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Last Updated: Monday, 27 June, 2005, 15:55 GMT 16:55 UK
Programme Transcript
What follows is a transcript of Panorama's Dead Mum's Don't Cry, broadcast Sunday 26 June 2005, 22:15 BST on BBC One.

Although taken from a script, this should be checked against transmission for accuracy and to ensure the clear identification of individual speakers.

STEVE BRADSHAW
If a healthy woman dies in childbirth in Britain it would be a disaster. Tonight - we report from an African hospital where it can be a daily event. But where promises to help are being broken.

Five years ago world leaders signed up to targets known as the Millennium Development Goals - targets for helping the world's poor...including women dying in childbirth and pregnancy.

Our story shows how we're falling behind - and also takes us across the world to find reasons for hope.

It is the story of one African woman's fight to stop women dying because they're pregnant.

TITLE Dead Mums Don't Cry

Grace Kodindo is an obstetrician is the main hospital in N'djamena, the capital of Chad in central Africa.

We spent a week with her - filming disasters and triumphs.

GRACE KODINO
She's three kilos 100 not so small

STEVE BRADSHAW
Triumphs that include presiding over the delivery of a baby every forty five minutes. Most of them quite safe.

CAPTION: Day 1 - Wednesday

STEVE BRADSHAW
The first crisis - helping a woman over a miscarriage. Miscarriages happen in Britain too. But not like this.

GRACE KODINO
Pregnant for the eighth time. Steve Bradshaw Eighth time? Grace Kodindo Yes. Seven children, four have died. That also shows a very high infantile mortality

STEVE BRADSHAW
Like Britain, Chad has both state and private healthcare. Grace's hospital is the showcase of the state system - but Chad's NHS is not free at the point of delivery. Patients have to pay for just about everything. Antiseptic - one pound. The drip - one pound fifty. The needle - twenty five pence. Not much to us - but here many earn fifty pence a day or less. The woman's family haven't bought all she needs.

GRACE KODINO
She has only paid one bottle of IV fluids and- it's not enough. Steve Bradshaw The hospital's supposed to provide some basics itself - but often they aren't there either.

GRACE KODINO
You know everything is lacking here - normally we should be having clean sheets to properly cover her, and we should also be having some oxygen.

STEVE BRADSHAW
Grace is on the front line of the battle to save women at risk in pregnancy and childbirth. But the odds are against her.

GRACE KODINO
This is not an environment to decrease the rate of maternal deaths.

STEVE BRADSHAW
Today even the light anaesthetic they normally use in this kind of operation has run out.

GRACE KODINO
We would have done anaesthetisia to prevent the pain. But we don't have that.

STEVE BRADSHAW
Despite everything - success. The patient's over the crisis.

GRACE KODINO
J'ai fini.

STEVE BRADSHAW
One emergency over - and some basic harsh truths established. But the day's toughest cases are still to come. Few pregnant women in Chad give birth in hospital. So the women who come here- local mums or those who've made it from the countryside - are in some ways the lucky ones.

In Chad the lifetime chance of a woman dying in pregnancy or childbirth is one in eleven. In Britain it's over one in five thousand.

The heart of the maternity ward is the birthing room. Two women are lying next to each other. In one bed is Fatime Izadine. She's sixteen. She is having her baby. One of over eleven thousand born here every year. The baby's fine. And Fatime's ok too - at the moment.

Lucky to be alive and healthy?

GRACE KODINO
Yes.

STEVE BRADSHAW
But in the next bed there's a problem. A woman and a baby very much at risk.

GRACE KODINO
This is a very risky case.

STEVE BRADSHAW
Batoul is bleeding internally, she may die, and her baby too before its born. She urgently needs a caesarean - which could happen in Britain. But in Britain your family wouldn't be asked to go looking for blood.

GRACE KODINO
We've sent her relatives to go for the blood. Most of the time in the blood bank there is no blood, so the relatives should give blood.

STEVE BRADSHAW
In the hospital's blood bank - just fifteen bags. Today none in Batoul's blood group.

The message has gone out to her family for urgent donations. Rushing round relatives for blood during an emergency is quite normal here. But as ever it takes time. And time is running out.

Now there's concern about the baby.

GRACE KODINO
Est-ce le bebe est encore la?

STEVE BRADSHAW
Grace listens for the baby's heartbeat.

STEVE BRADSHAW
In vain.

