Blessed Are the Peacemakers

Canadians have a golden opportunity to be peacemakers for those who suffer the most--women and their children, says Dr. Robert Walley of MaterCare International.

By Barbara McAdorey

The tireless efforts of Dr. Robert Walley of Newfoundland and his organization, MaterCare International, to bring basic obstetrical care to mothers in the developing world ( see "The Hidden Tragedy of Motherhood," Nov/Dec., 2002). We explored the "solution" of the international community to the problem of maternal mortality and morbidity-abortion and contraception-and compared this to MaterCare's response-basic obstetrical care we take for granted in our own country. In this issue, we continue our profile of Dr. Walley and MaterCare by looking at the response of the Canadian International Development Agency to Dr. Walley's request for funding for a Birth Trauma Centre in Ghana, West Africa.)

On June 26 and 27, 2002, the nations of the developed world met in Kananaskis, a scenic mountain resort in the foothills of the Rockies. At this G8 summit, the leaders would focus on three things: strengthening global economic growth; fighting terrorism; and building a new partnership for Africa's development. It was this third item that was Prime Minister Jean Chrétien's baby, and since he was hosting the summit, he would ensure it would not get usurped by discussions on terrorism.

One aspect of African development the leaders would address was health care for mothers. In section 6.2 of the document "G8 Africa Action Plan" dated June 27, 2002, the countries of the developed world offered to support "African countries in helping to promote more effective, and cost-effective health interventions to the most vulnerable sectors of society-including reducing maternal and infant mortality and morbidity."

On that same day, June 27, the Canadian International Development Agency (CIDA), in a letter signed by the Regional Director, Africa and Middle East branch of the bilateral branch of CIDA, informed MaterCare International (MCI) that CIDA would not support MCI's proposed Birth Trauma Centre in Ghana, West Africa. The reason given in the one-paragraph letter was that "the sustainability of this project and MaterCare's unproven financial and managerial capacity remain serious concerns for CIDA."

In an earlier meeting between CIDA and Dr. Walley on April 30, CIDA was asked to identify its concerns and what action would be necessary for MaterCare to take in order to address these concerns. "The director either could not or would not answer," says Dr. Walley, "and has not done so in the letter closing the file."

And so ended MaterCare's four year struggle with CIDA to get funding to aid in the treatment and rehabilitation of women in Ghana suffering the devastating effects of obstetric fistulae-a condition caused during obstructed labour by the pounding of the baby's head against the woman's bladder and/or rectum, leaving the woman incontinent, foul-smelling, and possibly ostracized from society. The problem is virtually non-existent in the developed world because of good obstetrical care, but it is a huge problem in the developing countries where an estimated two million women, mostly in Africa, are suffering the consequences of this horrible condition.

In an interview with LifeCanada News on April 28, 2002, Dr. Walley talked about his roller-coaster relationship with CIDA over the past four years.

MaterCare proposes a prevention and treatment program in Ghana

CIDA had funded MCI in 1997 for a project in Nigeria. After some environmentalists were hanged by the Nigerian government, it became too dangerous to continue working there, so CIDA asked Dr. Walley if he would be interested in setting up a similar project in Ghana. Dr. Walley put together a proposal which dealt with prevention and treatment. The project manager at CIDA thought the project was too big and would likely be rejected and suggested that the treatment portion of the proposal be removed. Once the prevention program was in place, they could try for the treatment program at a later date. Dr. Walley agreed. CIDA funded the prevention program 50% with MaterCare funding the rest. It was called the West African Maternal Health Project and the purpose was to provide essential obstetrical services in order to prevent maternal deaths and obstetric fistulae.

CIDA verbally agrees to fund a 60-bed fistulae hospital

Once that prevention program was up and running, Dr. Walley met with the president of CIDA at the time, Huguette Labelle, and the Minister for International Cooperation, Diane Marleau, in November, 1998 to discuss plans for a 60-bed fistulae hospital in Ghana, later to be called the Birth Trauma Centre. They liked the idea and the Minister said, "Let's do it."

