This article is based on an interview with Dr. Muldrow by Andrea Dukakis of Colorado Public Radio. You can listen to the podcast here. A transcript of the podcast is provided at the end of this article.
Dr. Margaret “Migs” Muldrow, a Denver dermatologist, has made it her mission to prevent maternal and neonatal deaths and treat gynecologic complications of childbirth in rural Ethiopia. Her nonprofit organization, Village Health Partnership (VHP), works with communities to improve maternal health in some of the poorest and most remote parts of the country.
Muldrow’s connection to Ethiopia began in childhood, when her parents worked there establishing educational, agricultural and medical programs. “We lived out in the bush and my father worked as an engineer, but we ran a small medical clinic,” she recalled in an interview. “From a young age I was just interested in medicine, and I used to tag along with our one health care provider, my father, when he worked in the clinic. So I think that’s where I got my interest in medicine.”
Even as a young girl, Muldrow witnessed the dire maternal health conditions in rural Ethiopia. “We would often see women come in, in labor with complications,” she said. One particularly haunting memory was of a woman who came to the clinic after laboring for days with a deceased baby stuck in her birth canal. “My father reached inside of her, pulled it through the birth canal. She thanked him for relieving her pain and asked for a cup of tea. He made a fire outside the clinic and boiled a pot of tea. They drank tea together, and then she died. And I’ve never forgotten that day.”
When Muldrow returned to Ethiopia decades later, she found maternal mortality rates remained staggeringly high. “Medical providers told me then that as many as one in 10 were dying in childbirth, and many more were suffering from complications,” she said. “So I think it was that trip that galvanized my desire to find a way to give back. And I knew as a medical doctor, I had to do something.”
Muldrow spent two years carefully considering how to intervene given the scale of the challenges. “How do you intervene when the poverty is so great and the need so deep?” she asked. “No other NGOs are working in the rural areas of Ethiopia where we’ve been. So it’s a daunting challenge.”
In 2008, Muldrow and a small group of others came together to form VHP. “We made it our mission to work to prevent maternal and neonatal death in childbirth and to treat women with gynecologic complications of childbirth,” she explained. With Muldrow’s “knowledge of the area’s language, culture, and medical needs, she was in a unique position to create an organization that could help tackle the challenges,” according to the VHP website.
A key VHP value is that “all projects and programs in Ethiopia are community-based and community-driven.” Each year, Muldrow and other VHP volunteers travel to Ethiopia to work with community leaders on needs assessments and defining priorities. Back in the U.S., they focus on raising money to support the community-based safer motherhood efforts.
While the challenges remain enormous, Muldrow and VHP are making important strides and demonstrating the power of global collaboration to advance maternal health as a basic human right. “It’s about giving back,” Muldrow said, “and it’s really about how you work.”
Transcript
Andrea Dukakis: You spent your childhood in Ethiopia. Your parents were missionaries there. How did you find yourself working in a health clinic as a young kid?
Dr. Migs Muldrow: We lived out in the bush and my father worked as an engineer, but we ran a small medical clinic and from a young age I was just interested in medicine. I used to tag along with our one health care provider, my father, when he worked in the clinic. So I think that’s where I got my interest in medicine.
AD: Describe what the conditions were like in the clinic.
MM: It was a two-room clinic, very primitive, no running water, no electricity. We had one small room with an exam table. And then outside of that, we had a little desk and a cabinet with medications. My job was to, even as a young kid, give shots. And then occasionally, for example, people would come in gored by a Cape buffalo, and I would help clean the person out and suture them up. So we did a lot, even though it’s kind of shocking to hear that maybe a little third grader was doing those things. But I started at a very young age and loved it.
AD: And being gored by a buffalo, was that a common injury?
MM: At harvest time, Cape buffaloes would come and stand in the corn fields. And people would monitor the corn, chase baboons away, and occasionally they would encounter a buffalo. So it wasn’t uncommon to see that.
AD: Your work in Ethiopia now is about maternal fetal health. And I imagine that it’s because of what you’ve witnessed there. Is there any story you remember from your childhood at the clinic that stuck in your mind?
MM: We would often see women come in, in labor with complications, but one day I was working with my father in the clinic and a woman came in. She’d been in labor for multiple days and her baby was stuck high up in her pelvis. And the woman was in terrible, terrible pain.
My father placed her on the one exam table and her baby was clearly dead. He reached inside of her, pulled it through the birth canal. She thanked him for relieving her pain and asked for a cup of tea. He made a fire outside the clinic and boiled a pot of tea. They drank tea together, and then she died. And I’ve never forgotten that day. I think that stuck with me over the years.
For a long time, I couldn’t even talk about the story. But I went back to Ethiopia in 2008 with my father to help him implement village-level water projects. And I asked about women. Medical providers told me then that as many as one in 10 were dying in childbirth and many more were suffering from complications. So I think it was that trip that galvanized my desire to find a way to give back. And I knew as a medical doctor, I had to do something.
So I took literally two years to think about how to intervene. I mean, how do you intervene when the poverty is so great and the need so deep? No other NGOs are working in the rural areas of Ethiopia where we’ve been. So it’s a daunting challenge. But I spent some time talking to the people at the Hamlin Fistula Hospital in Addis and up north in northern Ethiopia about the problems that they were seeing and a model for intervention.