GRACE KODINO
The baby is already dead.

STEVE BRADSHAW
Now Batoul could die too. She needs the operation. Her bleeding needs to be stopped and the dead baby removed. But still the relatives haven't returned with any blood.

GRACE KODINO
We're waiting for the blood Question - You're waiting for the blood? Yeah it's more than one hour they haven't come back.

STEVE BRADSHAW
In the next bed there's more trouble - Fatime's baby is fine but she is having eclampsia - a fitting attack that can lead to coma and death. With the right treatment and some simple drugs it can almost always be prevented. But while they're giving her some drugs they're not the ones Grace would have chosen.

GRACE KODINO
Normally we would give her Magnesium Sulphate.

STEVE BRADSHAW
Do you have Magnesium Sulphate?

GRACE KODINO
We don't have it here in the whole country. We don't have it. This is known as the most effective drug against eclampsia. And this really helps to save lives, and this would really help to reduce the maternal mortality.

STEVE BRADSHAW
By about one o'clock Grace is getting worried - Batoul's been here since about nine.

GRACE KODINO
I think she's now dehydrated -she's asking for water - it's not a good sign.

C'est la famille

STEVE BRADSHAW
The family comes back from their search. As well as trying to find blood they've had to go looking for drugs in local pharmacies. What on that list have you not got?

GRACE KODINO
He did not find the normal saline. He bought the antibiotics, he bought the syringe, he also bought the folic catheter. He bought everything.

STEVE BRADSHAW
He's done really well hasn't he?

GRACE KODINO
Yes. That's good.

STEVE BRADSHAW
So far the bill's come to about thirty pounds and they'll have to buy more.

GRACE KODINO
This is why some of them do not want to go to the hospital and they stay home until they become completely out of it and they are brought they just die.

STEVE BRADSHAW
Grace is full of praise for the family's efforts. They've been on a desperate shopping trip - like some macabre reality show - that has as its prize the life of the woman they love.

GRACE KODINO
It is not easy but you know they have tried to really help each other.

STEVE BRADSHAW
Five hours after Batoul came to hospital she is taken to the theatre - - along with the drugs her family has bought. Her baby's already dead - now the surgeons will try to save her life. But they're going ahead with just one bag of blood. It's all the family have managed to provide so far.

They'll need more. Grace stands by ready to help. Then - a shock.

GRACE KODINO
Elle a rempu - my God.

STEVE BRADSHAW
Batoul's womb has ruptured. Grace reckons it happened some hours ago. But nobody had realized.

GRACE KODINO
She has ruptured her uterus here apparently since she has been here since 9 am. We hope that she will have enough of blood and antibiotics she will survive, but the baby has died from the ruptured uterus. So it was a very high price.

STEVE BRADSHAW
Now there's an even graver emergency. The blood still hasn't arrived. Her blood pressure's dropping.

GRACE KODINO
It should be higher // what she needs is more blood, one bag is not enough because she has bled a lot. Steve Bradshaw

STEVE BRADSHAW
Outside - while some relatives give blood - her husband and the rest of the family wait anxiously. The blood finally arrives.

GRACE KODINO
They've brought more blood. The family have succeeded in bringing three more bags of blood. That really is a good thing, it will really decrease the risk of dying.

STEVE BRADSHAW
A life saved - as many can be when trained help and the right basic drugs are available. But the crisis isn't over yet. A relative rushes off with a new prescription.

GRACE KODINO
As I was telling you - she is still having fits again.

STEVE BRADSHAW
Back in the birthing room Fatime is having another eclamptic fit. Well into the evening the temperature's still over thirty centigrade. Through the night, lives hang in the balance. Over half a million women die in childbirth and pregnancy every year - almost all in poor countries. Saving three quarters of those lives by Twenty Fifteen is Number Five of the eight Millennium Development Goals.

The Millennium Development Goals were signed in New York five years ago by a hundred and eighty nine world leaders. For the first time leaders of the rich and poor countries alike taking collective responsibility for the world's poor. They set targets for education, health, empowering women, and cutting poverty. And they set deadlines.

But - no budgets or legal obligation to meet the goals. There's a world summit on the MDGs in September - and the UN's preparing a progress report. This week its author gave us a preview.

