Like Two 747’s Crashing Every Day: the worst airline accident in history


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What are the three leading causes of death in the United States? Most people quickly identify heart disease and cancer, which in fact respectively account for about 750,000 and 550,000 deaths annually. The third leading cause of death is usually a guess: Alzheimer’s? Diabetes? Obesity? Traffic accidents? Airline crashes? With at least 440,000 deaths a year almost no one guesses the correct answer: medical errors. The practice of medicine, including diagnosis, treatment and surgeries, is the cause of deaths that approximate the number of fatalities of two full capacity 747’s crashing every day. If on one day there was such a loss of life due to airline crashes there would be massive investigations and media comparable to the March 1977 crash in Tenerife considered the worst airline accident in history: the search for black boxes, analysis of the weather, integrity of the equipment, the qualifications and behaviors of the pilots, and the airline’s quality assurance procedures. If two 747’s crashed on two consecutive days, there would be implications of terrorism, accusations of conspiracy. If two 747’s crashed on three consecutive days, the impact and reaction are unfathomable, but one could only guess that mass panic would set in nationally and internationally. Yet 1,200 Americans, twice the number of the casualties at Tenerife, die day after day, 365 days a year with the resulting death toll being that of the annual wiping out of the populations of major US cities: Atlanta one year, Sacramento the next, Miami the next, year after year. These tragic losses are not just numbers. They are our grandparents, mothers, fathers, siblings, our children and our friends. They are the victims of wrong site surgeries, the aorta sliced instead of the renal artery, over-medication due to a misplaced decimal point, a misdiagnosis of a hypokalemia leading to cardiac failure, a hospital acquired infection from inadequate cleanliness of supplies, equipment and hands, or a sponge left inside the surgical site.

How this is happening without public knowledge, panic and outrage is a simple question of multiple determinants. There are explanations when required, which is seldom. Hospitals are complex environments. To Err is Human, as the 1999 Institute of Medicine report citing the underestimate of 98,000 deaths a year was titled. In 2013, John T. James, PhD, a NASA toxicologist who’s own son was the patient who died from misdiagnosed hypokalemia, published his robust study based on findings using four different research tools, in the Journal of Patient Safety. His study results more than quadrupled the IOM number to 440,000 deaths a year. To err may be human, but in truth, all too often decisions for care are dictated by financial initiatives to benefit the hospital rather than the best care of a patient; hospital error reporting that is voluntary ; hospital quality assurance that is actually cover up ”risk management”; the autonomy of doctors who are never evaluated, tested or required to upgrade training and cannot admit that they have made a mistake. Atul Gawande, MD, in his book Complications stated, “There is a saying about surgeons, meant as a reproof: sometimes wrong; never in doubt.” Government, regulatory agencies and patient advocacy organizations have pressed for changes in reporting, hospital policies and procedures, and checklists ironically based on those used in the airline industry, but the number of deaths has not decreased, the needle on the scale of improvement hasn’t budged.

The Veterans Administration hospital scandal in June 2014, exposed the deaths of at least 40 veterans who died due to medical errors including delays in their diagnosis and treatment. But months and even years before the exposure, when lives could have been saved, employees in the hospitals had been raising concerns and reporting dangerous practices, inadequate care, and fraud. These whistleblowers were intimidated, threatened, harassed, transferred, put on administrative leave without pay and fired. Not unusual treatment for whistleblowers as recent high profile cases have been broadcast in the news.   The VA is now hustling to correct care deficiencies and provide remedies to the whistleblowers, but not enough to restore lives and repair permanent damage.

The Veterans hospital deaths as tragic as they are, are the tip of the iceberg of the 1,200 a day medical error deaths. Patients are dying in private hospitals, public hospitals, community hospitals and super-sized academic medical centers. Within these facilities whistleblowers have attempted to report and correct wrongdoing and system flaws that lead to the daily death count as well as almost 4 million errors a year that leave patients disabled, damaged and compromised. Like the whistleblowers in the VA hospitals these health care employees, nurses, lab staff, managers, and some doctors themselves, have lost their jobs, their health insurance, their retirement benefits, their professions, and ability to find other employment. Dr. Marty Makary states in his book, Unaccountable, which documents his experiences of patients suffering from medical errors, “if I was labeled as a whistleblower, my career would be shot.” Telling the truth in health care is risky business.

