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Maternal mortality

I applaud your editorial of December 2003, "Why maternal mortality in developing countries is our problem," and wish to reiterate the need for the medical profession to refocus not only its priorities, but also its place in society. As physicians practicing in the United States, we have the highest technological advances available to us to care for our patients. While health care in first-world countries advances at unbelievable speed, the dichotomy of rich and poor nations continues to grow. The tenuous defeat of the Taliban by the US in the current war on terrorism showed us "up close and personal" the oppression of the Afghan women and children. In Afghanistan, the maternal mortality rate averages 1,600/100,000 live births as compared to the US, with an estimated rate of 12/100,000 (UNICEF 2002).

These numbers are repeated all over the developing world as you stated with regard to the African continent. Even as close to our shores as the beautiful Caribbean, women do not have access to health care. Many of these countries are experiencing political and economic upheaval, which negatively affects the rights of women and children. This serves as a call for social action for developed countries to assist those underserved populations.

How does a clinician answer this call? There are myriad nongovernmental organizations dedicated to assisting communities. Four years ago I accompanied four nurses and two physicians to Kingston, Jamaica, WI. We worked at a clinic in Trenchtown, an area known for extreme poverty and violence. Each year the number of participants has grown, as well as the number of patients treated. Last year we brought a group of 27 physicians, nurses, residents, and medical students, performed 23 surgeries, and treated 1,000 patients in 5 days. Over the 4 years we have developed a partnership with the community, bringing supplies and medications to a population that has very limited health care available to them.

Our goal is twofold: to care for a population that is greatly underserved, and to show residents and medical students what real medicine is all about. Faculty from Bridgeport Hospital and Yale School of Medicine oversee residents in clinic settings, teaching them the art of assessment, the art of listening to a patient, and the art of humanity. Medical students work alongside attendings watching how to rule out a problem without the help of a CAT scan or a laboratory. It is a learning experience that cannot be duplicated in the teaching/research hospitals where they are training. Curricula have been developed so that the experience will be part of their clinical rotation. From a small group of professionals, a program is developing that hopefully will change not only the lives of the Trenchtown community, but also the practice of these young physicians.

It is the responsibility of all of us to answer this call to action. We have the knowledge and technical ability to change the lives of women and children—the future generation of the world. How you answer that call is an individual decision—you may have the ability to spend 1 week a year caring for patients, teaching new physicians, building partnerships with others who desperately need our help. Or you may be able to send supplies, medications, or funds to support these projects. There are many avenues to take, you just need to do it now. Grassroots programs, working hand in hand with communities, result in improved care and hopefully will develop physicians who genuinely care about people. Our profession has always been based on helping others—let us not forget that as we grapple with insurance problems and a litigious society.

Thank you for your time.

Stephen Rosenman, MD
Bridgeport, Conn.

Dr. Lockwood's reply: Dr. Rosenman is far too modest. His annual trips in Jamaica, initiated by his own efforts, occur at substantial personal sacrifice of time and money as well as comfort. I encourage our readers to assist him in any way possible, including making donations to PRN Relief International, Stephen Rosenman MD, c/o Bridgeport Hospital, 267 Grant Street, Bridgeport, Conn. 06610. Recently, the focus of his volunteer work has been on gynecological surgery, but he is investigating the potential for an OB component as well. Kudos to Dr. Rosenman and count me in when there is a need for obstetricians.

Charles J. Lockwood, MD
New Haven, Conn.

Tort reform

I am a maternal-fetal medicine (MFM) physician in Montana. Formerly I was in Vermont for my fellowship, and you paid us a visit, which I really enjoyed.

I know you speak passionately about tort reform, and thought you might find this interesting. Maybe it can be of use if you speak publicly on this issue. Our neighboring state of Wyoming is experiencing a "crisis" because the largest provider of malpractice insurance (OHIC) will stop writing new policies in September. OHIC is the largest provider of malpractice policies in Wyoming. This comes on top of the financial liquidation of the insurance company PHICO a couple of years ago. About 400 physicians and 14 hospitals will be affected and will lose their insurance. In Casper, the largest city in Wyoming, 72 of the 103 physicians in practice will lose their insurance. The hospital in Casper (Wyoming Medical Center) has seen malpractice insurance rise from $400,000 in 2001 to $1.4 million in 2002, $1.9 million in 2003, and is projected at $2.3 million in 2004 (Data from an article in "The Billings Gazette" newspaper, March 29, 2004).

That is a terrible burden for a small, rural-based community hospital.

Dana P. Damron, MD
Billings, Mont.


Letters to the Editor. Contemporary Ob/Gyn May 1, 2004;49:23-27.

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