KEVIN WATKINS, UN HUMAN DEVELOPMENT REPORT
Maternal mortality is the goal which most countries are most seriously off track, the countries that account for the bulk of this problem in particular, most of them are either sticking roughly where they are or in many cases they are moving backwards. Now unless we can change that picture very dramatically over the next few years, there's really no chance at all of the world meeting the target of reducing maternal mortality by ¾ by the year 2015.

KEVIN WATKINS
This is a story which isn't a story of women and children first, it's women and children last.

CAPTION: Day 2 Thursday

STEVE BRADSHAW
It's the second day of the week we spent with Grace in Chad. It starts quite normally.

GRACE KODINO
For the whole twenty four hours, we have had forty one deliveries and one case of maternal death. // Lots of babies born. Forty one - isn't that something - forty one in one day.

STEVE BRADSHAW
Grace leads the ward round. Batoul is ok.

GRACE KODINO
She says she's fine thanks God!

STEVE BRADSHAW
Fatime is doing alright too. Then Grace spots a woman clearly in pain - and something her midwives haven't noticed. GRACE KODINO
Oh My God - serieux. Very serious case // we will have to open her abdomen. It must be pus, infection that has already spread in the whole abdomen. If she's not quickly, properly managed that also can cause her death. It is illegal abortion she has now a septic abortion.

STEVE BRADSHAW
Abortion is illegal in Chad - as it is in most sub Saharan African countries. It's estimated that about a fifth of maternal deaths are from illegal abortions that go wrong - very much part of the target of lives to be saved under the Millennium Development Goal.

STEVE BRADSHAW
The doctors and nurses are stunned at what's happened on their watch.

GRACE KODINO
(In French) This is an emergency, because the more time you lose, the more risk there is of losing the woman, just like that, under our noses. It's not good.

STEVE BRADSHAW
Grace demands action.

GRACE KODINO
Urgence..

GRACE KODINO
This is an emergency case - that can be fatal for her.

STEVE BRADSHAW
It's almost midday - the girl will need an operation this afternoon. In the theatre - dealing with a septic abortion is serious enough - the question now whether there could be more complications. Earlier the girl told Grace a local nurse - whose identity she didn't reveal - had performed the abortion at his house. The state she's been left in is about to become clear.

GRACE KODINO
Oh My God, Mon Dieu, very bad. Uterus is completely perforated.

GRACE KODINO
The surgeons are now trying to remove her uterus and save her life. She is going to lose her uterus but she will be alive. All this could have been prevented if only she has been using contraceptive method. It's ignorance and lack of money the two bring to this.

STEVE BRADSHAW
So another life saved.

STEVE BRADSHAW
While elsewhere in the maternity wards - one more death that wouldn't have happened in the rich world. But for all its daily death toll the hospital is a sanctuary where mums give birth with trained midwifes and emergency care if needed. And that's unusual in Chad.

CAPTION: Day 3 - Friday

STEVE BRADSHAW
So what's having a baby like for women without any medical help? Grace took us into the barren landscape outside N'Djamena to find out.

In the world's poor countries almost one woman in two gives birth without help from a qualified doctor or midwife - that's over sixty million births. They happen in places like Chawa.

The only help available here is what are called traditional birth attendants - or TBAs. Three traditional birth attendants were waiting to see us. They told us how they try to help with emergencies like - a retained placenta.

MAIMOUMA KADJAR, TRADITIONAL BIRTH ATTENDANT
When the baby is coming out I help it. When the placenta is stuck inside I put my hand in to take it out.

GRACE KODINO
They have no other way to remove the placenta. They're only using their hands, and they try. If they remove the whole piece, sometimes there are remaining pieces, and the woman die. And / they have many, many cases of maternal mortality here

STEVE BRADSHAW
The birth attendants don't have drugs or equipment. They're untrained - and they know it.

HABIBE HISREIMI, TRADITIONAL BIRTH ATTENDANT
The only way to reduce maternal mortality is to have a qualified nurse. We need to be trained and to have equipment.

GRACE KODINO
They know that as they are now they know nothing to save a woman's life. This is a traditional way of doing things. And it's not helping to save a woman's life.

STEVE BRADSHAW
Chawa does have a small clinic. Built with big hopes. It has targets set by the government for medically attended births. Last year the target was 299 and this year 307. In reality - we were told - there were no medically attended births at all - and women won't come here because there are no specially trained attendants or drugs.