There is a long history of retaliation against those who have spoken out against the medical status quo that puts patients at risk. In 2008, Dr. James was presented with the Semmelweis Award, named for Dr. Ignatz Semmelweis, considered now the father of patient safety.   The observational case control study conducted by Semmelweis in the mid 1800’s indicated that women and babies in hospital maternity wards were dying because doctors were not washing their hands after examining cadavers and then delivering babies. With a maternal and infant mortality rate of over 18% in hospitals where doctors delivered babies in comparison to a 2% mortality rate for deliveries at home with midwives or even poor women whose babies were delivered in tenements, Semmelweis wrote a treatise, The Etiology, Concept and Prophylaxis of Childbed Fever, on the imperative for doctors to wash their hands between patients. The medical community was outraged that he would state that doctors’ lack of clean hands was killing women and babies. Semmelweis was declared mentally unfit, and confined to an institution where 14 days after his admission he was mysteriously found dead, presumably beaten to death by guards. His work was not recognized as valid until two decades later after Pasteur and Lister presented evidence of germ theory. In 1965, to mark the 100th anniversary of his death, Semmelweis was honored with his image on an Austrian postage stamp. Doctors in the United States today are still less than 50% compliant in hand washing.

Despite current legislation in healthcare law, shooting the messenger is still the general practice in medicine. Retaliation is often couched in legal defense of protecting patient confidentiality, and hospitals misuse HIPAA as a way to attack whistleblowers. But more effective to deter whistleblowing, hospitals maintain cultures of don’t talk or else.   Special Counsel Carolyn Lerner of the Office of Special Counsel, a whistleblower protection agency, has stated that 125 VA hospital employees have filed retaliation cases. Three of the whistleblowers she has represented are Dr. Katherine Mitchell, Paula Pedene and Damian Reese. Mitchell reported understaffing and inadequate training of staff in the emergency department at the Phoenix hospital and was removed from her position as the co-director of the emergency care. Pedene, formerly the hospital chief spokesperson, was re-assigned to a job in a windowless basement office after she reported financial mismanagement in Phoenix. Reese complained about the data manipulation that covered up delays in care; he was given a negative performance review. Lerner stated in a PBS report, (September 29, 2014,) “Dr. Mitchell, Ms. Pedene and Mr. Reese followed their consciences and reported wrongdoing, and their efforts have improved care and accountability at the VA,”

The recent British National Health Service report on whistleblowing, Freedom to Speak Up? (February 2015,) by Sir Robert Francis QC, documented the retaliation that was mounted against staff in hospitals for reporting systemic problems, incompetence and medical errors that impacted patient safety. The report includes recommendations for a shift in culture to not only protect but value whistleblowers, and zero tolerance for retaliation.

Like whistleblowers in other fields, most healthcare whistleblowers say they would do it again even knowing what the consequences would be. Why would they engage in such high-risk behavior? A 2011 National Business Ethics report states that most whistleblowers are very committed to their workplace and they have been successful performers. An article by Vicki D. Lachman, Whistleblowers: Trouble Makers or Virtuous Nurses? (MEDSURG Nursing, April 2008,) bases whistleblowing in healthcare as driven by the ethics of the duty to tell the truth, the standards of professionalism (nursing Code of Ethics,) virtue, and that inexplicable courage that causes an individual to jump into harm’s way to safe the life of another. She also states that, “They (whistleblowers) are above average performers committed to the organization with a strong belief in moral principles.” Lachman however notes the potential retaliation:  “The list of negative consequences to whistleblowers seems endless: broken promises to fix the problem, disillusionment, isolation, humiliation, formation of an “anti-you” group, loss of job, questioning of the whistleblower’s mental health, vindictive tactics to make the individual’s work more difficult and/or insignificant, assassination of character, formal reprimand, and difficult court proceedings.”