And after two years of thinking about what to do, then a small group of us in Denver came together and formed the Village Health Partnership. We made it our mission to work to prevent maternal and neonatal death in childbirth and to treat women with gynecologic complications of childbirth.
AD: Can you give us a sense specifically of how the medical care and the conditions in some of these clinics affect women now, some of the conditions they end up with after giving birth if they even survive birth?
MM: Well, I think the issue is in the remote areas of Ethiopia, there’s really no access to health care. Often there’s heavy conflict. Women have to walk long distances. When they get to a clinic, there’s no place for them to stay. They often sleep under trees in the rain. There’s no food for them to eat while they wait for delivery.
And then when you look at the medical clinics, really they’re in desperate shape. There’s no running water. Open defecation is common. Surgical instruments aren’t sterilized. Delivery tables tend to be dilapidated and covered with old blood. It’s really, I think, a deadly place for women to deliver. So if they make the journey to a clinic, they’re often faced with the choice, do I deliver in this desperate building, or do I just try to go home again? So it’s not much of a choice.
AD: And I understand there are some pretty serious conditions that they end up with after having a child.
MM: Well, if women must deliver at home, or if they have no access to health care, one of the things that can happen is the baby can become stuck high up in the pelvis. And as the woman is in labor with the child’s head pounding against the pelvic floor, either the infant dies and slips through the birth canal, the baby’s dead, the mother may survive with obstetric fistula, with necrotic tissue, you get holes between the bladder and the vaginal area or the rectum and the vaginal area, and then they leak urine and stool. If the woman in labor can’t pass that fetus, then her uterus ruptures and they both die. So that’s not an uncommon scenario.
Certainly, during childbirth, there’s other complications that can happen. Women can bleed out and they can become septic, et cetera. But obstructed labor is probably the most horrendous one. And that really, to fix the problem, requires a cesarean section. So out in southwestern Ethiopia, even until very recently, one or two years ago, there was absolutely no access to cesarean sections. There was barely any access to skilled assistance with delivery, but certainly no access to cesarean sections.
Now, with the work that we’re doing in partnership with the government, there are two hospitals that are starting to come online to provide cesarean sections. And you described fistula, that leakage that you talked about. If they suffer from that, we have a program in Western Ethiopia where we seek out those women. They tend to hide in shame. We seek them out and then transport them to either a general hospital or the university teaching hospital, where they undergo surgical treatment.
But in the rural areas, fistula happens, tends to happen to younger women with their first pregnancy. But the other thing that happens is without birth control, women get pregnant again and again. And they develop organ prolapse. Their bladder and the rectum fall through the vaginal area. Even the uterus falls through the vaginal area. And for the people on the ground, the consequences are the same. There’s no water to bathe and they can’t function.
You know, it’s a subsistence community. You have to work in the fields and give back to your community to even survive. They can’t do that. So they tend to be put away in huts, hidden away, and then they die. So again, in Western Ethiopia, we search out those women and try to get them treated.
AD: I should say we’re talking about labor and delivery, but you are a dermatologist in Denver.
MM: Disclaimer here. I’m not an obstetrician.
AD: But your mission there is labor and delivery. I also should say you’re a white woman. You’re returning to a poor country in Africa where the majority of residents are black. And I wonder if you ever worry about being seen perhaps as a white savior coming in to help those less fortunate. But that’s of course with the growing awareness about colonialism around the world.
MM: You know, it’s painful to hear that white savior complex, but I think let’s reframe the issue from little white girl goes back to deepest, darkest Africa to save souls to perhaps doctor goes back to the community that raised her to give back.
And maybe that doctor now has medical knowledge, experience with economic development, and cross-cultural skills that can help intervene in the crisis for maternal health. And I think what people really need to look at is the large coalition of people that we’ve brought together to work for safer motherhood, Ethiopians and Americans, and then look at how we work, where we’re working, the challenges that we’ve faced and overcome and what we’re achieving. And it’s pretty amazing. It’s about giving back, and it’s really about how you work.
AD: I just want to go back to your childhood in Ethiopia. You left there and went to college in the US and stayed in this country. And you say that despite the enormous challenges the country has had and still has, you missed your childhood home and that while the country lacked in resources, it had something you couldn’t find or didn’t find in the US. Can you just talk about that?
MM: I think it’s hard for people to understand, but I lived pretty much in Ethiopia till I was 13. So the people there raised me up. They gave me all the love in their hearts and took me in at every moment in my life, and I miss them.
Now, it was a hard transition coming here. I didn’t understand this country. I grew up without running water and electricity and cars and TV. And it was overwhelming to come here. So I couldn’t get back to Ethiopia for a long time because of political situation there. But my father, who was working on village-level water projects, convinced me to come back. He saw the health care situation in the rural areas and said, you’ve got to come back. And I said, I’m not going to go back and be a doctor. I will take you back and help you with village level water projects. But I knew going back would open the floodgates. And sure enough, it did when I went back.
But I think you have to understand that people of Ethiopia are just absolutely just kind and loving, wonderful people. They actually stop and have tea in the afternoon and talk to you. The relationships there are just priceless.
So I really valued that. It’s not that you can’t find those things in the United States, but it’s just different. We have so much in the way of material things. I think sometimes we miss that social interaction and that sense of community. And I think that’s what Ethiopia has over the United States.
AD: Dr. Muldrow, Migs, as you’re called. Thanks so much.
MM: You’re welcome.