So women give birth at home. When we asked how often they die, we were told there were no records. e were directed instead to a village close by. In a family hut women had gathered for the funeral of a heavily pregnant woman who'd died - just two days earlier.

She was called Fatime. She left a two year old daughter - Mariam - now being looked after by her grandmother. Fatime had been eighteen.

ACHE ABDELKERIM, GRANDMOTHER
She was complaining of fever, headache, pain in her throat and chest and she could hardly drink. Steve Bradshaw

STEVE BRADSHAW
Deaths like Fatime's are effectively off the medical map - no treatment, no record. Relatives showed us Fatime's grave. There are thousands of graves like this in the world's poor countries. Their obscurity makes progress on the Millennium Development Goal almost impossible to measure.

GRACE KODINO
It always goes like that, unnoticed. Especially for rural women, very far from hospitals. They always die unnoticed. So how are the millennium development goals going to be reached? I don't know. It's unjust for an 18 year old girl to die like that, it's very, very unjust.

STEVE BRADSHAW
What will happen to the grave?

GRACE KODINO
Well, when it rains it may even become completely flat, so no one will even notice that there is a grave here. It will become flat, that's all.

CAPTION: Day 5 - Sunday

STEVE BRADSHAW
Grace is a Protestant and takes inspiration from her religion. As does her daughter Halime. Most of the time. Grace adopted Halime after finding her abandoned in the hospital.

GRACE KODINO
I decided to adopt her because I wanted to give her... you know...something, a chance in her life, because apparently I mean she has no luck. She was just a bundle like that. It did something to me.

STEVE BRADSHAW
And now?

GRACE KODINO
And now we are both happy with each other. (laugh) I love her, she loves me and that's wonderful.

STEVE BRADSHAW
But even Grace's commitment can be affected by what happens in the hospital.

Animate: Day 6 - Monday

GRACE KODINO
We've just had a second maternal death now.

Courtyard
There's already been one death today - now another.

GRACE KODINO
Mon dieu

STEVE BRADSHAW
The woman's died from eclampsia. She's one of about a hundred who die from eclampsia ever year in this hospital - compared to just four or five in the whole of Britain. It's another preventable death.

GRACE KODINO
We had one death on Saturday, Sunday and, Monday, this morning, no this morning we had two.

STEVE BRADSHAW
How many would there have been in the West?

GRACE KODINO
None - none in the west.

STEVE BRADSHAW
How does it affect you personally?

GRACE KODINO
Well personally it is removing all my enthusiasm and I ask myself what am I doing here in this kind of environment where I cannot even use my knowledge to save life. So I feel depressed

STEVE BRADSHAW
But life in the hospital is an emotional rollercoaster.

Grace is told by a midwife that a mother she's helped has named her baby after her.

MIDWIFE
Congratulations.

GRACE KODINO
She is named Grace, Dr Grace.

STEVE BRADSHAW
How many babies have you had named after you?

GRACE KODINO
Oh my God so many.

STEVE BRADSHAW
But then - the most shocking case so far. One that will make Grace not only depressed but angry. There's a new patient - only twelve years old.

GRACE KODINO
She has attempted an abortion - she's twelve year old. She has succeeded in aborting but now she is in pain and bleeding. She will need a lot of antibiotics now.

STEVE BRADSHAW
Have you got them?

GRACE KODINO
She bought some but her mother has no money to buy the other one, so her aunt went home to look for more money.

STEVE BRADSHAW
She is only a kid?

GRACE KODINO
She is a kid.

STEVE BRADSHAW
What did she do to herself?

GRACE KODINO
She received some injection to abort, but they will never tell you the truth what they have really done.

Animate: Day 7 - Tuesday

Next morning the 12 year old girl's had an operation.

GRACE KODINO
They have removed pus, they've cleaned it and now she is on IV fluids and antibiotics.

STEVE BRADSHAW
She's still fighting for her life. But whatever happens, her future may be grim.

GRACE KODINO
The future may be infertility, she may become sterile and she may have pelvic, abdominal pain. Chronic pain.

STEVE BRADSHAW
The girl's mother tells us they live thirty five kilometres away. And had come here in a taxi. A taxi they could only afford by sharing with other people.

GRACE KODINO

She couldn't pay for a taxi would have taken them directly here so they have to use a taxi where other people are also driving in the same, so the taxi has to drop everyone off before taking her here to the hospital.

