Surprises in a new study of maternal deaths

Scratch that last post.

It appears that societies around the world are working to improve the survival rate for mothers in birth after all -- and that their efforts are working.

Even as I was tapping out Monday's post, The Lancet was publishing a new study online that shows that maternal mortality has actually been dropping dramatically in many countries.

"The overall message, for the first time in a generation, is one of persistent and welcome progress," Lancet editor-in-chief Richard Horton wrote in a commentary that accompanied the study.Pregnant Graffiti

The number of maternal deaths per year worldwide has been tallied at 500,000+ in 2005, based on United Nations survey published in 2007. However, the new study, which was conducted by researchers at the University of Washington and the University of Queensland in Brisbane, Australia, and funded by the Bill and Melinda Gates Foundation, shows deaths to have fallen from 526,300 in 1980 to 342 ,900 in 2008. That's good news.

Not only that, but taking out deaths from HIV/AIDS, which has emerged as a major factor in global maternal mortality, the figure would have been 281,500 in 2008.

More than half of maternal deaths are concentrated in six countries-- India, Nigeria, Pakistan, Ethiopia, the Democratic Republic of Congo, and Afghanistan, which has the highest maternal mortality rate in the world, this survey states. (Italy has the lowest rate, according to this report.)

The United States, Canada, Denmark and Norway are among the prosperous nations that are experiencing increases in maternal mortality (less than 1 percent for the U.S.). More comprehensive reporting could account for the increase, the researchers noted.

Not everyone is excited by the new survey's findings, Horton wrote in his commentary.

"Even before the paper ... was submitted to us, we were invited to “delay” or “hold” publication," by some members of  what Horton calls the "global health community" who fret that the relatively rosy picture the new study paints will lead to a flagging interest in working to make birth safer around the world.

Horton dismisses those worries, but expresses concern that the figures in the new report are so different from those in the 2007 UN survey.

"A process needs to be put in place urgently to discuss these figures, their implications, and the actions, global and in country, that should follow," he writes.

So it appears that MDG5, the Millennium Development Goal that has to do with improving birth safety for moms is, after all, alive and well.

"This new evidence suggests there is a much greater reason for optimism than has been generally perceived, and that substantial decreases in the (maternal mortality rate) are possible over a fairly short time," the report states.

Image by Petteri Sulonen

No Canadian heroes? Here’s one.

Canada's full-bore pursuit of gold at the Olympics the country is hosting in Vancouver, B.C., has attracted much comment, mostly about how out-of-character overt ambition supposedly is for Canadians.

Writing in the New York Times last week, Charles McGrath quoted the Canadian writer George Woodcock on the subject: “Canadians do not like heroes, and so they do not have them. They do not even have great men in the accepted sense of the word.”

Here's one for the books, then -- William Osler, the so-called "father of modern medicine," a great man if ever there was one, born in Bond Head, Ont., in 1849.

William Osler

Dr. William Osler

Osler received his medical degree from McGill University in Montreal in 1872 but, critically, then went abroad to study in London, Berlin and Vienna before returning to join the McGill faculty. By 1883, he was one of two Canadian fellows of the British Royal College of Physicians. The next year, he accepted a post as professor of clinical medicine at the University of Pennsylvania in Philadelphia.

It was as a founding faculty member of Johns Hopkins School of Medicine in Baltimore, where he went in 1888, that Osler had the opportunity to put the innovations he had seen in Europe to work.

Osler insisted that the patient could teach medical students nearly everything they needed to know -- that the study of medicine was properly conducted at the bedside -- and that hands-on laboratory research must also be part of medical training.  He also introduced the German model of post-graduate training, a one-year internship followed by several years of full-time residency.

These innovations began a profound change in American medical education, which up to this point had been largely a matter of learning from lectures.

Osler was able to implement his ideas because he was an excellent doctor. In 1905 he moved to England to take up a prestigious post as professor of medicine at the University of Oxford. His book, The Principles and Practice of Medicine, was a major work in medicine for nearly half a century.

Osler died in England in 1919, of the Spanish flu.

Canadians might say that Osler's absconding to the United States and England rules him out as a national hero, but it says something when a boy from Bond Head can hit the heights of world medicine.

First baby of 2010?

Who was the first baby to greet the world in 2010? Little Gulrose Abdullah, born to Zahra and Mehboob Abdullah right at midnight on Friday at the MetroHealth Medical Center in Cleveland, Ohio, is certainly a contender for the U.S. title.

In Toronto, Canada, Eva Violante was born to mom Christiane Hachey and dad Alexis Violante at 12:00:01 a.m. at St. Michael's Hospital -- that's one second after midnight.

And let's face it, many more babies were born in the early minutes of the first day of the new decade, perhaps somewhere where no one was paying much attention to the time. Welcome to the world, little ones! May it always be kind to you.