The 'Three Delays' Killing Mothers, and How We Stop Them: Professor Hadiza Galadanci

Professor Hadiza Galandaci has spent decades watching Nigerian women die from postpartum haemorrhage, a condition we know how to treat. She chose research over clinical practice because the math demanded it. Her E-MOTIVE bundle reduced severe bleeding complications by 60%, was published in the New England Journal of Medicine, and was adopted by the WHO in six months flat. This is the story of a woman who refused to leave Kano, refused to accept the unacceptable, and changed the world from there.

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Disclaimer: The views expressed by our guests are their own and do not necessarily reflect those of the hosts or producers.

Transcript

SPEAKER_00 0:00

Women are not dying because we don't know what causes them to die. Women are just dying because the society is yet to value their lives.

SPEAKER_02 0:10

When a woman in Nigeria finds out she's pregnant, she immediately thinks about two things. Yeah. Is it one, is she going to have a baby at the end of this and survive?

SPEAKER_00 0:18

Yeah.

SPEAKER_02 0:19

Or two, is she gonna end up in heaven?

SPEAKER_00 0:21

In the Western world, in the high-income countries, women don't die giving birth. And he came to Africa. Wow. And within a week, he saw women die. And he was really surprised. How could a woman die giving birth? It's not a disease. I want a pregnant woman in Nigeria when she gets pregnant, where she should be thinking is the color of the room she's gonna paint for that baby. Not think that she's going to die from this pregnancy.

SPEAKER_02 0:54

Hi everyone, welcome to Born in Two. My name is Israel Shake, the CEO of Every Pregnancy, and I'm so glad you're here. As you know on this podcast, each week we bring you stories of resilience, courage, and hope from around the world about what it is like to help a mom support her on her journey or respond to the needs that are happening on the ground. This week's episode is extremely important and very, very special because I am actually here in Kano, Nigeria, where the maternal mortality rate is very high in a country that actually has the highest maternal mortality rate globally. And so we came to the heart of the issue where not only is there saddening statistics, but there's also tremendous hope and potential. And hearing the stories directly from the ground from the leaders who are changing the way that maternal health is operated on here on in Nigeria is one of the best one of the best features of this episode. Today I'm excited to announce our special guest, an amazing obstetrician, researcher, and maternal newborn health advocate from Kano, Nigeria. And she said she will never leave the famous, the infamous Professor Hadiza Galadanshi. We are joined by her. And I actually met Professor Hadiza through every pregnancy last year. And I have heard everyone sing her praises from around the world because she is a true trailblazer in every meaning of the word and what she's been able to do for moms and babies in Nigeria, but also globally, really setting the new trends on how we save their lives, but also help them thrive in the next chapter. Professor Galadanchi, welcome to Born in Two.

SPEAKER_00 2:31

Thank you very much, uh Israel.

SPEAKER_02 2:34

It is so lovely to be here with you. My first time in Nigeria. We had an amazing first day here today.

SPEAKER_00 2:40

Actually, it's so lovely to have me at your podcast.

SPEAKER_02 2:43

Oh, I'm so excited to have you. We're gonna call you Prof through this episode. That's like what everyone calls her. Okay, I do. I like calling you prof, Lisa, but if I come up with that, um, you know, prof, you are an amazing champion. And I feel like your incredible work at ACEFAP, which I want you to explain in a little bit, leading, being the director of this incredible institution for excellence, leading research, implementation, direct services, and really training so many people on not just maternal health, but especially maternal health to make sure that we are saving moms' lives here in Nigeria first and foremost, but also replicating that and scaling that in other communities globally. So you're an inspiration. But before we jump into the work that you do in the technical way, what is something about you or what personal story would you want to share with people who are tuning in and hearing you for the first time?

SPEAKER_00 3:34

All right, so uh I'm uh an obstetrician and a gynecologist, and I come from a family where education is very important. So, right from when uh we're young girls, what our father made sure he got into our head is that the best thing he can give us is education. And once you educate a girl child, then there is no ceiling in front of her. I mean, it's there is no glass ceiling because she can continue to break that ceiling until she gets you know to the highest level she wants. And one my dad was um, he is my mentor, my inspiration. Uh, so he is a professor, but of course, professor in Islamic studies and uh Arabic language. Uh, but I also wanted to be a professor, and that's why, even being a doctor, I continued my education until I became a professor in obstetrics and organic college.

SPEAKER_02 4:34

Masha'Allah. So there's two professor Gaudanji's two professors.

SPEAKER_00 4:38

Actually, we're now getting to four.

SPEAKER_02 4:39

Mashallah.

SPEAKER_00 4:40

Yes.

SPEAKER_02 4:41

That's amazing. This is the true narrative that people don't realize is how hard so many people work to be able to change the outcomes for their community. Prof, your story is inspiring. You were telling me a little earlier today that, mashallah, you have four very successful children, mashallah. What do your children do?

SPEAKER_00 4:58

Uh, my first boy is an uh architect, and he's into buildings, and uh he does great uh buildings across uh you know Nigeria. My second boy is actually a civil engineer, and he also wants to be a professor, so he will be the fifth professor in our family, hopefully one day. And then my uh third boy is a mechanical engineer, and he's into using his hands and his brain to really have a lot of innovations that will save uh, you know, women, children, and the rest of the world. And then my last baby, who is actually a girl, the only girl, is actually a doctor, mashallah. And she wants to be like mom, yeah, but she doesn't want to be an obstetrician, yeah. Um but she wants to be a global health expert, but probably ophthalmology or something else. But I don't think she wants to be an obstetrician.