STEVE BRADSHAW
Didn't anybody say hey we've got a sick girl here - we've got to go to hospital first?

GRACE KODINO
No - nobody

STEVE BRADSHAW
Because?

GRACE KODINO
They think they have paid the same fare, they have the same right - they don't have any compassion for her.

DANDE
What can I say - there are no words. All I can think about is how to find the money to save my daughter's life.

STEVE BRADSHAW
A few days later she/her daughter died. One of over half a million such deaths in the world's poor countries. But is such high maternal mortality inevitable? There's now remarkable research that suggests it's not - that poor countries can save more mothers lives.

It's by one of the top authorities on the politics of maternal mortality in the developing world.

DR JEREMY SHIFFMAN, MATERNAL MORTALITY EXPERT, SYRACUSE UNIVERSITY
I do not want to discount resources, I do not want to discount poverty, I do not want to discount donor AID, all of that is critical. However, poor countries can surmount maternal mortality problems. There are reasons for optimism. I've looked at several countries where individuals and groups of individuals have managed to mobilise the political system to push political leaders to make maternal mortality reduction a policy priority and actually to have achieved documented success in reducing maternal mortality.

STEVE BRADSHAW
Individuals persuading governments to save more mothers lives. It seemed like a dream to Grace until she read Doctor Shiffman's work. His model - a little known civil servant called Doctor Cipriano Ochoa. An unsung hero from Honduras, one of the poorest countries in Central America.

GRACE KODINO
fascinated.

STEVE BRADSHAW
I'd really like to get you to talk to Dr Ochoa.

GRACE KODINO
I really would like to, yeah.

STEVE BRADSHAW
I am wondering if there is some way we can do that, whether we could get him on the phone or email him

GRACE KODINO
Or email

STEVE BRADSHAW
Or we could bring back the video film.

GRACE KODINO
I would really like to know how he did it.

STEVE BRADSHAW
Or we could take you with us!

GRACE KODINO
Why not? Why not? I would really like to know how he did it.

STEVE BRADSHAW
A week later we met Grace in Honduras. What we hoped to find out - how poor countries could still cut maternal mortality in time to reach the Millennium Development Goal - and save hundreds of thousand of women's lives.

STEVE BRADSHAW
What Doctor Ochoa and his colleagues had done was galvanize their country into taking mothers lives more seriously. We met the modest Doctor Ochoa in the town of Marcala at one of the simple birthing clinics he'd helped persuade the government to build across the whole country.

Senor Ochoa?

DR OCHOA
Si

STEVE BRADSHAW
How do you do? This is Grace

DR OCHOA
How are you (in Spanish)

GRACE KODINO
Pleased to meet you also.

STEVE BRADSHAW
He made it clear right away he thought other poor countries can do what Honduras has done. Do you believe it is possible to achieve the millennium goal of reducing to three quarters the maternity death?

Dr CIPRIANO OCHOA, MEDICAL HEALTH EXPERT, HONDURAS
Yes, I am almost sure we can achieve that goal and that it will probably be before 2015

STEVE BRADSHAW
In the clinic women waited for antenatal check-ups. Back in the Nineties Doctor Ochoa - then a civil servant - wondered how many women like these were actually dying while pregnant. He and his colleagues conducted a survey - and found the results far worse than their own government had estimated. Mothers - they told both government and international donors - urgently needed help.

And with a programme including simple clinics like this they got it. The result - a dramatic forty per cent drop in maternal mortality in seven years. Grace and doctors discuss Partograph In the labour room the nurse in charge showed us how the course of every pregnancy is recorded moment by moment.

The partogram helps doctors spot problems. Grace's said her hospital used to do the same until United Nations funding dried up.

Remember the woman we saw who had the ruptured uterus in the hospital?

GRACE KODINO
If she had been properly followed up by a partograph, it would not have come to that.

STEVE BRADSHAW
So that could have been prevented with this kind of system.

GRACE KODINO
Exactly, yeah. Exactly.

STEVE BRADSHAW
Grace spots something else they don't have in her hospital in Chad.

GRACE KODINO
They have oxygen in the labour room. For the mother and baby that's a very big difference.

STEVE BRADSHAW
Salaries here are paid by the government. Women are charged a standard eighty pence fee and additional funds are raised voluntarily in local communities. The buildings often paid for by foreign donors. Then - a simple device to revive dying babies. Again - nothing like it back in Grace's hospital.

