Listening to other voices

'Medical Voices from the Developing World' was the topic chosen by Sister Doctor Martine Makanga, a paediatric surgeon, for her keynote address for the Chaplaincy's Social Justice Week at the University of Limerick on 17 October 2012.

After touching on the global context of our healing mission, Sister Martine focused on the reality of health today, especially in Africa. She showed data gathered by the World Health Organization (WHO) that are indicators for health standards. Among the most important is the neonatal mortality ratio. Half of all neonatal deaths in Africa occur in five countries: Nigeria (over 255,000 neonatal deaths each year), Democratic Republic of Congo, Ethiopia, Tanzania, and Uganda. The under-five mortality ratio in sub-Saharan Africa is currently 148/1000 live-births (estimated by World Vision to be 4.5 million in 2007), compared to 4/1000 in Ireland.

Home Care MinisteriesRelated to maternal health is the maternal mortality ratio: 920/100,000 in Africa compared to 3/100,000 in Ireland. The staggering fact is that each year in Africa, 276,000 women die during pregnancy, labour, or from delivery-related complications (WHO). Only 45% of women in Africa are delivered by a skilled attendant.

Seventy-five years ago Marie Martin founded the Medical Missionaries of Mary, with a special concern for mother and child. How relevant that vision still is today!

Martine mentioned current challenges in our healing ministry. We often work in conflict situations. It is difficult to provide even the most basic health services when confronted with the need for emergency relief for internally displaced persons and refugees. Civilian populations are victims of violence and torture. Women in particular are affected by rape by armed militias, leaving them at risk of HIV, vesico-vaginal fistula (VVF), etc. Men are sexually assaulted, which often leads to suicide. Youth are abducted and forced to be male and female child soldiers. The effects of trauma, direct or indirect, on professionals such as soldiers, police, medical and paramedical personnel, and relief workers, can be overlooked.

Women RowAnother factor is patriarchy. In many African families medical decisions are taken by the male head of the family. The woman often needs the permission of a male relative to go for treatment. Women and children often present very late at health facilities - sometimes too late to be helped.

Modern technology is often lacking. The medical missionary has to make do with very little and rely heavily on clinical acumen. We are often faced with personnel shortages and fake drugs and reagents.

Martine spoke about challenges for those from 'the West'. We need to be adaptable, to have humility, to be willing to listen, and to look at the situation from a different cultural perspective. This requires flexibility, creativity, and the willingness to teach and mentor. We need to learn from and share our knowledge with traditional midwives, healers, and wisdom figures.

As missionaries we are sent to share the life of people in cultures other than our own. We face challenges of language, cultural perceptions, and interpretations of disease. We learn to multitask, taking care of administration, personnel, advocacy and lobbying; buying drugs and medical equipment. Missionary health services are perceived to be more humane than those of governments, so facilities are often swamped with patients. Another concern is on-going education of personnel.

Demands from donor agencies absorb huge amounts of time. Our priorities do not always match donor priorities and we cannot allow ourselves to be 'donor-driven'. With all that we see to be done, a big challenge is knowing when to stop! Missionaries have a high incidence of burn-out.

MMMs Ul Chaplains Ronan BarryMartine also spoke about what we are proud of as Medical Missionaries of Mary in Africa. We are with those most in need, delivering a good, much-needed service. We collaborate with Ministries of Health, local authorities, and all people of goodwill. Working in other cultures, we have learned a lot from a human and professional point of view. To do this we have worked with and valued the support of volunteers and friends.

While general medical and surgical services are needed, our experience in the developing world shows the equally-important need for a much broader, holistic agenda. MMMs have been pioneers in community-based health care, palliative care, and the needs of people affected by HIV and VVFs. We have worked to empower local staff and communities to care for their health, the earth, and for human development. Research and advocacy must be part of this: there is no health without respect for human rights.

Finaly, Sister Martine emphasized that to reach our goals we need human and financial resources and collaboration with many others to bring about health for all with equity, justice and peace.

She offered a challenge: Will you join us in solidarity with the health adventure in Africa?

Sister Doctor Martine Makanga is currently undertaking a PhD in Medical Sciences at the Universitas Libre de Bruxelles in Belgium.