SPEAKER_02 5:54

I mean, mashallah, you are a leading example and what an incredible example for your children to follow. And we wish them success in all their endeavors. And I especially love that you encourage all of them to follow and pursue their dreams and what it really means. One thing I asked you earlier today, because I know that Prof. Mashallah gets invited to so many places to do training, speaking, and literally connect with the world. I've run into in Geneva, I've run into in Dubai, we have so many layovers together and in connections and overlaps. But I asked you, would you ever leave Kano today? And your answer was so strong, so quick.

SPEAKER_00 6:31

Yeah.

SPEAKER_02 6:31

Tell much.

SPEAKER_00 6:32

I you know, I've had I've had that question over and over and over again. What will take us to take you out of Cano? Yeah, you know, Hadiza or Prof or whatever. And I tell them nothing, yeah, absolutely nothing, because I feel there's still a lot that my people require in Cano. And I think I can still give more to my people. And if all of us run away from where we are, then who is going to help us? So I feel it is our responsibility to do as much as we can to really support our community. And your closest community is where you come from. Nigeria is my community, but Kano is my closest community. So my responsibility starts for the Kano and then Nigeria, Africa, and then the world. But Kano is the primary responsibility. So nothing would take me out of Kano.

SPEAKER_02 7:28

And I love that because I feel like we live in a time where so many people leave based on a job opportunity, based on additional income, because it's very enticing. You know, you could live anywhere, truly, and have all the amenities, but you would rather live in your community where things are the hardest for moms and babies. And I think that you are such an inspiring leader. I feel like you're very famous here. Everyone very influential, of course, very well deserved. But everyone will sort of do whatever is needed for Prophet Disa when she asks, everyone comes. And so I feel like all day I've been with a celebrity here and it's been incredible to watch. Rough, you know, one thing that we talked about, and one thing that I think the the listeners really need to understand is that maternal health is not a mystery. I think oftentimes people think, like, what does that really mean? And what can I personally do to help save a mom? We're not talking about really challenging concepts here or things that are hard to understand. So when we say maternal health is not a mystery, what does that mean to you?

SPEAKER_00 8:28

Pregnancy is not a disease. Pregnancy is a process whereby a woman, you know, passes through the process of pregnancy and delivery to bring a life into this world. So it's not really a disease. And over time, we've learned what are the real complications that a woman can have when she's pregnant, when she's delivering, or immediately after delivery that can really be dangerous to even cause her to die. Absolutely. The same five courses of maternal mortality when I was trained as a medical student are the same five courses of maternal death that we still teach our medical students today.

SPEAKER_02 9:09

It hasn't changed. Wow. And how many decades?

SPEAKER_00 9:12

This is like how many decades I've been literally, yeah, I've been an obstetrician for getting to you know 30 years. So so absolutely nothing has changed. And the interventions we've continued to learn about how we can actually save our mothers. And we have it. And in the Western world, in the high-income countries, women don't die giving birth. I've seen a professor that said for 30 years his practice as an obstetrician in Sweden, he hasn't seen a single woman die. Wow. And he came to Africa, and within a week he saw women die. And he was really surprised. How could a woman die given back? It's not a disease. So that is, you know, the question that we need to ask ourselves. Why is it that we have the answers to why women are dying and we're still not able to save our women in low-middle-income countries?

SPEAKER_02 10:10

I think that's such a powerful question. And I think today, um, earlier, and I want to get into the conversation about it, we hosted this incredible round table of Muslim leaders and scholars that can really help change the narrative around this. But you presented an incredible slide deck that was so informative. The last slide stood out to me tremendously. It was a famous quote. And if you don't mind sharing, even if it's paraphrasing it, with the with the with our listeners, I think this is part of the answer to your question that you just posed on me.

SPEAKER_00 10:42

Absolutely. That quote was actually from Professor Mohammed Fatallah who is an Egyptian, actually, a professor in obstetrics and gynecology, and an Egyptian. He's been an inspiration and mentor to many of us. And he said it very simply that women are not dying because we don't know what causes them to die. Women are just dying because the society is yet to value their lives. Wow. That is just the simple statement. But it still matters now. Because just as I said, the same causes of death are still the same causes of death. There is no new cause of death. There is no new cause of death in every single research we do. It's still hemorrhage excessive bleeding. It is eclampsia where you have high blood pressure and therefore you fit. It is sepsis where you get infection because you're delivering and you're not in the right environment, you're not using the right instruments, and you end up with infection. It is lack of blood, which is anemia. It is obstructed labor, which means you're in labor, you can't deliver this baby, and people say you can deliver it, and you stay for ages, for hours trying to deliver this baby until both you and the baby die. Absolutely. So these are the five causes, and they haven't changed. And we all have interventions for them. So if their lives are worth saving, why can't we ensure these interventions are gotten to every single woman that requires them?