The victimization of patients and the victimization of people on the inside of healthcare trying to save lives cannot be ignored. These tragedies are deserving of a hard look at where the bodies are buried, who is causing these deaths, and what needs to be done to protect whistleblowers so that when we access medical care we are not inadvertently boarding a plane destined to crash and burn.

 

 

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On the Road in Uganda


on the road

I arrived at Entebbe Airport on Saturday night June 7, 2014 after about 26 hours of flights and stopovers. Was picked up by David and Joseph and immediately taken to a party at the home of Dr. Sarah Nkonge to celebrate the work we had been doing together, the Rotary of Makindye and me. Thus began my journey in Africa. The following is from a few days later when we traveled to the Lwengo District.

 

I didn’t sleep much last night and got through some of the toss and turn hours by reviewing my suitcase contents…why did I pack Catwalk Sleek hair spray?  Maybe for my visit to the King of Tororo…but more about that another time.  We left Kampala for a 3 hour drive out to Lwengo; of course it takes well over an hour just to get out of Kampala, the city of no public transportation or beltways so all roads lead to massive “jams.”  Our driver Joseph is amazing (the best, except maybe for Mahindra who drove me from Kathmandu to Hetauda for 8 hours over hairpin turns up very steep, narrow mountain roads with no guard rails.)  Sarah, David and a reporter from a local TV station and I all loaded in the four wheel drive Ford.  Sometimes beautiful landscape of rolling green mountains and then the villages of rusted tin sheeting and concrete blocks, the ubiquitous charcoal smell and piles of mostly plastic garbage, rotting foods and road kill.  A strange occasional battered phone booth, odd because almost everyone seems to have a flip phone and there are ads for “mobile money” everywhere. Always the sad lost discarded flip flops.  Traffic of cars, mini buses, bicycles, motorcycles piled with people, bananas, mountains of plastic containers; on one, a man and a women; on another, a man, a woman, a baby and a goat; on one several boxes of condoms that spilled out in a trail along the side of the road precipitating, among those in our car, several hilarious adaptations of and responses to, “why did the chicken cross the road?” which during all drives was prominent as many chickens actually crossed the road right in front of our wheels. Women walking with massive bundles of sticks, huge plastic jugs of water or gasoline, and bowls of cassavas on their heads, and babies scarfed onto their backs, the little baby feet peeking out on both sides of his or her mother’s breasts. Children playing in the gravel alongside the roadway and a few elderly people crawling.  All this takes place at dizzying speeds in a dangerous dance of near misses, and every moment that someone isn’t killed is a miracle, proving that Uganda is actually overflowing with miracles.

 

We arrived at a Girls School, a collection of large low buildings and toward the back of the “campus” was a large barn with a dirt floor and about 50 women and their children waiting for our presentation and distribution of the birthing kits.  The women are beautiful and the children adorable.  They were all obviously dressed in their best colorful clothes, some very worn but still bright and bespangled with sequins, decorated with embroidery.  The clinic director introduced me in Luganda, one of the several languages in Uganda that vary from district to district. She said I was bringing the kits from Australia, short cut for I am from the United States and I got the kits donated from the Birthing Kit Foundation in Australia.  I told them I was so pleased and honored to be there, that I had been all around the world but they were the most beautiful women and then I went through the contents of the kits.  The little piece of soap, a pair of latex gloves, black plastic sheet for the birth area, 4 cord ties, and the one clean wrapped razor blade  “Please don’t use this for anything but cutting the umbilical cord,” I pleaded, knowing that some research had indicated that the blades were sometimes used prior to the birth for any number of household tasks like cleaning fish.

womens group 2

I marveled that the babies and children actually looked quite well and healthy and were very playful and engaging.  When I commented to a few of the mothers later they told me that it is the healthiest babies that survive, the ones that are “right sized;” the others that are too small die at birth or shortly thereafter, the ones that are too big die with their mothers since they often can’t be delivered at a hospital that can perform C sections.  Other children that aren’t really strong die in the first year of malnutrition, malaria, dehydration or accidents…so it is the healthiest, most resilient that are with them.  Tragic Darwinism.

