Monique and the Mango Rains: two years with a Midwife in Mali is a memoir of Kris Holloway’s experiences in the peace corps. Kris was 21 years old when she joined the peace corps as she set off to a village in Nampossela, Mali, in West Africa. Throughout her two years, Monique Dembele was her host during her 2-year tour. Monique and Kris face many challenges like maternal morbidity and mortality, child malnourishment, and how Monique was a catalyst of change for the women and children of Nampossela. In the United States, there are similar maternal morbidity and mortality related to racial disparities.
Monique was the midwife and the sole healthcare worker in her village, with only six-grade education and nine months of medical training. Monique specialized in women’s health, provided prenatal consultations, assisted women in labor, delivered babies, and provided check-ups and vaccinations. The birthing house was a small makeshift building made up of mud bricks, a leaky tin roof, and a concrete birthing table where women would lay to give birth. There was no running water, no ambulances, and minimal emergency medical supplies and vaccines. It was typical for Malian women to have many pregnancies starting very young, expected to work long hours with little prenatal care. One out of twelve Malian women risk dying during pregnancy or die while giving birth due to hemorrhage, infection, and malnutrition. The children would face a similar fate; if they did not die at birth, two out of five would die before age five from infection and malnourishment. The talk about birth control was taboo, and it wasn’t the women’s choice to outwardly consider these options. Monique was knowledgeable about birth control; in fact, she would be on birth control unbeknownst to her husband. The women did not have the education on prenatal care or education to recognize the dangers of malnutrition or treat their sick children.
There continues to be a significant disparity in maternal mortality in the United States for Black women compared with white women and women of other races, and this disparity appears to be worsening (Brown, & Small, 2021). Maternal mortality rates in the United States have continued to exceed those of other developed countries. These rates show considerable racial disparities, in which black mothers are at three to four times the risk compared with their white counterparts (Bernet, Gumus, & Vishwasrao, 2020). According to the Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System, the risk for mortality is highest among non-Hispanic black women, with 41.7 deaths per 100,000 live births for non-Hispanic Black women compared with non-Hispanic white women 13.4 deaths per 100,000 live births (CDC, 2020). These maternal disparities are a significant public health problem in the United States, and more than half of all maternal deaths are preventable. Unlike in Mali, Bernet, Gumus,& Vishwasrao (2020) indicate that hemorrhage is no longer the leading cause of maternal mortality, but increasingly due to cardiovascular disease, hypertension, diabetes, and obesity seem to be contributing factors.
Monique was far more intelligent than her time, and she strived to improve women and infants’ health. She knew that women’s bodies could not keep up with the unhealthy pregnancies and that children’s nutrition needs to be addressed to maintain their growth and development. Monique knew that Malian women lack education on women’s health and prevent/treat dehydration in infants. Holloway and Monique would use the birthing house as a clinic and have women bring their babies for a wellness check. Monique was innovative, making health charts easy to understand by the mothers. She would teach on signs and symptoms of dehydration, prepare food for their babies, clean water, and the importance of self-care. Monique would have follow-up appointments, reminded them to come back to the birthing house for check-ups, vaccines, and weight monitoring. Monique and Holloway would continue to educate women on birth control.
Bernet, P., Gumus, G., & Vishwasrao, S. (2020). Maternal Mortality and Public Health Programs: Evidence from Florida. Milbank Quarterly, 98(1), 150–171. https://doi-org.umasslowell.idm.oclc.org/10.1111/1468-0009.12442
Brown, H.,& Small, M. (2021). Overview of maternal mortality. UpToDate. Retrieved from: https://www.uptodate.com/contents/overview-of-maternal-mortality?search=maternal%20disparities&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H26
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