In summer 1999, a group of University of Utah OB/GYNs were lecturing at a hospital in Lhasa, Tibet. And before their first hour had passed there, they had a life-threatening case on their hands: a nine-months-pregnant woman with anemia, toxemia, malnutrition and no prenatal care was about to give birth.
The woman couldn?t even afford the blood needed to treat her anemic symptoms and she soon went into shock.
The visiting U personnel bought blood for her, managed her case and delivered the baby within an hour. Both the mother and the baby survived.
?It was a very frightening and, at the end, a very rewarding experience,? said Arlene Samen, U nurse practitioner. The baby was born on Samen?s birthday. As a tribute, the mother gave her baby Samen?s Tibetan name, Lhamo, which means ?angel.?
?Right then and there we all decided [to] help these people,? Samen said.
Since then, Samen and Dr. Michael Varner, an obstetrician, have been working on a rural midwifery program for the Tibetan people.
On Jan. 26, through the work of Samen and Varner, the U department of maternal/fetal medicine was awarded a $4 million National Institutes of Health grant to fund their project, ?a self-sustaining perinatal system for Tibet.?
Samen is the coordinator, and Varner functions as the principal investigator in the project.
Having children in Tibet is different than in the United States. The percentage of mothers who die during childbirth, also called the maternal mortality rate, is much higher in China than it is in the U.S.
The Chinese government reports that the maternal mortality is about 430 per 100,000 births.
In some places in Tibet, the mortality rate is one in 20. In nomadic areas, it can be as high as one in five, Varner said. This is a sharp contrast to Utah?s mortality rate of 10 per 100,000 or the U.S. average, which is about double that.
The danger in little or no peri natal care affects infants too. One in every 10 babies born in Tibet doesn?t survive the first month, and one in 10 of those surviving babies will die during its first five years of life.
?Tibet is one of the few societies in the world which really has no skilled birth-attendant traditions, not even midwifery,? Varner said. ?Many women literally deliver by themselves in a barn.?
According to Samen, about 98 percent of women deliver at home without hospital care or skilled professionals.
The NIH money awarded for establishing the Tibet program comes from Bill and Melinda Gates, who gave NIH roughly $20 million to create programs to reduce maternal mortality and increase newborn survival in developing countries.
NIH requested grant applications last April, planning to divide the $20 million among eight to 10 projects. NIH received more than 70 applications.
When Varner and Samen learned they?d received the grant, Samen said her reaction was one of ?pure joy.?
?[It was] kind of an uphill battle,? Varner said.
The grant provides $3,724,109 for the next five years of work in Tibet, providing resources to train village researchers, birth attendants and Tibetan physicians in newborn and maternal health care.
The project also hopes to further establish collaborative work between the U?s department of obstetrics, the People?s Republic of China and the Tibetan Autonomous Region, Samen said.
The People?s Republic of China, which invaded and occupied Tibet in 1950, has provided full cooperation and enthusiasm for the project.
?It?ll make a perfect marriage for optimum health care that [the Tibetans] can continue.? That?s the point behind the system being ?self-sustaining.? If the project is successful, the Tibetans eventually will no longer need Western intervention, Samen said, referring to the saying, ?If you give a man a fish, he eats for a day. Teach a man to fish, he can feed himself for life.?
Cultural obstacles have long barred the path of quality obstetric care in Tibet, where the birth process is considered ?contaminated? because of the blood and placenta involved, Samen said.
?Because they think it?s polluted, they didn?t think it was necessary to be sterile. Why use a clean knife when you?re doing something dirty [like] cutting the umbilical cord?? she said. ?Birthing is also a natural process; historically, it didn?t need intervention.?
In Tibetan birthing situations, only close friends and family are usually present. If strangers are present at the time of delivery, Tibetan tradition holds they could bring bad luck or ghosts to interfere with the newborn?s developing consciousness, Samen said.
Despite the inherent cultural differences, Samen is confident in the program?s capacity to intertwine Tibetan tradition and western medicine.
?I just don?t think [cultural differences] are going to be a problem. The people involved are so?embracing of the Tibetan culture. We just want to?make things safer,? Samen said.
The program is also seeking to develop a reliable system by which mothers can be transported to health-care facilities.
?A lot of places have no transportation. [We?ll] help them utilize what is available,? Samen said.
Health-care providers will begin working and studying in the Tibetan counties of Thulunk and Dhmshung, using the Thktse and Nyimo counties as a control test. If the model works, they will extend it through all of Tibet.
Samen, who will spend at least six months each year for the next five years in Tibet, initially went there in 1997 as a volunteer for Interplast, which repairs cleft palettes and similar problems for people in developing countries.
While doing her volunteer work with Interplast, she talked with women there and learned about the high number of deaths women suffered due to poor perinatal care.
?It is going to make such a difference for the Tibetan women. We?ll be able to really set up an infrastructure and be able to prove that setting up a training module like this will make difference,? said Samen. ?It will serve as a model for all other third-world countries.?