 

The women so were appreciative of the kits, but said they needed more than one pair of gloves, because they sometimes tear, and more pads for the bleeding after birth.  I said I would try.  Someone delivered bottles of soda. Fantas all around.

 

Then we went over to the Girls’ School to distribute sanitary pads and soap during the student lunch break, which I was told would be chips and soda.  There were about 50 girls in red uniforms.  This was outside on a hill and the breezy atmosphere was an opportunity to have a good time with them.  The girls all spoke English, so I could speak with them without a translator. I talked to them about staying in school, staying strong and being sisters.  Having babies when they were really ready and in a good relationship.  I found myself saying the same things I had said to kids in the Bronx:  Your body is your own. If someone hurts or touches you, tell an adult you trust.  I had an almost imperceptible heart pang thinking of my work at the Child Advocacy Center in the past.  They sang a song for me and we all danced and I taught them to kick like the Rockettes. Then we gave out the sanitary pads and soap which was like giving out party favors on someone’s birthday.

 girls kicking

The women had talked to me about how bad a local clinic was and that was why they would rather have their babies at home, so before we drove back to Kampala I asked to visit the clinic.  We drove to the clinic and on first sight I could see why.  It was literally a hole in the wall shack attached to other shacks.  The crumbling concrete steps alone spoke volumes about how difficult it would be to give birth there.  The clinic director showed me around and said she had been trying to get more support from the Ugandan government so she could improve the facility. She also has to charge 15,000 Ugandan Shillings for a delivery, the equivalent of about $6 US, and some women just can’t afford to pay. There was a small room of deteriorating concrete for the exams, the labor room with a damaged table and stirrups, and a room with 4 little beds side by side for recovery.  The women can stay for 6 hours after the birth to recover before they have to leave. I asked if (since there was a long drive back to Kampala) I could use the bathroom and was shown a rocky path to a shack beyond a stubbly field.  Let’s just say it was much more rocky than path.  The toilet inside the shack was a squat hole. Now I have used many squat toilets and they can be quite nice, tiled, clean and you get a good stretch workout in your quads while peeing. This one was covered with excrement and urine and dirt and full of insects.  Mosquitoes and flies and any number of unidentified winged things buzzed around my head. A caterpillar that could have morphed into an exotic butterfly or something that would rip my leg off humped past my foot as I stepped onto the two bricks on either side of the hole.  I did a quick flashback of all the meds I had taken: Hep A, Hep B, Polio booster, Yellow Fever, Typhoid capsules with live bacteria, Cipro in my bag and antibacterial wipes at the ready.  The women who gave birth there and the staff who delivered the babies did not quite have these advantages.

 

The four hour ride back to Kampala was quiet.  I perused a local newspaper:  Article “Uganda Fails to Achieve the Millennium Goals and Reduce Maternal Mortality.”  17 women and 106 babies die every day during childbirth.  That is a maternal mortality rate of 370 per 100,000. Most “economically developed” countries have a rate of between 5 and 10 per 100,000. The United States has a rate of 26 per 100,000 which has been increasing.

 

As the Ugandan landscape sped by my window, I needed a little “normal” and slipped in my earbuds, turned on my Ipod and slid the power bar.  It was on Shuffle, which i call Random.  Paul Simon’s most tender, sad, wrenching lyrics:  In a phone booth in some local bar and grill, rehearsing what I’ll say my coin returns.  How the heart approaches what it yearns.

 

 

 baby

MPH Cupid

Heart and Blade

My name is Karel and I am an Internet dating failure.   Yes, I have met a few nice men on OK Cupid for the requisite coffees, drinks or dinners and “nice meeting you, good-bye.”  There of course have been the fascinating respondents who live in “New York, New York” but only write back at 2:00 AM and have no idea where the George Washington Bridge is.  The men who live in suburban apartments who had very lavish life styles and were very financially successful, but “lost everything in the divorce.”  (I don’t know which planet these men are from since, having been divorced myself, I happen to know first hand that wives definitely do not “get everything” as these men claim was their judicial fate.)   There was the very attractive somewhat familiar looking man who was wearing an Eddie Bauer shirt with the logo prominently displayed in every photo; nicely scanned from the catalogue.

