, the most gratifying memories they report are of times they saw their hard work actually bringing change in the nursing practice at the Edna Adan Maternity Hospital:

“My happiest moment was when I went downstairs one morning after breakfast and saw the nurses and midwives put two babies in the Embrace warmers! It was a proud moment. Not only did they do it correctly, but they actually remembered to use them! It’s hard to tell when you get through to some of the nurses, but at that moment, I knew that our in-services and teachings had some sort of impact because the neonates were in Embrace,”  Sarah David

The  nurses report feeling proud of some of the small, yet significant, changes they brought to the Edna Edan Maternity Hospital such as putting together an emergency resuscitation kit for the med/surg ward. They are particularly proud of the part they played  in the prevention of neonatal hyperthermia.

“When we first arrived at the hospital, neonatal resuscitation were being done on an old cart with a heating pad. The babies would get extremely cold (like 34 C cold). They had two radiant warmers shoved into corners so we decided to check them out. One of them didn't work but the other one was in beautiful shape. It took several weeks to get everyone to leave the warmer on and plugged in at all times. But eventually, with perseverance and a little duct tape, we made it happen.”Kim Law.

Although the mission to Hargesia was challenging, each nurse expressed how very grateful they are to have had this experience. Each feels this experience both gave them a fuller appreciation of their nursing careers at home, as well as helped to prepare them for future medical missions. Each member of the Nurses for Edna team: Sarah David, Wanda Chestnut, Kim Law, and Kerra Plesko plan to continue to volunteer in the global arena. One nurse at a time they will change the world!

 The nurses of the Nurses for Edna team want to thank One Nurse At A Time as well as the Barcos Nightingale’s Foundation for their generous support of this medical mission.

Kim Law in Hargeisa Somaliland

Recently the Nurses for Edna team traveled to the Abdi Idan MCH Clinic in one of the poorest neighborhoods’ in Hargeisa, Somaliland. This  free, government funded clinic provides multiple services including antenatal and postpartum care, low risk deliveries, nutrition clinic, pediatric health and immunization clinic, and a lab services. In a recent report from nurse, Kim Law, she describes her experience:

        “After a thirty minute drive down what one would generously call a very bumpy road, or realistically call a 4x4 trail, we arrived.  The clinic is next to what looks like a military or police building, but it's hard to be sure. In between the two buildings is a heaping pile of garbage. There is no waste disposal system in Hargeisa, so garbage lines the streets; it is a common site to see 'urban goats; chewing on discarded plastic.

     On arrival, we were given a quick tour; there was already a lineup at the pharmacy for the nutrition program. Next we settled into the antenatal clinic. The antenatal clinic is staffed by one community midwife, and two community midwife students. Patients were given an antenatal record that they are expected to bring with them to every clinic. At her first visit, the woman is weighed, her height is measured and her obstetrical history is taken. Many of the women guess at their age and the years their children were born.

I noticed a trend that many of the women's first children were born at home, but their more recent deliveries where at an MCH clinic or hospital. Hopefully this is an ongoing trend.

        If available, the women are offered an on the spot HIV, Syphilis, and Hep B testing, but supplies are scarce. On the day we were there, there were only Syphilis tests available, and we ran out of those before the day was over.  After the finger prick, the woman's blood pressure is checked, and then she is assisted onto the examining bed. Her fundal height is measure, the fetus is palpated with Leopold's maneuver, to determine its position, and then the fetal heart is assessed with a fetoscope.

       Joining us on this trip was Dr. Mary Margaret O'Neil, and OB/GYN from California. I had never used a fetoscope before nor done very few antenal exams before 25 weeks gestation, so, she was instrumental in not only teaching the midwifery students, but teaching me as well.

I spent a lot of time helping the students learn how to accurately measure blood pressures, their technique significantly improved over the course of several hours. We instructed them on how to improve their Leopold's maneuver, and the importance of determining fetal position to make it easier and faster to locate the fetal heart. The students very quickly improved their technique for measuring fundal height.

     Another aspect we were able to reinforce, was caring and compassion. For example, helping the woman sit up and get off the examination table, not
leaving her to fend for herself.

     Muuna, the Community Midwife who runs the clinic was so patient with us, letting us teach the students. We definitely made the clinic run late, but the extra time was worth the knowledge we were able to share.”