SPEAKER_02 12:13

That's such a powerful statement. And that's the truth. Because, like you said, it's like if we valued women's lives, then this wouldn't happen. Absolutely. And I guarantee you, if these things were happening to men, we would not have any male maternal paternal mortality rate in any way, shape, or form. But that's but that really shows you how unfair and how much of sexism and misogyny plays a role in in this, in this crisis almost, and the urgency that we must feel. Prof, you know, thinking and looking back at your career as an obstetrician and in the labor ward, which I know is like one of your favorite places to be. Has there ever been a woman that's really stood out to you or a mom or a case that you can share with us that has really impacted your career?

SPEAKER_00 13:01

Yes. And I think I've um said this story a couple of times because it's really, it's really something that changed the way I see medicine, the way I see my career. And simply, it's a cousin of mine who I'm very close to. She's had two babies with me. And that was her, she's had actually three babies with me. So that was her fourth baby. And she gave me routine antenatal care. There was no problem at all. And I was happy with her progress in in the pregnancy. And then just towards the end of the pregnancy, she started having raised blood pressure. You know, and I just said one of the complications is raised blood pressure. So I was like, let's treat this blood pressure so that it doesn't become a problem. And we started treating it, and then somehow we weren't succeeding. The blood pressure kept on fluctuating. And the next thing was that she was already termed, she was already said nine weeks. So why don't you bring the baby? That's the treatment, that's the normal thing. If the blood pressure you're having difficulty in addressing or in controlling the blood pressure, then deliver the baby because the baby is fit to be delivered. And therefore, we said, okay, let's let's do an induction. And this was a discussion with her. I had with other colleagues that were managing her together. So it wasn't even my only my own uh uh you know um uh decision. So we had a collective decision. I was like, let's induce her. We've induced many people, and there was no problem. So we induced her in the morning, and then by evening, I had a I had a call that she's already in the second stage of labor, which means baby is about to come out. And I said, okay, let me rush, you know, to go and see. There were many other there were doctors in front of her, there were nurses that were taking the delivery, and then I just came in and I ran, you know, to the labor ward. I I wanted to just carry the baby and celebrate with her. Yeah, you know, this is a baby that we've got, and then I saw blood everywhere. And then I saw them, you know, trying. Everybody was looking, you know, uh looking worried and uh trying to give all sorts of uh drugs. And I was like, what's happening? And they said she started bleeding immediately after the baby came out. Have you given oxygen? Yes, have you given this? Yes, have you given me soprossol? Yes, have you given I was asking for everything, yes. I was looking for everything, you know, to be given, and they all said yes, and then this woman was still bleeding. Oh my god, and then I realized that if I don't do something, this woman will just slip away from her hands. She was just bleeding everywhere with her. And she started looking at me, and she was telling me, you know, look after my babies. Oh my god. She was already saying that. I know I'm going, you know, look after my babies. And then I was like, let's take this woman to the theater. Let's see what we can do in the theater.

SPEAKER_02 16:02

Which is like the operating room.

SPEAKER_00 16:04

This is the operating room. And then we rushed. I had an anesthetist, I had two anesthetists with me, I had two doctors with me, I had all the best of midwives with me. We rushed her to the theater. I did everything I could, even in the theater, to stop this lady. This woman was a bleeder until the anesthetist told me, you know what? You better take a decision because we're losing this woman. That's exactly what she told me. And I now said, you know what? Can we take this uterus out? Because she was bleeding from a uterus. Can we remove the womb?

SPEAKER_01 16:39

Yeah.

SPEAKER_00 16:40

And then they said they should ask the husband because you can't remove, you have consent. Yeah, you just you had consent for laparatin. Yeah. So I now quickly said, you know, can they ask him? And before then, I had many relatives donating blood. I had people, we got like seven pints of blood, fresh blood. That's what saved us. It's fresh blood. And then they were already bringing the blood into the theater. And then we removed the uterus and this woman was still alive. When we finished the surgery and we moved her to the peri up uh uh, you know, room. I couldn't leave her. This was like around 1 a.m., 2 a.m. at night. I was standing by her because I just wanted to see her breathe in and out. I was just looking at her. I couldn't leave, I couldn't leave her for a second. I couldn't leave her for a second. And I was like, if I move, she's gonna die. Wow. We had given her all the blood. We gave her like five pints of blood. That's almost all her blood level, which means she lost almost everything of her blood. I stayed there until in the morning, and after my morning prayers, I also saw her. At that time, she was out of anesthesia, and all she did was to hold my hands. So, you know, when when she saw me in the morning, it was just oh, she probably couldn't believe it. Yes, because she also said she thought she had reached the other side. In fact, she was hoping to open her eyes and see white angels. Oh, well, you are a white angel, yeah, and and that made me to start thinking. I was there, I had the skills, I had the knowledge, I had the expertise, I had all the help I needed. And that was how I saw this woman. How many of our women have that portrait? Not many, majority don't. Not the majority don't. So somehow we need to get back and see what we can do to actually prevent women from dying from post-parton marriage. So instead of just you know addressing one case at a time and saving one life, yeah, can we save thousands and millions of people? And that's when I started thinking of research as an opportunity. And when I got the opportunity of working to address the problem of save of post-fatim hemorrhage, which is the excessive bleeding. I mean, I grabbed it with all my arms. Yeah, maybe I can find a solution that would prevent people like Fatima. That's the name of my cousin.

SPEAKER_02 19:23

Oh, I'm so glad Fatima survived, alhamdulillah.