My profile remains on OK C and I check in from time to time approximately once a month because though not an enthusiast, I am sort of academically interested in the process, maybe even a little bit hopeful.  And recently to refresh my memory, I checked in few times before writing this blog.

Of course I have heard the various urban legends of a cousin of a friend of someone’s sister-in-law who found true love, got married and had five children and lived happily ever after with a man she met on eHarmony. Or the neighbor of a woman in yoga class who is engaged to a man she met on Match.  There was even an article in the New York Times “Weddings” about two people who met on OK Cupid.  Read it, Believe it!  If it is in the New York Times it must be true. http://www.nytimes.com/2013/06/09/fashion/weddings/malini-sur-arpan-jhaveri-weddings.html

Alas, I have not even come close to this experience, although I suppose it would help if I updated my profile from time to time (I went to St Petersburg, Russia two years ago.)  Maybe I need to add something really compelling like my broken ankle last winter with a photo of my scar.  Kind of makes me think of Ben Stiller’s Walter Mitty trying to get a wink on eHarmony, although I actually have been to the Himalayas and Iceland.

In spite of this failure to find true love on my computer, two years ago I met David and since then we have exchanged I am sure hundreds of emails, photos, ideas, feelings, thoughts, plans.  We have written sometimes several times in one day.  About year ago when I wanted to set up a meeting, he disappeared for over a month and I thought it was over.  I was pretty angry.  And there have been times when he has been angry and critical and seemingly very demanding.  But still we continue and in fact I just received an email from him this morning.  “Good morning,” he wrote.  “Thank you for your humble reply.  We have much work to do.”  David lives in Uganda and I live in New York.

David and I didn’t meet on a dating site.  We met on the Global Health Forum of LinkedIn when I posted my MPH thesis in 2011.  Over the two years we have been working together to establish Holistic Care for Mothers, a project of the Makindye Rotary and soon to be an independent not for profit registered with the Ugandan government.  I am more than academically interested; I am hopeful that we can make some positive change for women and girls.

This is not my only Internet relationship.   Early in my thesis process at New York Medical College, probably around 2008, I found the Birthing Kit Foundation and Dr. Joy O’Hazy.  Joy and I have written to each other over the years about the distribution and efficacy of birthing kits,, but also about her travel, her singing and dancing; her wisdom and experiences.  There are often long gaps in our correspondence, but I always feel a connection to her and every day I look at the beautiful appointment book she sent me last year with her photographs and poems.  It was Joy who was my contact to the Foundation that yielded the donation of birthing kits to Holistic Care for Mothers that David has distributed in rural Uganda. http://www.birthingkitfoundation.org.au/

I met Kirtiman Tumbahangphe in Nepal, the director of  MIRA, Mother and Infant Research Activities http://www.mira.org.np/mira/ and after many emails and exchange of phone numbers, Kirti and I did meet in Hetauda where I visited several women’s projects out in the beautiful lush mountains of southern Nepal.  We talked about maternal mortality in Nepal and the very successful MIRA project using women’s empowerment, peer health education and community leadership.  Kirti and I even had dinner together at the Hotel Avocado and Orchid Resort where I stayed.  We said goodbye in the parking lot and he rode off on his motorcycle.