How much does it cost?

Dr CIPRIANO OCHOA
(In Spanish) Forty dollars.

STEVE BRADSHAW
Forty dollars.

GRACE KODINO
That would be really helpful and almost cheap.

STEVE BRADSHAW
The few simple things needed to deliver most babies safely - ready and waiting.

GRACE KODINO

I really feel envious. I feel envy. They have what is really needed to help to save life.

STEVE BRADSHAW
Honduras has been helped in saving mothers lives by a relatively stable political environment. By a culture that's come to take women more seriously. By a good long term relationship with aid donors. And by the quiet determination of Doctor Ochoa and his colleagues.

GRACE KODINO
He is a good man - really I like him, he is humble and simple. He is also very realistic I would have loved to work in this environment. It would make me even more efficient, you know, in my work, to help to save the women and babies lives. I would really have loved to work here in this condition. So most mums much safer. STEVE BRADSHAW
But what about women who live far away from the new clinics?

GRACE KODINO
In remote mountain villages like San Isidro really poor women often have trouble even raising the bus fare to a clinic.

STEVE BRADSHAW
As in Chad they still have to rely on traditional birth attendants. Eugenia's been a TBA for two decades. Grace watched her at work with Maria, five months pregnant with her fourth child.

EUGENIA DOMINGUEZ, TRADITIONAL BIRTH ATTENDANT

You have to eat lots of vegetables. You must feed yourself better. You're not eating enough. The baby isn't growing, it's very small.

STEVE BRADSHAW
But here's the difference with Chad - if things go wrong, Eugenia has been trained to refer women like Maria to a clinic. Grace was curious.

GRACE KODINO
If they tell you to go to hospital, would you go to hospital?

MARIA
If there are no problems, I'll have it here at home with Eugenia. But if there are complications I'll go to the hospital.

STEVE BRADSHAW
In Chad Grace had despaired of the traditional birth attendants - untrained and self-appointed. But here most are now state-trained. And for Grace - it worked.

How do they compare to the traditional birth attendant women in Chad?

GRACE KODINO
It is completely different. Not only they have been trained but they have been also given equipment. I have never seen that in Chad. It is wonderful.

STEVE BRADSHAW
It's true that Honduras is a little wealthier than Chad - but out here in San Isidro you wouldn't know it. The next day Maria's husband Santos showed us his larder. More colourful than well-stocked.

He grows enough corn and beans to feed his family - but only just. After all his wife had been told she wasn't eating enough for the baby. When he has a little extra he sells it - making a cash income of about forty pounds a year.

For Grace it all seemed very familiar.

GRACE KODINO
It is similar to some parts of Africa, this is extreme poverty. Mountain Village

STEVE BRADSHAW
So new clinics and trained birth attendants - what about real emergencies?

Suyapa's fifteen, heavily pregnant and she's had a miscarriage already. Today she's off up a mountainside with her mother in law - an hour's slog before she can reach any sign of civilization. And she tells us she may be due inside a week.

Cases like this can still turn out badly - pregnant women in Honduras still over seven times as like to die as in Britain. But Suyapa's lucky. Her local town is Esperanza. And it's home to one of the big regional hospitals which do treat mums with real emergencies.

She's given the all-clear. You could almost kid yourself it's the NHS. Or almost - there's a nominal fee. In the delivery room - another safe birth. They handle up to ten deliveries a day. There were just two deaths last year - again one after insisting on delivering at home.

GRACE KODINO
How do you say congratulations in Spanish. - Felicidad. I want to tell her felicidad.

STEVE BRADSHAW
In a poor country, it's a standard of equipment and care close to rich world standards.

GRACE KODINO
Do you need to be a rich country to have this?

Dr CYPRIANO OCHOA, MATERNAL HEALTH EXPERT, HONDURAS
I'm not sure, I'm not sure. I think there's a lot of poverty here. But I think what there has been are some good decisions to put what little money has been borrowed or donated, where it's needed. These are examples of that, so not only are we a country with poverty, debts and corruption, but we're also a country that takes good decisions.

GRACE KODINO
It is the political will to do things - even with fewer resource - if the government really wants to attack the problem and take good decisions, as you say, they will succeed.

STEVE BRADSHAW
When a hundred and eighty nine countries including Chad and Honduras signed up to the Millennium Development Goals part of the deal was rich countries increasing aid. Plus action on trade and debt relief.