Thank you everyone for your help and support in making my dream a reality. ~ Kim Law, RN.BSN

NURSES for EDNA -- Kim Law

Kimberly Law graduated from University of Northern British Columbia in 2009 and began her nursing career at Penticton Regional Hospital in the areas of obstetrics and pediatrics. In the fall of 2012 she completed her Nursing Specialty in Perinatal Nursing through the British Columbia Institute of Technology, as well as certificates in Contraception Management and Sexually Transmitted Infections Management. These certificates allowed Kimberly to obtain certified practice in reproductive health. She utilizes the advanced practice in providing reproductive health care at the Kelowna Women’s Services Clinic as and Options for Sexual Health. She is currently in training for the Penticton Regional Hospital’s Sexual Assault Response Team. There seems to be a women’s health theme running through most everything I do, eh?” Kimberly noted.

She became an active volunteer while in nursing school. She took an active part in the Community Health Initiative by Northern University and College Students (CHINUCS), a student run organization that developed outreach programs for marginalized populations in Prince George. Kimberly also travelled with International Student Volunteers to Thailand, and worked in an animal rehabilitation and community education center.

 In 2012 Kimberly traveled to Liverpool, United Kingdom to obtain a professional certificate in Emergency Obstetrical Care and Newborn Care, as well as her Diploma in Tropical Nursing, taking a step towards her long standing goal of contributing to global healthcare.

When asked to speak about her upcoming medical mission, Nurses for Edna, in Somaliland Kimberly said, “I appreciate the support from both Barcos Nightingales Foundation and One Nurse At A Ttime. I see this first trip to Somaliland as one of personal growth. I want this project to be long term. I’m passionate about women’s health and global health. The way I see it, what we need to do first, is see what they are doing there and what they need done.  I believe you can’t do short term solutions for long term goals and I see this medical mission of Nurses for Edna to be a long term project,”

The first Nurses for Edna is being assisted by the generous support of Barcos Nightingale’s Foundation as well as many others.

Barco’s Nightingales Foundation, operating as a 501(c)(3) nonprofit organization, was founded by Michael and Frida Donner on behalf of Barco Uniforms. The Foundation serves to advance the nursing profession and honor those women and men who devote their lives to serving others through nursing. The Foundation supports the vitality and courageous heart of nursing, while dedicating itself to honoring the spirit of those women and men who choose nursing by focusing its philanthropic efforts on helping to mend lives. For information, follow us on Facebook, contact Barco’s Nightingales Foundation headquarters at 310.719.2108 or email info@barcosnightingales.org

Nurses for Edna

Within just a few weeks last Fall, seven nurses, from different parts of the States, as well as Canada, reached out to One Nurse At A Time. Each had questions about women's healthcare volunteer work. All wanted to volunteer in the global arena. Sue Averill, President, One Nurse At A Time, met with those nurses who live in the Seattle area, and arranged a Google Hangout later to include the entire group.

Several of the nurses had read the Book, Half the Sky; some had seen the documentary by the same name. They were all inspired, particularly by the work being done by a nurse/midwife, Edna Adan in Hegesia, Somaliland. The idea of Nurses for Edna was born.

Located in the Horn of Africa, Somaliland is an unrecognized, self-declared state. Women of the country struggle to receive equal rights and healthcare services due to gender inequalities, weakened infrastructure, lack of education, poor literacy rates, and limited access. After learning about the issues women and girls face across the globe, Nurses for Edna is joining the movement to empower and uplift women and prove that you can make a difference.

Nurses for Edna hopes to build a lasting relationship, and empower the nurses of the Edna Adan Maternity Hospital, as well as create a pathway for future nurses to volunteer. Those participating in the first mission include Wanda Chestnut, Sarah David, Beth Langlais, Kimberly Law, and Nancy Harless, Playing a supporting role during the first medical mission are nurses Lynn Calkins, and Fiona Smith, who both plan to go on future missions.  

Edna has expressed the greatest need is teaching. Nurses for Edna will teach courses in Basic First Aid and General Physical Assessment, as well as share nursing practice and skills on the hospital floors while supervising student nurses.