Diana Nabiruma is a health writer for the Ugandan newspaper The Observer.  I was researching health in Uganda when I found one her articles about violence against women and girls.  Thinking she might be interested in Holistic Care for Mothers I sent an email to the address in her by-line; an arrow shot into the cyber dark for sure, but she wrote back.  She was interested and interesting and funny and smart.  And, she interviewed David and Dr. Sarah Nkonge.  And….she did indeed write an article about maternal mortality in Uganda, about the Holistic Care for Mothers. The%20Observer%20-%20No%20more%20%E2%80%98labour%20suites%E2%80%99%20in%20banana%20plantation.html

And then there is Mike Cook who is one of the most amazing Internet contacts I have ever had.  I was thinking about how razor blades in birthing kits might be replaced with natural, local sustainable materials.  I thought about repurposing broken glass bottles; could blades be made from glass? So I searched “GLASS BLADES.”  And there was Mike Cook.  His website states, “Hi I am Mike Cook and I was born to be a flintknapper.”  Mike lives in Portland, Michigan and has a company called Art of Ishi www.artofishi.com He in fact makes blades from glass and stone, but not the kind of glass I was thinking of.  He uses natural volcanic glass, obsidian, flint, chert.  Take a look at his website and you will be totally astonished.  You can watch his videos about how he makes these blades.  For those of you who are not faint of heart, watch him shave with a blade he strikes off of a hunk of  obsidian http://www.youtube.com/watch?v=QWSTE6WLB0Y  All I can say is “DON”T TRY THIS AT HOME.”  So I wrote to Mike.  Generous, thoughtful and expressing interest in birthing kits, Mike sent me a few of his blades.   I have them on my desk (although I have not used them on my legs,) and there is the possibility of natural blades to cut umbilical cords safely, cleanly, sustainably.  Thanks, Mike.

These are some of my Internet relationships.  I don’t think any of them will lead to a date for New Years Eve, dinner on Valentines Day, not even the cup of coffee or drink.  I have not found my one true love, but I have found passion.

As I, a la Joseph Campbell follow my (Internet) bliss, I think of a web perhaps not so different from our www in Walt Whitman’s “A Noiseless Patient Spider”:

A noiseless patient spider,

I mark’d where on a little promontory it stood isolated,

Mark’d how to explore the vacant vast surrounding,

It launch’d forth filament, filament, filament, out of itself,

Ever unreeling them, ever tirelessly speeding them.

And you O my soul where you stand,

Surrounded, detached, in measureless oceans of space,

Ceaselessly musing, venturing, throwing, seeking the spheres to connect them,

Till the bridge you will need be form’d, till the ductile anchor hold,

Till the gossamer thread you fling catch somewhere, O my soul.

50 Shades of Designer Bags

My children could tell you just how nerdy I am since they have experienced my crazy obsession with their school projects (“Oh, no, not foam core again, Mommy!”) and my over-preparedness for classes I have taken (at least half the text book read and HIGHLIGHTED before the semester started).  My  friends, fortunately for me, welcomed me back after I had spent months in the cocoon of writing my MPH thesis. My reading material tends to be the daily New York Times, The New Yorker and the American Journal of Public Health. (I actually have a once a week date night with The New Yorker; I have found it some mornings stuck to my face.)  I have been known (or hopefully unknown) to steal copies of Journal of the American Medical Association from my doctor’s office.  The most recent book I read is Classified Woman by Sibel Edmunds.  Although I do have to confess to having read……no actually I am going to take the 5th on the 50 Shades books.   When I fly I do totally indulge in something like Vogue or Glamour, but that is in response to my suppressed fear of flying and is for purely medicinal purposes.  So when 4 times a year The New York Times has a fashion supplement I feel completely justified in wallowing through those pages of luscious, colorful, crazy expensive designer clothes and accessories because after all, it’s The New York Times.  The Fall 2012 issue arrived last weekend.  I continue to wallow.

It seems that darling little designer clutch bags are very much in style for the Fall.  There’s a page of them in yummy colors and another section called Grab Bags:  Know when to hold ‘em and when to fold ‘em, with no apparent apologies to Kenny Rogers.   Somehow I did not fashion forecast well when I bought that big red Prada knock off in Hong Kong for $15.  These little bags are of course very pricey.  They are designed by Celine ($2,100,) Phillip Lim ($625,) Victoria Beckham ($650,) Marc Jacobs ($550,) and Coach (only $148,) among others.  My guess is they are just big enough for a credit card, a lipstick, a cell phone and a couple of condoms…maybe a box of Tic Tacs.   Just the basics for survival at some soignée soirée.