In return poor countries committed themselves to better governance - spending money honestly and effectively. The aim - a global partnership for development - enshrined as Goal Eight. And here it's worked.

Honduras doing everything its government believes is right to try and save mothers lives - hospitals in a Catholic country even giving away contraceptives.

They've got condoms and contraceptive pills here in the pharmacy. Back in N'djamena you have¿

GRACE KODINO
None.

STEVE BRADSHAW
How important is that for preventing maternal death?

GRACE KODINO
It's really important because if we prevent unwanted pregnancy that most frequently led to criminal abortion, we would decrease maternal deaths from abortion.

STEVE BRADSHAW
Grace had begun her journey feeling defeated. So how did she feel now in Esperanza - the town whose name translates as Hope? Are you as pessimistic as you were before coming here about cutting maternal mortality?

GRACE KODINO
No, no because I can see that even a country not very rich like Honduras, when they are really aware of the problem and they want to fight it, with their small means they can do something. And that really gives me hope the Millennium Development Goal can be met if people are really responsible enough to take the right intervention to work for it

STEVE BRADSHAW
So are you still feeling as depressed as you were when we last filmed a ward round in Chad?

GRACE KODINO
No, less than that because I know that it is possible to do something if there is a will to do it.

STEVE BRADSHAW
We told the man writing a progress report on the Millennium Development Goals about Grace. And we asked him whether her newfound optimism was justified.

KEVIN WATKINS, UN HUMAN DEVELOPMENT REPORT
Grace's optimism is completely justified, we know from the evidence from a large group of countries that it's possible to get maternal mortality and child death rates down very quickly, countries like Malaysia, Sri Lanka, Egypt and Honduras have all shown that, we also know that it would cost very little / We are talking around 6 billion dollars a year to cut these maternal mortality rates and child death rates at the level needed to achieve the millennium development goals, that's equivalent to roughly one weeks worth of what rich countries currently waste on subsidising agriculture. The real problem is not the lack of financial resources, it's not the technologies, it's not the policies, it's the political resolve to make them happen.

STEVE BRADSHAW
Back in Chad - time to celebrate. At least for this high society couple. Suddenly there seems to be money to spare. Look more closely and it's recycled.

Still the few western haunts in Chad seem to be booming. Chad does have something to celebrate - oil - - a billion barrels discovered under its desert sands. Petrol has long been something you find here in old bottles. Now Chad's own reserves are set to boost government revenues.

But will more money really help Chad's mothers? In hospital Grace encounters attitudes that money alone won't change.

Fanne is fifteen. She has just had her second child at home - close to the hospital. But it's gone wrong - and now she's here with a potentially serious complication.

GRACE KODINO
The baby has come out but the placenta did not come. Should normally follow the delivery of the baby and that hasn't happened in this case.

STEVE BRADSHAW
Is that dangerous?

GRACE KODINO
Yes and she might have haemorrhage, bleeding, and this is a cause of maternal death. Husband at pharmacy window Husband Hassane has gone to buy some drugs.

STEVE BRADSHAW
Grace tells Fanne they'll help pull her through.

GRACE KODINO
It will help to contract the uterus and detach the placenta, so it will come back easier now.

STEVE BRADSHAW
But Grace is furious Hassane let Fanne deliver at home.

GRACE KODINO
When she starts to have pain she tell her husband, I want to go to the hospital, her husband say, wait, I have some business to attend in town.

GRACE KODINO
It tell us about the low status of woman in this country. Woman have very, very, very low status.

STEVE BRADSHAW
She goes to find Hassane. He says Fanne didn't tell him she was about to deliver.

STEVE BRADSHAW
Still Grace decides to issue a stern warning.

GRACE KODINO (in Arabic)
Don't ever do this again - you're lucky Allah helped you - otherwise she will bleed to death and that's why I needed to see you personally Don't ever do it again.

GRACE KODINO
Whoever's in the wrong, the incident raises a crucial issue for Grace. We need people to change their way of thinking, especially about the woman status. Woman is not something that we buy, we keep, she produce baby, she die and you buy another woman. But they think like that. You know, I buy her, she make children, she die, I buy another woman, that's all. It stinks that you can buy, keep, that's all.

