Safe Delivery

A Letter from Inge and Larry Sthreshley, serving in Congo

Fall 2023

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Dear friends,

In March of this year Larry and I became grandparents for the first time. Gabriel Francis Sthreshley Green was born to our daughter Lisa and son-in-law Hugh Green on March 9 in Atlanta. Due to potential complications for mother and child, Gabriel’s due date kept getting moved up. We scrambled to change our travel reservations and were on a plane across the Atlantic when Gabriel was born. Knowing they were at a good hospital and would receive good care was reassuring. When we touched down at Newark, our hearts were filled with joy and gratitude when we received the news of Gabriel’s birth and saw the photos of Lisa and Gabriel. In DRC, a “safe delivery” is far from certain in many health facilities, so we were particularly recognizant of the good health care available to our daughter and new grandson.

Gabriel Francis Sthreshley Green at four months

All of Larry’s public health career in DRC has focused on improving access and availability of quality health services, particularly for pregnant women, newborns, and young children. Ensuring a safe delivery for pregnant women is a priority for good reason. In 2020, the maternal mortality rate for DRC was very high at 547 deaths per 100,000. In comparison, the global maternal mortality rate is 223 deaths per 100,000 live births. According to the WHO, globally a woman dies of pregnancy-related causes every two minutes. Overall, the African Region accounted for 69% of global maternal deaths in 2020. Most of these deaths are preventable with the right care at the right time.

There are several factors behind DRC’s high maternal mortality rate. Often women face complications in labor because they are too young, too old, have had too many pregnancies, or pregnancies that are too close together. These factors can be compounded by the difficulty of getting to a health facility early enough in labor and the lack of well-trained health staff at the facility. As a result, management of obstetric complications remains sub-standard.

While the maternal mortality rate in the Democratic Republic of the Congo increased by 16% between 2017 and 2020, the two health projects we have been involved with over the last 10 years have reduced maternal mortality by 38%, saving 831 lives per year. Neo-natal mortality decreased by 52%, saving 5,408 lives per year. Through the combination of improved health services for pregnant women and the nutrition program, low birthweights were reduced by 66%.

To continue this reduction in maternal and neo-natal mortality, the current health project that we are involved with called SEMI (Maternal and Infant Essential Health Services) continues to build on progress made and has taken on several strategies to further reduce maternal and neo-natal mortality. The first is to build the capacity of 424 health care providers in the Kasai Province in emergency obstetrical and neo-natal care (abbreviated EmONC) and provide coaching to health care providers through clinical mentoring. Currently 78 mentors have been trained.

A chart showing the reduction in underweight births as a result of the implementation of the Access to Primary Health Care Program (ASSP) and the program for Health Systems Support in DRC (ASSR).

To reinforce the emergency obstetrical and neo-natal care training, an app called the “Safe Delivery App” (SDA) developed by the Maternity Foundation in Denmark has been deployed in every health center. (Being half Danish, I am very happy for this!) The app was tested in the Maniema province and led to an improvement in knowledge, skills, and raised providers’ awareness of how to organize their obstetrical and neo-natal service. Based on past success, the Safe Delivery App is now being rolled out in the SEMI project throughout the Kasai province.

This app gives providers access to educational videos that are five to 10 minutes long on various emergency situations related to childbirth and neo-natal care. It is an interactive job aide accessible offline on phone or tablet, that is helping providers improve their skills in identifying and managing obstetric complications. It helps providers maintain the knowledge they acquired during the theoretical EmONC training. The app automatically updates when linked to the internet, so the latest best practices are always available.

Recently on a What’s App group, a health center nurse in the Kasai shared a story of a pregnant woman who developed pre-eclampsia after delivery. The nurse explained how the EmONC training and safe delivery app guided her through the steps she should take in that urgent situation. She was able to save the mother’s life. Both the nurse and the family are exceedingly grateful to God for the assistance that they received through the SEMI project.

Emergency obstetrical and neo-natal training of health service providers in the Kasai Province is helping to ensure safe deliveries for pregnant women and infants in the DRC. (Photo credit: Crystal Stafford)

Another strategy that is being used to improve outcomes is increasing availability of transport for women experiencing obstetric and neo-natal emergencies in rural areas. In rural areas in DRC where there are very few good roads and vehicles, transport by motorbike is often the only solution. The project is piloting a motorbike-ambulance system.

To continue the reduction in the number of babies born with low birth weight, community health volunteers are now screening all pregnant women for malnutrition every quarter in the community using MUACs, a simple color-coded band for measuring upper arm circumference. They are also providing nutrition counseling for pregnant women and systematic follow-up of underweight mothers to decrease maternal malnutrition and increase the number of infants born at healthy birth weight.

Thank you for your support of Presbyterian missions that are helping to ensure a safe delivery for pregnant women and their infants in the Kasai Province of DRC. We appreciate your support and ask for your continued prayers and financial support.

Blessings,

Inge

Please read this important message from Director of World Mission Rev. Mienda Uriarte

Then the King will say to those at his right hand, ‘Come, O blessed of my Father, inherit the kingdom prepared for you from the foundation of the world; ³⁵ for I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, ³⁶ I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.’ Matthew 25:34-36

Dear friends,

Great things are happening in World Mission! As you know from the letters you’ve been receiving, our mission co-workers are at the forefront of showing us what Matthew 25 looks like in the U.S. and in the wider world. They are addressing issues related to eradicating systemic poverty, building congregational vitality and dismantling structural racism. Together with our partners, mission co-workers are engaged in life-transforming ministries in 80 countries around the world. Here are just a few examples:

As an education consultant in the Democratic Republic of Congo, José Jones assists the Presbyterian Community of Kinshasa (CPK) education department in the development, implementation and evaluation of strategic plans to strengthen the church’s primary and secondary education programs for more than 350 schools.

Based in Manila, Rev. Cathy Chang works closely with the United Church of Christ in the Philippines (UCCP) and other partners in ministry to engage programs and networks across Asia that advocate for people vulnerable to forced migration and human trafficking.

Nadia Ayoub works alongside our Greek partners as they faithfully hold to the biblical call to welcome the stranger. Nadia serves with Perichoresis, a ministry of the Evangelical Church of Greece that provides housing and support to refugees; most of whom have come to Greece from Arabic-speaking countries.

Joseph Russ strengthens and supports a network of partners working in El Salvador, Guatemala and Honduras to address migration issues in the Northern Triangle. Based on the needs people on the ground identify, Joseph empowers U.S. congregations to engage in advocacy related to Central America and immigration reform.

Revs. Drs. Noah Park and Esther Shin serve as professors at the Evangelical Theological Seminary in Cairo (ETSC). ETSC graduates work toward revitalizing congregational ministries in Egypt and work with refugee and peace ministries in various countries in the Middle East.

Please consider giving an extra gift this year to support our mission co-workers as they walk alongside our partners and help shape a more life-giving, equitable and hopeful world!

Prayerfully,

Rev. Mienda Uriarte, Director of World Mission
Presbyterian Mission Agency
Presbyterian Church (U.S.A.)

To give online, visit https://bit.ly/23MC-YE.

Honorary gifts can be made by checking the box and writing the mission co-worker’s name in the comment field online.