Of course I know what little bags can carry and the impact on health outcomes they can have because I spent about two years of my life studying the contents of little bags about 6” by 4”.  These darling little bags, not so pricey, not so pretty, carry things like a razor blade, string, a piece of soap, a sheet of black plastic: not really contents for a fun evening out, but pretty useful if you are going to have a baby at home in a rural region of Nepal or India or Uganda or Ghana or Rwanda or Afghanistan. At least 350,000 women a year die in childbirth internationally.   One of the leading causes of death is infection which can result from unsanitary delivery conditions.  So these little bags of useful items, called birthing kits, have been developed by several organizations including Zonta International, the World Health Organization and UNICEF. More than a million of these kits are distributed annually, especially in developing countries where maternal deaths are the highest in the world.

The kits have been designed by medical providers and organizations.   They are standardized and able to be mass produced, inexpensive and extremely compact.  Dr. Joy O’Hazy who works with Doctors Without Borders and Zonta told me that, “While quantifiable data is difficult to acquire what we have received is a large amount of anecdotal evidence from our partners about reduced infections and deaths in places like Kenya and Afghanistan.”  (Joy by the way is an amazing person and I have been fortunate to be able to stay in touch with her since completing my thesis.  “Hello, Joy!!!!”)

So here’s the thing I just can’t stop wondering about.  We know that birthing kits save lives, but to save lives they not only have to be available, they have to be used.  If rather than having a pretty little clutch bag, the only thing you could carry your evening supplies for a party in was a plain plastic baggie would want to do that or would you just leave your stuff home? Do you want someone to pick out that plastic bag for you or would you want to shop for something you like or you feel expresses who you are?  Do these seem like silly questions in relation to clean birthing supplies?  I don’t think so.

Social design is based on the understanding that for products to be effective they must include user end participation in the design, i.e., if you are going to design something ask the people who are going to use it to be involved with the design of that product.  How do I know this? I have a brilliant neighbor named Dan Formosa, Ph.D., who is one of the founders of Smart Design, and he told me about social design and he helped me with my thesis.  So I know this is true.  For birthing kits to be truly effective in saving the lives of women and babies, the design of the kits has to include the women who will use them.  They need to be social designer bags.  Not mass produced but in at least 50 shades.   The bags that women use in Uganda need to be Ugandan.  The bags that women use in Afghanistan need to be Afghan.  The bags that women use in Nepal need to be Nepali.  Not only is this social design, it is beautiful design.  All of these countries have wonderful traditional designs, colorful crafts, amazing creativity.

So here’s the challenge for designers.  Design beautiful, inexpensive, small birthing kits that can be distributed and used and can save lives.  You can include women from their countries, you can use some of the proceeds from your $600 pouches, you can engage the design community in saving women’s lives.  You can make preventing maternal mortality sexy and cool.  That’s what designers do.

Here are some direct challenges:

Hey, Prabal Gurung, do it for Nepalese women.

Mimi Plange, for women in Ghana.

Georgio Armani, Louis Vuitton, Channel, Estee Lauder, Gucci, Calvin Klein, Hermes, Prada, Marc Jacobs, Tod’s, Salvatore Ferragamo,  Celine, MaxMara, Michael Kors, Balenciaga, Missioni, Chloe………pick a country and get to know the women there.  And design with them.

And Kenneth Cole, how about some really cool compelling billboards.  You are so very clever.

Perhaps Tyler Brule, the editor of the hip international travel, design, political magazine Monocle would take on the coordination.

So I guess it is just my inherent nerdiness that got me from those darling little clutch bags to preventing maternal deaths.  Or maybe it was the women I met in Nepal and India and Brazil and my friend David in Uganda and Joy O’Hazy , who constantly inspire me and make me think, actually believe, that “it only seems impossible until it is done.”

PS…Hey, Prada, so sorry about buying the knock off.  I promise never to do it again.