SPEAKER_00 19:26

Yes, can prevent Fatima and have you know opportunity of saving many more fatims. Wow. And that was how I got into research.

SPEAKER_02 19:35

Prophetizer, that is like I got goosebumps listening to that story because I actually thought the outcome was gonna be negative. Yeah, because I feel like there are so many more stories that are horrible outcomes where the mom couldn't be saved just because of a slight delay, just because of a medication not being refrigerated, just because someone not knowing how to put in a balloon tamponade. And you, like you said, with all your skill set and all your expertise, still struggled at the end of the day to save her. Absolutely. And it is a miracle that she survived that. But I really am so grateful that you have a positive story because it shows me and it hopefully shows all the listeners that there are solutions that moms can survive this. Earlier today, the health commissioner, yeah, um, the honorable health commissioner made a comment. Yeah, I don't know if you remember it, but it stood out to me significantly. Yeah, he said, when a woman in Nigeria finds out she's pregnant, she immediately thinks about two things. Yeah. He said, one, is she going to have a baby at the end of this and survive?

SPEAKER_00 20:36

Yeah.

SPEAKER_02 20:37

Or two, is she going to end up in heaven?

SPEAKER_00 20:39

Absolutely.

SPEAKER_02 20:40

That literally shook me to my core because I think about my own self when I was pregnant with my son, that never came across my mind. And I can only imagine all the women out there that are living in you know industrialized countries that never have to even think that there could be a situation in which that 50% chance, if not higher, they'll end up dying. And so that was significant, I think, to Nigeria. Yeah. Any reflections on him sharing that and what that really means in terms of the even anxiety women feel being pregnant here.

SPEAKER_00 21:13

But that's the truth, Isra. Unfortunately, that's the truth. Unfortunately, when a woman gets pregnant, and they say that, you know, one of the countries where you have the highest risk when you become pregnant is actually Nigeria, because of the numbers that die. So once she becomes pregnant, it's not only her that is worried that she's gonna die. It's her husband, it's her mother, it's her mother-in-law, it's her friends. Everybody, everybody is worried, probably except the healthcare worker. Wow. Because if she comes to the healthcare worker, we know that we can do what we can to save her. But every other person around her is worried. Can she really make it to the end? Is she really going to have a baby at the end, or is she going to die, or is the baby going to die? Now, and as you said, This is not an issue at all for women in the high income countries. So why should it be in Nigeria? Yeah, why? So because there's so many, you know, first of all, so many women die. Yeah. Because there's so many causes of death, apart from the five causes I mentioned at the beginning of this podcast, you know, the five major causes, there are other sociodemographic factors that contribute to the death of women in places like Nigeria. Can you tell me about those? Yeah. The first is the delay. You know, if a woman is in labor and you don't take her to a hospital on time, even if she goes, you know, to the best hospital, but it is too late, they can't save her. So a lot of a lot of families don't take the decision to get to the facility on time. This could be because one, they don't have the knowledge, two, they don't have the funds. Most of our facilities are out of pockets, even though we're doing a lot of interventions to address that. Maybe the hospital is too far.

SPEAKER_01 23:07

Yeah.

SPEAKER_00 23:07

And they're thinking of how do they get to that facility.

SPEAKER_01 23:10

Yeah.

SPEAKER_00 23:10

And somehow, in some places, up to 60% of women deliver at home anyway. So if they have a complication, before they can get to the facility, there is a delay. And that delay can be a delay for their lives. The second delay that occurs is that okay, a woman decides she wants to go to a hospital, or the husband says, Look, we've got to go to the hospital. But then, how long is it to the facility? Do they have the money? Because then some of them will have to go and look for the money before they get to the facilities. Like money for a taxi. For taxis, for the transport, money for the facility itself. They pay in the facility. They pay in the facility. They pay for cards, they pay for drugs, they pay. Some places there is what we call the free maternity care, which means you go without paying. But some of the things are not available. You might still need to go and buy them. So they want to do a cesarean section, but some of the things needed for cesarean section are not available, so you have to go and buy them. So all this now becomes the second delay. So she's still yet to reach the facility because of this uh, you know, delays. The third delay is actually the delay that happens within the facility. So she gets to the facility, they know enough healthcare workers. If there is one doctor, he might be doing one surgery and he might be the only one. He might have five complications. Oh my god. So he has to do one before he does the other because he's one person. That's lucky to have yes, she's waiting. Or she goes to that first facility, and there are no no uh um, you know, healthcare workers to address her problem is the first level of care. So they say go to the next facility. Oh my god. So get to the next facility. So it might take her ages before she gets finally to come to, for example, myself in a teaching hospital. And then now in the teaching hospital and in other health facilities, you also have delays. You also have delays, you know. So at the end of the day, if a woman has eclampsia in high-income country, she'll be saved because she gets straight. First of all, she has the eclampsia in front of her healthcare worker. Exactly. She does what she's supposed to do, she sends her to the facility and they take care of her within seconds. And uh, but in our own facility, she has eclampsia at home. It might take her hours before she can get that health care that expertise. Hours from decision to get into the facility to the delay within the facility. So this all contributes to the issue of maternal mortality.