“I’m hopeful that the success of Nurses for Edna will inspire other nurses to join with us, sharing their passion, skills and knowledge to benefit those most in need at home and around the globe,” said Sue Averill, President. “I do believe we can change the world, One Nurse At A Time.”

The August 2013 medical mission for Nurses for Edna is being supported through your donations which can be made via our website www.onenurseatatime.org. ; and, through the generous support of the Barcos Nightingale’s Foundation.

Barco’s Nightingales Foundation, operating as a 501(c)(3) nonprofit organization, was founded by Michael and Frida Donner on behalf of Barco Uniforms. The Foundation serves to advance the nursing profession and honor those women and men who devote their lives to serving others through nursing. The Foundation supports the vitality and courageous heart of nursing, while dedicating itself to honoring the spirit of those women and men who choose nursing by focusing its philanthropic efforts on helping to mend lives. For information, follow us on Facebook, contact Barco’s Nightingales Foundation headquarters at 310.719.2108 or email info@barcosnightingales.org.

A Different Kind of Mother's Day

We all know that being a mother is not an easy job.  Imagine being a mother in a underdeveloped country.  The obstacles they face seem insurmountable!  According to the World Health Organization, "Maternal mortality is unacceptably high. About 1000 women die from pregnancy- or childbirth-related complications around the world every day".  One of the most significant ways to decrease maternal mortality is to have skilled health personnel involved in the prenatal care, present at births and continued follow up and provide care of the mother during her child bearing years.  Nurses are the ideal educators for teaching these community skilled health personnel!  Kimberly Garcia, a 2009 One Nurse Scholarship recipient, traveled to Guatemala with Refuge International to teach Guatemalan lay midwives about nursing interventions to prevent postpartum hemorrhage, the leading cause of maternal death in the third world. Results of the study were published in the American Journal of Maternal Child Nursing in January 2012.

Save the Children has published their annual report "State of the World's Mothers 2012" which gives an in depth look at the complexities of being a mother in different parts of the world.  It's a fascinating report and one well worth the time!

How can you help?

1.  Volunteer to teach maternal nursing to skilled health workers with organizations like Refuge International, Midwifes for Haiti, Grounds for Health or Empathy Uganda.  You can also search our Directory for more organizations that focus on Women's Health.

2.  Not able to travel overseas?  Try volunteering at a women's shelter or crisis pregnancy center locally.  These women have struggles and needs that can be addressed by those willing to reach out and care.

3.  World Vision has fantastic blog articles related to Mother's Day to read and consider sponsoring a child. 

Celebrate International Women's Day

5 Facts about Women's Health 

from the World Health Organization:

1. Women and girls continue to face gender-based vulnerabilities that require urgent attention - especially in sub-Saharan Africa where 80% of all women living with HIV are located. Improving women and girls access to antiretroviral therapy, HIV and testing and a range of care, treatment and support services (such as screening for cervical cancer or CD4 count diagnoses) requires specific targets and benchmarks for women and girls.

2. Even though early marriage is on the decline, an estimated 100 million girls will marry before their 18th birthday over the next 10 years. This is one third of the adolescent girls in developing countries (excluding China). Young married girls often lack knowledge about sex and the risks of sexually transmitted infections and HIV/AIDS.

3. Every day, 1600 women and more than 10 000 newborns die from preventable complications during pregnancy and childbirth. Almost 99% of maternal and 90% of neonatal mortalities occur in the developing world.

4. In most countries, women tend to be in charge of cooking. When they cook over open fires or traditional stoves, they breathe in a mix of hundreds of pollutants on a daily basis. This indoor smoke is responsible for half a million of the 1.3 million annual deaths due to chronic obstructive pulmonary disease (COPD) among women worldwide. In comparison, only about 12% of COPD deaths among men each year are related to indoor smoke. During pregnancy, exposure of the developing embryo to such harmful pollutants may cause low birth weight or even stillbirth.

5. Once thought to occur mainly in wealthier countries, the health impacts of cardiovascular disease, cancers, diabetes, depression and other mental, neurological and substance abuse (MNS) disorders are increasingly felt by women globally. In fact, noncommunicable diseases (NCDs) account for 80% of deaths among adult women in high-income countries; 25% of deaths among adult women in low-income countries are attributable to NCD.

***taken from WHO website: http://www.who.int/features/factfiles/women/en/index.html