World Health Organisation

Baroness Chalker of Wallasey Excerpts

Wednesday 2nd July 2014 Lords Chamber

[Baroness Chalker of Wallasey (Con)]

My Lords, I begin by apologising—particularly to my noble friend Lord Ribeiro—for my lateness, which was caused by inattention to the annunciator screen. I also make the declaration that I am president of the Chalker Foundation for Africa, and we assist in the training of basic medical workers in Africa for Africa. That is often assisted, as my noble friend Lady Brinton said, by teaching skills in Africa. That may be done by people from other countries, but increasingly Africans are teaching Africans, which is a very worthwhile advance.

I wish to concentrate on two aspects of the need for surgery across the developing world. I support all the comments that I heard my noble friend Lord Ribeiro make, and thank him for initiating this debate. The two aspects that I am most concerned with are fistula repair—which is essential for maternal health, under millennium development goal 5—and cleft palate and lip surgery.

We all know that fistula is an abnormal channel or passageway in females, usually caused by the lack of prenatal and obstetric care, as well as by poverty, malnutrition, early marriage and childbirth, harmful sexual practices and violence, and a lack of quality and accessible maternal care and healthcare. There are also traditional practices like encouraging women to drink water to aid a baby’s birth. That does not help: it increases the risk of fistula, because a full bladder during childbirth is a bad thing. As was said earlier, obstructed labour and obstetric fistula cause 8% of maternal deaths worldwide, but a much higher percentage in the developing world—and it is clear from the statistics on very hard and prolonged labour that about 80% of the problems result from that cause.

I have mentioned many times in this House the fact that the problems are also caused by poverty: the distance that people must travel and the uncomfortable travelling conditions; the lack of nutritious food and the cost of care; and the lack of access to healthcare, particularly in rural areas, which are most deprived in terms of transport. Above all, there is the lack of trained midwives and doctors. We also know that, as my noble friend said, malnutrition causes stunted growth in mothers, which makes giving birth much more difficult.

About 63% of those on a Nigerian fistula programme needed surgery. About 37% had, fortunately, had access to a catheterisation programme within 75 days of the birth—but that can be implemented only where people have been trained to do it, and in rural areas that is just not going to happen.

There are also cases in which a caesarean operation is critical, when a surgeon can see that there is likely to be a real problem. But how can we possibly take that on board when we are not preventing the problems in the first place? That, too, needs the sort of surgery that my noble friend spoke about. The advantage of a caesarean section, if it can be done, is that it can prevent fistulas recurring in later births. But the cost is somewhere around $300, and the aftercare may be as much as $150. It is vital that that surgery be available, and I commend the work of the Addis fistula hospital, and the surgery carried out by Marion Sims, and by Reg and Catherine Hamlin. That is the largest fistula repair centre in the world. We now also have the Niger Danja centre, operated by the Worldwide Fistula Fund.

I now turn to the need for surgery for cleft lip and palate. In the developed world, although the causes are mainly unknown, a cleft lip is usually detected between the fourth and seventh week of pregnancy, and a cleft palate between the sixth and ninth week. It is highly unlikely that that will be diagnosed in developing countries, and so the surgery needs to be done in the first few months of the life of the child. I have been much impressed by the fundraising done by the Smile Foundation, which, through its donations to hospitals and its support of doctors, is carrying out a large number of operations every year, which can prevent children being disfigured for the rest of their lives.

That is why I wanted to speak in support of my noble friend in this debate. I believe that it would be right for DfID to support the role of surgery as a public health measure. There are some occasions when it actually happens, but it happens by default, not because we have made it happen by our policy decision. I also believe that, as my noble friend said, we need to find a way to review the development goals in respect of surgery post-2015. I am pleased to have been able to contribute a little in this debate. These areas of work are absolutely vital, alongside treatment for club foot and the many other surgical procedures that can make all the difference between a mere existence for somebody, and a real life.