STEVE BRADSHAW
So as Chad's oil money starts rolling in - will it seize the chance to save mothers lives? Or do cultural attitudes to women in countries like Chad mean that even if they find the means to help they still don't have the will?

STEVE BRADSHAW
Aziza Baroud is Chad's health minister. She's also an economist who/and co- ordinates how to spend the country's new oil revenues. We asked to meet in the hospital - Grace wanted to show her around. She's promised to increase spending on maternal health - though there are few signs of it so far.

Just explain to me why the oil is already flowing out and we're getting the benefit of it, but the syringes, the drugs as we see here are not yet coming in.

AZIZA BAROUD, MINISTER OF PUBLICH HEALTH, CHAD
So you have to understand one thing also, it is not because the day you have the money that the day you will change everything because you have your system of management, you have all those manager that you have to¿

STEVE BRADSHAW
Well there's always management and stuff but somehow the oil is going to the West but the drugs and the syringes aren't coming in here.

AZIZA BAROUD
Yes, this is much more a matter of organisation inside the hospital, inside the services

STEVE BRADSHAW
If the drugs and syringes aren't yet coming in some people are going to say¿ some people will say that's African corruption and incompetence.

AZIZA BAROUD
It is not a matter of corruption and here.. you know.. again I would like to maybe to put the emphasise here in what I'm saying that it's a problem of management, it is not a question of corruption.

So corruption not a relevant issue she claims, although management competence is. But what about cultural attitudes - and caring?

STEVE BRADSHAW
Do you think countries like Chad care enough about mothers, care enough about women?

AZIZA BAROUD
Culture and attitudes you can change through communications, through information and that's it.

STEVE BRADSHAW
What some people are saying at the moment, at the time of the G8 is, "Hey, you get your act together first. Change your attitudes, change culture, spend the money with more efficiency, and then we'll think about giving you some more."

AZIZA BAROUD
Ah, spend the money with more efficiency, I agree with them. Change your culture - this is very difficult because we are human beings and you don't have any computer that you put our mind inside and change as you want. This is a problem.

STEVE BRADSHAW
We went to visit a sixteen year old girl called Dana who had eclampsia. Grace Kodindo She is 16 years old and she was admitted for high blood pressure. She was another patient Grace had been unable to treat with the cheap effective drugs that might save her life.

What do you think when you see that?

AZIZA BAROUD
I feel very sad. I feel very sad.

STEVE BRADSHAW
Grace took the chance to tell the minister about what she'd learnt in Honduras and about the need for a national strategy on maternal mortality.

GRACE KODINO
The problem in Chad is that we should have a strategy for maternal mortality, and they have.. you know they have found out that the maternal deaths was very high, so they tried to put out a committee who have worked on the strategy.

AZIZA BAROUD
It is okay that someone moved in Honduras and we need someone to move here but I don't believe that we have to go in Honduras and copy what is going on there.

STEVE BRADSHAW
But while you're waiting...while you're waiting there's a woman¿

AZIZA BAROUD
Who is saying that we are waiting? Who is saying that we are waiting?

STEVE BRADSHAW
- Well there's a woman waiting there behind the shutters for the right drugs.

AZIZA BAROUD
No, okay, because you take one case and you say that people are sleeping in their houses.

STEVE BRADSHAW
But this woman is waiting. She's waiting behind those shutters.

AZIZA BAROUD
Okay. Okay¿

STEVE BRADSHAW
She's waiting now.

AZIZA BAROUD
...but you want today because of this woman that Chad could change, okay, thank you for the lesson.

STEVE BRADSHAW
Back inside Dana was being looked after by her family. She'd developed eclampsia after having a caesarean. It had been her first pregnancy A couple of hours later Dana was passing into a coma. We went back later to find out what had happened to Dana.

Grace what happened to Dana?

GRACE KODINO
Well she died... she died. This is a preventable death you know - she could have received the proper drugs, to cut convulsion to cut blood pressure, probably remission and she would have survived. 16 year old, one baby - it's very sad. Again a useless death. It could have been prevented.

STEVE BRADSHAW
Despite this you keep going - your optimism - is that putting it too strong?

GRACE KODINO
Well, I don't know how long I am going to keep going like this - really I don't know. I may just stop because it is working on my nerves also. So I don't know how long I can go on this. GRACE KODINO
OK.

Grace walks away. Two weeks since we filmed with Grace she's still trying to stop mothers dying - she's not given up yet.

CREDITS



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