Last year, the evening before Eid-al-Fitr, the celebration marking the end of the Ramadan fasting and one of the most important holidays in Bangladesh, Dr. Nowrozy Kamar Jahan's cell phone rang. On the line was a government fieldworker whom Dr. Jahan had recently trained to distribute misoprostol, a drug that can be used to prevent postpartum hemorrhage-the number one cause of maternal death in the country.
He explained that a woman in a village had just given birth and taken misoprostol afterward, as directed, to contract her uterus and prevent potential hemorrhaging. The woman was not bleeding excessively, but she was shivering intensely. The fieldworker recognized this as a normal side effect, but the woman's husband was not convinced. "Her family is very afraid," the fieldworker told Dr. Jahan, who asked the him to put the anxious husband on the phone.
That night and throughout the next day, Dr. Jahan spoke with the family, quelling their fears, reassuring them that shivering was indeed a normal side effect of the drug that may have saved their loved one's life.
Answering such calls, at any hour, is not in Dr. Jahan's job description as a team leader for EngenderHealth's maternal health program in Bangladesh—called the Mayer Hashi Project—but that has never stopped her. In a country where 85% of women give birth at home without skilled birth attendants, she is committed to saving lives. Through Mayer Hashi, Dr. Jahan leads a team that collaborates with the government to increase access to misoprostol, which has been proven to save lives when taken right after delivery.
The community-based maternal health project began last year in the Tangail District in central Bangladesh, and to date Dr. Jahan has supervised the training of nearly 600 fieldworkers. In addition to client counseling, she has taught them how to identify and register pregnant women, to encourage the women to deliver at hospitals, to distribute misoprostol (which costs pennies per dose) in case of home delivery, and to monitor new mothers carefully for danger signs. In December 2009, the project expanded to the Cox's Bazaar District, in the southeastern part of the country.
The results from Tangail are striking: Approximately 12,000 women registered in the program delivered at home, and among these, 92% took misoprostol after giving birth.
Early in her career as a physician, Dr. Jahan worked at a hospital in Dhaka, the country's capital, and witnessed firsthand the devastation of postpartum hemorrhage. "I saw women dying on blood-soaked mattresses," she said.
One reason that hemorrhaging kills so many new mothers, she explains, is that it is difficult for the average person to tell the difference between normal and excessive bleeding-until it is too late. This led her to a revelation: "Prevention is better than a cure."
And that led her to EngenderHealth, where amid supervising the training of field workers, making visits to monitor the project's progress, attending meetings, and writing reports, Dr. Jahan answers her cell phone, no matter what time it rings.
She recalls when she received a call a few days after the one that came on the eve of Eid. The woman who had shivers was better, explained her husband. He apologized for disturbing her during Eid. "I said it was okay, he was worried. He then invited me to their house the next time I was in the area—a house now home to a healthy mother and baby."