SPEAKER_02 25:53

Can you imagine if we were able to solve for the delays at any stage? And I know that's what you're actually working on, and you've already had success in many ways on it. Yeah. And I know through the collaboration with every pregnancy in particular on generating and bringing in resources into the work that you're doing. Can you share a bit about how the solutions? Because we love on this podcast to talk about, of course, the reality, and then also really direct people towards like we have the solutions, and here's some of them at work.

SPEAKER_00 26:23

All right. So I will I'll tell you two solutions, but I want to tell you the solution that has really showed us the light at the end of the tunnel. I love that. And that is the emotive intervention. You know, the same delays that actually cause the death of a woman are similar to the delays that actually get a woman with a postpartum hemorrhage to die. Wow. All right. So we found three reasons why, as I said, somebody with postpartum hemorrhage, which is excessive bleeding, will be saved in high-middle-income countries and then will not die in low middle-income countries. So why? We found out three reasons. The first reason is that we really delay in making the diagnosis. So a woman is bleeding. We really cannot estimate the amount of blood she's lost because we do a guesswork, we do a visual inspection, we look at the blood on the floor, we look at the blood on her cloth, we look at the blood on the on the uh provider's gown, and we say, okay, this is about 300, 400, and once it's less than 500, we don't start treatment. So unfortunately, we're not good in estimation. So a woman will lose 700 mils, but we're still saying it's less than 500. And we showed this with data. Wow. We showed that you know 70% of women that actually have 500 mils of blood loss have not started being given treatment because somebody has decided their blood loss is less than 500.

SPEAKER_02 27:57

But by the time she gets to 500, she's already in critical condition.

SPEAKER_00 28:00

She's already in critical, she might have lost 2000 at that time. That's when you realize it's 500 and you start rushing. Oh my god. So that was the first delay. The second delay was that okay, you found out that she's bleeding and she's bleeding a lot, but you have like three other three different interventions. You give one, you wait for it to work before you give the second. And therefore, by the time you give the three interventions, you have it's almost an hour, she would have lost all her blood. Oh my god. Then the third delay is that okay, it hasn't worked, but it's up to two hours. Can you now rush her to the theater as I did for Fatima? We didn't wait for two hours to take Fatima to the theater. Within minutes, when we realized it wasn't stopping, we took her to the theater and that's why she's alive. Yeah, but if you had stayed to continue to try saving her life in the labor work, we'd have lost her. Absolutely. So, these three delays we said, how can we address them? So the first delay was instead of you waiting to estimate blood loss, why don't you have an objective way of knowing that she's lost that blood with a simple drip? Put a drip and every single blood gets in. And you can actually say, oh no, this woman is losing 300 mils. Don't wait for 500. Site treatment at 300. So you get ahead of it. You're ahead of the delay. You're ahead of it. She doesn't even lose, she doesn't lose after 500 because we've started at 300. A majority of our women don't even have blood when they come to deliver because of anemia. Yeah, so 500 in low income countries is not the same as 500 loss in high income. In the US, for example. It's not the same. Yeah. Because she has more than enough. She can lose 500 and nothing happens. Here she loses 500, she's already going into shock.

SPEAKER_01 29:43

Yeah.

SPEAKER_00 29:43

So we said, objective assessment. And then the second thing is that don't do one intervention and wait. Do all the three and do a bundle treatment. And that's why we came with the bundle, the motive bundle. Do the massage, the oxytocin, the tranosemic acid, the ivy. Give them all within 15 minutes. And then we said, don't wait for two hours trying to save this woman. If you try 15 minutes, it is not working. Go to the next stage. Either send her to another facility, take her to the theater, put her balloon tamper, but do something. Don't wait again. So that's how we're able to reduce the numbers of men with severe postpartum marriage, which is the loss of 1,000 mil by 60%.

SPEAKER_02 30:28

So you reduced it by 60% just by implementing these three.

SPEAKER_00 30:32

And you know what is right? We didn't innovate any new treatment. It was the same treatment that would be used in before, but we did a different approach.

SPEAKER_02 30:42

I love that.

SPEAKER_00 30:43

And that approach is because we considered our situation. It might not be important in the US because, first of all, the woman has more than enough blood. And anyway, there will be one one nurse who be looking after her. So immediately she's losing blood, she'll quickly do something. Yes. And she has all the facilities to do everything. Absolutely. But for me, in low-income country, first of all, the woman will come already having anemia. Two, uh, if I don't start treatment, I don't even have the things in front of me. And I might be the only one looking after so many women. You understand? Yeah. So I need you need to start early, identify her early, quickly give all the three interventions, give it out a bundle so that you just stop her, and then you can go and do other things and you can save her.

SPEAKER_02 31:37

And then be ready to escalate if need be.

SPEAKER_00 31:39

And be ready to escalate. So it's just a preparation. Yes, it's an approach. It's not a new treatment. There is no new treatment in emotive, it's just an approach. And Israel, anywhere you actually implement emotive intervention, no woman dies from postpartum.

SPEAKER_02 31:58

That's amazing. Postpartum himar. So literally, it reduces it completely. Completely. It solves it for this reason.

SPEAKER_00 32:07

Yeah. I've had people say this is a magic. It's like you have a tap opening with blood coming and you close the tap. Wow. It's that simple. That's amazing. It is not expensive. There is nothing too expensive in this. And you don't need any new new training for people to do it. You just need to train them on the new approach and it is done.

