A Mother's Day Gift to the Women of Zambia

This past year many of us here in Zambia have been working on a project to reduce maternal mortality called Saving Mothers, Giving Life. The basic idea is to help the Zambian Ministry of Health to implement the Campaign to Accelerate the Reduction in Maternal Mortality in Africa (CARMMA). It has been an amazing experience - working with some 20 partner organizations and all of the US Government agencies (USAID, CDC, DoD, Peace Corps, Dept of State) and the Government of Zambia Ministry of Health.

Reducing maternal mortality has been one of those public health efforts that has seemed somewhat impossible to achieve, even though we basically know what it takes - good prenatal care, access to good delivery services, and a safe blood supply (the number one killer is maternal hemorrhage). I am optimistic that this time we may be able to make progress. Right now Zambia's maternal mortality ratio is about 591 deaths per 100,000 live births (about 3,000 women each year die in child birth), compared to about 13/100,000 for the US (about 520 women total despite almost 7 times as many pregnancies in the US). I am optimistic because the folks here in Zambia are working together better than ever, and we are receiving some much needed attention from the US and Europe.

Take a look at the project, just launched this past mother's day: http://www.savingmothersgivinglife.org/about_smgl.html

A New Family Member!

Well we finally broke down and did it. It was not a decision we took lightly. We considered the added responsibility and expense. But we are sending John off to college, so why not add another child? Now that we have made the plunge, we are asking family and friends to help us decide on a suitable name for....our latest edition to the McAuley's in Zambia. He is a full bred German Shepherd who was imported by an Embassy family. They are now moving to a location where a big dog is not practical. We have plenty of space and several children who have been lobbying for a dog for some time. He is 14 months old, still very much a puppy. So far he seems very bright, a quick learner, and eager to please - not to mention all vaccines are up to date and he is neutered. He does come with the name Kayber, but we feel free to change it, so any great ideas are welcome. He arrived on Mother's Day - not at all what Amy wanted for Mother's Day (she did also receive some plants as seen in the photo). The dog is definitely what we in the family refer to as a basket gift - a long story, ask Norm and Alice for full details, but basically a gift that really is something you want. As always Amy is willing to support her children and husband. Jim and Amy like the name Dietrich, having just finished a biography of Dietrich Bonhoeffer, but other ideas are welcome. The dog and Rascal are slowly getting used to each other. We have never seen Rascal shoot up a tree before proving how spry he is for a 15 year old cat. Send in your name suggestions.

The Road to Recovery

Well we returned to Zambia late Tuesday May 1st. The children had done a great job keeping the house in order, or frantically cleaning up that day! I have been getting better day by day, but the energy and focus is not quite the same yet.

On May 2nd I jumped back in to the craziness at work - Zambia was to host five US Senators over the next several days as they made a whirlwind tour of projects in Africa (stops included South Africa, Namibia, Malawi, Zambia, Ivory Coast, and Morocco). I became involved in various aspects including a small lunch with two senators, and escorting them as they toured one of our projects screening for cervical cancer (the same site that President Bush had toured). It went quite smoothly. The senators (both parties represented) were quite honest about how difficult it is to work in DC - trying to balance a budget with extreme polarization. I learned several interesting things I want to share:

Polling data show that Americans believe we spend 20% of our federal budget on foreign assistance (health, economic, development, etc.) - we actually spend 0.5 % (that's right - one half of one percent), post World War II we peaked at about 3%. When these same folks are asked how we should balance the budget and eliminate the debt they say, "First eliminate fraud and abuse, second cut foreign assistance..."  Most say don't touch defense, medicare/medicaid, or social security, which make up almost 80% of the budget. So the senators I spoke with said they are at a true impasse. No one knows how much fraud and abuse there is and exactly how to get rid of it so its not clear if there was zero what the budget would look like. If the US literally closed all its embassies and stopped every penny of foreign assistance (how good would that be for US companies trying to enter new markets?) - the national budget and debt would be practically unchanged!

I had a few ideas but I knew they would not work politically - like do we really need 11 aircraft carrier attack groups? (no other country has more than 1, we spend almost 8 times as much on defense as the next highest spending country - China). Now I am not a passivist, and I think aircraft carriers are really cool, but really? Of course people argue that the military employs lots of people, but so does our foreign assistance infrastructure. And just maybe doing foreign assistance well - having stable democracies that like us - is just as important as a big military, I am just wondering. For example, Zambia is a stable democracy now, the people love us. This is because there are some 400,000 Zambians with HIV alive and on treatment today, they are developing an expanded and improved system for training doctors and nurses, some 150,000 babies each year are born free of HIV, etc...all because of the wisdom of of our foreign assistance. Makes me proud of being an American.

My other ideas were even more radical - if I am blessed to have saved a lot for retirement by living and working in the US, no need to give me social security, even though I paid into it. Maybe we should think of it as if it is term life insurance - thank God I never needed it, but it was good to have it there in case. 

Then there are medical costs and medicare. None of us will live forever and we should stop spending enormous resources trying to do so. Fifty percent of all health expenditure occurs in the last month of life.  This is complicated of course - because we don't know in advance it will be the last month. We need to get smarter on how we make decisions, especially as Christians, who know the final outcome - eternity with God. And we need to get smarter on how we pay for health care - there are really warped incentives in how we pay doctors (and how much for some specialties). And of course as a doctor I feel we need reform of our tort system - maybe a no fault system like auto insurance? It runs too much like a lottery these days.

Well, now that I have finished fixing the US economy and alienated all my family and friends, I will get back to life here in Zambia. Amy continues to connect with the church here, exploring options for engagement in places like prison health ministry, taking care of seminary students and their families, and supporting Peace Corps Volunteers. I think it moves too slowly for her liking (now who is the workaholic in the family?). My work is interesting, but less direct patient contact than I would like. I was just about to begin direct care at the University Teaching Hospital when my health unraveled, so I will re-start that process. We will all come back to Evanston this summer - John and Ruth to work at Church Camp and John to prepare for college. Ruth will visit some Art Schools. Miriam is exploring re-connecting with PACE and therefore may stay in Evanston. Chris simply wishes to connect with friends. Amy to support all of us, as always. And I am aiming to be put back together again sometime between June 20th and July 10th...

Much love. prayers appreciated. Jim