SPEAKER_02 32:29

I feel like this is so easy, I can do it. Yeah. And I think that if I was trained in it, anybody could implement it. Absolutely. Truly. So it's like no barriers to entry here.

SPEAKER_00 32:39

None. Doctors, nurses, midwife, we train everybody. So it's not a it's not a doctor that will only save life, even a midwife. A midwife has told me that, you know, the training she had is like a magic because she's now saving lives.

SPEAKER_02 32:53

Oh, I love that. I love that story, prof. Absolutely. That's incredible. And to think about, so now you've talked about okay, here are the solutions, which I really love. Is there a second solution you wanted to highlight?

SPEAKER_00 33:03

Yeah, so I wanted I wanted to say that you see, we know what's is causing women to die. Yeah. We know the interventions. Yeah. We haven't been able to get this intervention to every single woman that requires it. Can we now ensure that every single woman that is pregnant gets this intervention? There are many interventions. It's only the PPH I've told you about. We know how to treat eclampsia.

SPEAKER_02 33:27

Yeah, you do.

SPEAKER_00 33:28

So can we get every single woman that gets eclampsia to get treated? We know how to treat piperasepsis. Can we get every woman that has piperasepsis to be treated? Can we get every woman that needs antinatal care to have an antinatal package where we make sure we give her MMS? These are multivitamin products that can prevent her from getting anemia. Can we make sure that we prevent prayer clumsy by monitoring her blood pressure? Can we make sure we give her at least one ultrasound to make sure that her baby is in the right position and is one baby?

SPEAKER_02 34:04

And it's growing healthy.

SPEAKER_00 34:05

And it's growing healthy. When she comes in labor, can we ensure that there is a skilled birth attendant in front of her that can identify when she has a problem and know where to uh refer her to? And can we make sure that if she gets a clamps here, we treat her, we know the treatment. If she gets PPH, we treat her because we know the treatment. We make sure we give her antibiotics so she doesn't get paperal sepsis. Can we make sure that after delivery, we make sure that she puts that baby to breast immediately so that we can have, you know, a baby that babies can survive, give kangaroo mother care, make sure we have delayed uh cut clamping. Can we make sure that every woman that has a cesarean section or needs a cesarean section is given quality cesareal section? Absolutely. So if we're able to do all this, at least we will address the issue of the health system.

SPEAKER_02 34:58

But this feels like the bare minimum, prof. Like you're listing out these things, and I'm like, this feels like bare minimum.

SPEAKER_00 35:04

They look a very bare minimum to you, but they're not to us. Wow. Do you have do you have the infrastructure? Yeah. Do you have the human resource? Do you have the training that this uh healthcare workers require? Do you have the resources in terms of consumables and drugs?

SPEAKER_02 35:25

Yeah.

SPEAKER_00 35:26

Do you have, when I say infrastructure, you're talking about water, you're talking about light, you're talking about all this basic things.

SPEAKER_02 35:31

Like wherever the most basic things, electricity, basic things, water, everything. So these are the challenges to be able to implement these things.

SPEAKER_00 35:38

Absolutely. And there's one more challenge, which is actually in the community. People need to access the facility. So if people don't get to the facility, I can't save them. No, you can't. Nobody can. All right. So they've got to utilize the health facility. If they don't utilize the health facility, then we get the services to them. Because that is something we're thinking of. This is innovative. This is innovative. You're flipping the switch. Yes. So how are we gonna do that? So what we need to do is we need skilled birth attendant.

SPEAKER_02 36:11

I love that.

SPEAKER_00 36:11

So can we get this skilled birth attendant to take the delivery of a woman that has low risk at home? I love that. But she has to be skilled. Yeah. Is not somebody that is not skilled. Because then, if it's not skilled, she will not be able to identify risk. And then, of course, a skilled birth attendant, you have to link her up with a referral system. Exactly. So that if she finds a complication, she knows where to go to. And she can take her to the critical formation. Yes, she has to take her to the facility.

SPEAKER_02 36:39

That's critical formation, and all of it needs to be prepared.

SPEAKER_00 36:42

Absolutely. So if a woman is low risk, in some states, as I said, 80% of our women deliver at home. 80%. Wow. 80%. They don't go to the facility to deliver. We've been pushing them to the facility to deliver. They are not going. So why don't we look for an innovation? For those that are low risk, find out, get them to have at least one antenatal clinic and screen them. If they are high risk, insist they get to the facility. You'll reduce the burden even in the facility. If they are low risk, then send a healthcare provider to take that delivery. And healthcare providers, community health workers, are allowed to take a delivery. And they are roaming around in our streets not having work to do. Wow. So we can actually engage them. That is a steady way trying to do. And we're going to do a research to prove if this will work. It is a research. So we want to see whether it will work. If it works, it's going to be a game changer.

SPEAKER_02 37:44

Game changer. Okay. Said the same word.

SPEAKER_00 37:47

Yeah.

SPEAKER_02 37:47

I mean, Prof, I love your passion and and the you have everything we need. This is like the guidebook. If anyone wants to know the guide to save moms and babies' lives, watch this episode, download it, share it with people. But I have a question for you. Now, we have some social issues and cultural issues in around this too, right? So it's not just about the infrastructure and systems, which are really important, but it's also about the community and families, even in the family unit, recognizing that we all have a role to play. Absolutely. So what are some of the challenges that you have identified in the family unit or the societal level that also needs to be addressed and should really be named in this conversation?

SPEAKER_00 38:27

All right. So decision making. Yeah. Decision making. Actually, you see, for a woman to decide if she's having a complication or um if she wants to go to the hospital to get to the facility, she has to make that decision. Now, in our community, that decision making is not by that woman alone. Yeah. So many other people take that decision. Importantly, her husband. Yeah. So supposing the husband is not in town, supposing the husband cannot be rich. How do you now ensure that woman gets access to when she needs help? So decision making is very important. Sometimes it's even the mother-in-laws that take decisions. Wow. Sometimes it's the mother-in-laws that take decisions. So I think it is very important that part of creating awareness and educating our community is the importance that a woman should be given education so that she can take a decision. A woman that is not educated cannot decide for her, she can't decide for herself, she can't decide for the family, she can decide for her children.

SPEAKER_01 39:36

Absolutely.

SPEAKER_00 39:36

But an educated woman will surely be able to take a decision. Whether her husband is there or her husband is not there. She will know what she will do, you know, so that she can access him to even ask him for permission. An educated woman will sit down waiting for somebody to do it. So really, I feel it is very important. Girl child education is one way to tackle the issue of decision making, plus the community awareness. Once you educate a girl child, you have really given her the opportunity to save herself, save her family, and save the community.

SPEAKER_02 40:15

I love that. And even just encouraging her to have her own agency in this. Absolutely. Like you know your body better than anyone else knows your body. Absolutely. And I kept thinking about there are so many black women in particular who are told that you know that that there's something wrong with them, that there's something that they're or they're being ignored for their issues. So I can imagine that even a um woman delivering in Nigeria being told, oh, actually your body is yours, and you should ring the alarm if you feel like something is going wrong. And if and then also being educated on what it is that could go wrong. So there's a responsibility here also on women, I think. Like if you don't have the education, find the ways to get those resources. And I know that you are doing a lot of that, also community building and education piece. Um Prof. Today we talked a lot about earlier the role of like the Muslim community and Muslim leadership. I think people don't recognize that obviously the context around maternal health is different in how it's applied and how it's approached, depending on countries, different countries, but also even as different cities, right? And so we I know Nigeria has a lot of different sects, even within the Muslim community. Yeah and that there's very tribal ways of approaching this issue. So if you're trying to build coalition and trying to get stakeholder engagement for tackling maternal mortality, which affects all women, right? Every sect, every religion, every identity, how do you go about doing it in a place as complicated in some ways as Nigeria? And what have we been working on together on this?

SPEAKER_00 41:48

Yeah, so you've seen it today. Yeah, we're able to bring all the different sects, Islamic sects, into our meeting because you needed to have all their buy-in.

SPEAKER_02 41:59

Yeah.

SPEAKER_00 42:00

And I was amazed with you know the agreement by all of them.

SPEAKER_02 42:04

Literally all of them.

SPEAKER_00 42:05

Literally all of them, all of them believed, you know, the importance of saving life, preserving life. All right? Sheikh Mustafa reminded us of the five, he call it the muqasid. Yeah, the muqasid of our muqasid, you know, the laws of our sharia. The laws of sharia. Yeah, he said faith, yeah, he said preserving life, yeah, he said preserving wealth, he said lineage, and then he said mental health. Yeah, and he said from number two to number three, is actually all related to saving women and children.

SPEAKER_02 42:40

Absolutely.

SPEAKER_00 42:40

If you preserve a life, if you save a life, then it's like you're saving the nation. Yeah, and we know the importance of giving Islam. Zakat, workab, sada'ah. We know what it is. Your neighbors, you should give them everything. So when we now mention it, every member of and all the sects in Nigeria were like, yes, you need to mobilize funding, mobilize whether it's through zakat, whether it's through workab, whether it's through uh sada'a, to be able to actually mobilize money for resources for our women and and children.

SPEAKER_02 43:18

Absolutely.

SPEAKER_00 43:19

And yes, and I mean the global funding is dwindling.

SPEAKER_02 43:24

Absolutely.

SPEAKER_00 43:25

We know that you know we're really getting to an era where there is no more donation, there is no more donor funding, especially from big uh you know, countries. So somehow we need to wake up from the sleep. We need to realize that we need to generate funding from ourselves.

SPEAKER_02 43:43

Exactly, that our community will be the only community to save us. And we often talk about challenging the status quo. Yeah. I feel like every pregnancy exists to challenge every status quo. Yeah. Dependency on the wrong funding models, yeah, working in silos and really breaking through that, and also reaching more. Moms and babies who need the care the most. And it's something, you know, I was nervous a little bit coming in today's meeting because I wasn't sure what to expect. This is a new type of concept. It's foreign to say all of a sudden we're just gonna work all together and everyone's ego is on the side, and everyone's identities is not important to the mission because you should be using your identities to help fuel your commitment, but don't let it be a barrier to working together. And Prof, I think that you really started us off in a way that painted the issue as one that affects all Nigerians. And it was really powerful. And I could see that the room was resonating. And by the way, the room was majority men, and it was majority people who are from Islamic background, Islamic scholars and clerics, and every single one of them, like you said, agreed, but also I felt were committed to taking action. And so one of the things of every pregnancy is really working with the Nigerian community, having them lead and us support and amplify, especially because you are already implementing the solutions. Absolutely. You already know what the needs are on the ground, and we're just here to amplify that. So can you talk a little bit more about the importance of having stakeholders like the Muslim leadership community involved to be able to really solve maternal mortality here in Kano, but at Nigeria at large?

SPEAKER_00 45:15

You know, as I said in that presentation, every single one of us is a stakeholder. And maternal mortality has, you know, a whole lot of stakeholders. You know, you have the women, you have the men, you have the policymakers, you have the healthcare providers, but importantly, you also have the religious leaders, the traditional leaders, and our you know, community leaders. Yeah. These are people that when they talk, people listen. Yeah. People listen to them. So if a religious leader comes up and says that, you know, these are the rules of Sharia to preserve life, and therefore you should give. And anyway, in the Quran and in the Sunnah, these are the hadith and the surahs that talked about the importance of giving. Therefore, come out and give for the sake of women and children so that we can save our own women and children. These are women and children of the society, they're not women and children of somebody else. They are our own mothers, our own sisters, our own cousins, our own daughters that are dying. So if we come out, if they speak, people will listen. I love that. People will listen. Once you say it is from the Quran and it's from the Sunnah, our people are ready to follow. And that is why it is important for us to have their buy-in. If we're able to get their buy-in, then we will be able to actually mobilize resources for our women and children. And at the end of the day, they are the trusted people. So people will trust them so that if you give, you know that they are given and your funds are going to be used for what they said they're going to use them for. So it is very important that we get there by you. And but as I said, all other stakeholders are very also very important. And as you can see in that hall, we had other stakeholders as well.

SPEAKER_02 47:17

Yeah, I think being able to build this ecosystem where you really have the religious stakeholders, the government stakeholders, the traditional stakeholders, the NGO stakeholders, and even those who are the healthcare providers, then the champions overall. So, Prophet, where would you like to see maternal uh health in a year from now?

SPEAKER_00 47:38

Well, I don't want to say that I want to see no woman die from pregnancy-related complications, pregnancy and delivery in one year. I know that is that is not that's impossible, but I really want to see, you know, that women have access to quality antenatal care, quality intrapartum care, and quality postpartum care. And our women are able to access the services. If they are not able to access the services, the services get to them at home so that at the end of the day we can reduce the unacceptable numbers of women that die. I want a pregnant woman in Nigeria when she gets pregnant, where she should be thinking is the color of the room she's gonna paint for that baby, the the pants she's gonna put for this baby, the clothing she's gonna put for this baby, the showless she's gonna use to bundle this baby. Not think that she's going to die from this pregnancy, or not think that probably her baby will not survive the delivery and she might not have this baby. That's what I want a pregnant woman in Nigeria to have at the end of the day.

SPEAKER_02 48:50

That's so powerfully said. For those listening to this and thinking, wow, Prophetizage inspired me, motivated me. How can they get involved and how can they take action? What would you tell them?

SPEAKER_00 49:02

I think everybody can contribute to reducing modern mortality. Every single person. And I mean it every single person. If you're a husband, then you ensure that you know your wife gets quality antenatal care and delivers in a health facility. If you're a young girl, you ensure that you encourage your parents to give you the education so that at the end of the day you can save your life, save your family's life. If you are a healthcare provider, make sure that you learn all the skills to save uh uh you know women. If you are a policymaker, make sure you have all the policies that will save our women and make sure that you provide the enabling environment for these policies to be implemented. If you are government, part of the policymakers, that make sure that the policies are there. And of course, uh you provide the enabling environment. Community leaders, religious leaders, make sure you continue to create awareness on the importance of you know the health of women and children. And let us see how collectively we can actually come together to end the numbers of women and children that die.

SPEAKER_02 50:14

So incredibly powerfully said. The last thing I'll ask you is almost to finish the sentence. Are you ready? Every mother should.

SPEAKER_00 50:25

Every mother should deliver safely. Every mother should have a safe pregnancy and a safe delivery.

SPEAKER_02 50:35

I love that. Every baby should.

SPEAKER_00 50:38

Every baby should have the opportunity of surviving and thriving.

SPEAKER_02 50:43

I love that. Every community should.

SPEAKER_00 50:46

Every community should ensure that women in that community get safe pregnancy, safe delivery, and safe postpartum care.

SPEAKER_02 50:55

And every Nigerian should.

SPEAKER_00 50:57

Every Nigerian should make sure that every single pregnant Nigerian woman ends up with a safe pregnancy and delivered.

SPEAKER_02 51:05

And with that, what a beautiful way to end this recording for this podcast. Thank you, Professor Hadiza, for being on our incredible show, Born Into, bringing your incredible insights, your passion, the commitments, your expertise, and your storytelling to really help people understand the true crises on the ground in Nigeria, but even globally, and also recognize solutions that are here, that are affordable, and that can be implemented with very little training. We are honored to be here with you and in partnership with Every Pregnancy and AceFap. If you want to learn more about Professor Hadiza's work, please look at the notes on this episode, follow her on social media, follow the incredible work ACEFAP is doing and contribute to support them. Thank you so much for being on Born and Two. Subscribe to this podcast, share it with your friends, follow more on Every Pregnancy social channels as well as our website, everypregnancy.org. Thank you all so much for tuning in to Born and Two live from Kano, Nigeria. We'll talk soon.