So MCI worked on a proposal, and then in May, 1999, CIDA wanted to do a site visit to Ghana. At the end of the visit, CIDA concluded MCI had strong project. MCI was asked to have the completed proposal to the Minister within a month so she could announce it at the United Nations. Dr. Walley complied.

Atmosphere at CIDA changes

And nothing happened. "The whole atmosphere at CIDA changed," says Dr. Walley. "They were antagonistic. They were argumentative about everything. I was taken aback, after telling us it was a strong project."

What had changed was that in July, 1999, Diane Marleau was let go as Minister for International Cooperation and Maria Minna became the new Minister. "And it was clear to us then that the CIDA bureaucrats didn't like the idea," says Dr. Walley. But they didn't say no and they didn't say yes to MCI. Instead, they announced they had serious concerns with the project and further detailed work by MCI was required. Dr. Walley and his team had already written a proposal and had done a gender equity analysis, and they were asked to do it all over again. They did budgets, environmental assessments, building plan evaluations, and plans for funding. This went on until December of 1999.

CIDA selects MaterCare for the fistulae project

"Then the new Minister Maria Minna wrote in December, 1999, congratulating us on being selected to do the project. So we were delighted," says Dr. Walley. There were still a few financial and managerial details to be worked out, but Dr. Walley and MCI thought they were on their way. They sent letters to Ghana announcing the decision, and now they just waited.

Then in April, 2000, CIDA went to St. John's, Newfoundland to do a risk assessment of the project all over again. After the risk assessment, Dr. Walley was told, "You will hear from us within a month." In July, MCI finally heard back from CIDA. "There's a 70% risk and we're not prepared to fund the project at this time," Dr. Walley was told. He was dumbfounded. He tried to set up another meeting with CIDA and couldn't get one until December, 2000.

CIDA assigns new conditions for funding

"The atmosphere at that meeting was quite antagonistic," says Dr. Walley. "There was not even one ounce of cooperation in seeing this through, even though it was important to Canada and important to women."

But CIDA did not reject the proposal yet. Instead, CIDA sent MCI a letter stating that MCI had to have a half million dollars in the bank and had to appoint business managers and project managers. "And I think these were designed, you know, as the coup de gras- they would kill it," says Dr. Walley.

During the next few months, Dr. Walley and his team worked on proposals. They got the guarantee from an Australian foundation; the Government of Ireland agreed to $150,000, provided Canada agree; they got the Government of Ghana to agree to help with consumables and salaries; and England agreed to give $50,000 to the project.

MCI meets all CIDA's requirements; CIDA brings up new issues

Dr. Walley had met all of CIDA's demands, but when they met again, CIDA started bringing up new issues. CIDA said that a gender equity analysis had not been done. It had been done. When CIDA asked where it was, Dr. Walley pointed out that it was in the appendix of the proposal. "They said, 'Why isn't it in the proposal?' I said, "Because it would get too thick.' We gave them a binder like this ," Dr. Walley says during the interview, pulling out a binder three inches thick.

Dr. Walley continues with more examples. " 'You didn't say how long it was going to take to teach a resident how to do this.' I said, 'We did, about four months.' And, 'You haven't got the approval of the Government of Ghana.' I said, 'We have got the approval. How many do you want, we've got three!' And, 'Have you been back to the Government of Ghana?' I said, 'No, not since you've been spinning this out for two years. Why should they change their mind?' So this is what went on. We met again last October 10, 2001. And since then we have had not one word. They haven't replied to anything. They keep saying it is still being assessed."

Minister for International Cooperation offers new hope, then does nothing

The Honourable Susan Whelan, current Minister for International Cooperation, met with Dr. Walley on April 29, 2002, the day after the interview with LifeCanada News . She told him that the proposed Birth Trauma Centre Project had not been handled well in the past, said Dr. Walley, and that she would be prepared to override the bureaucratic decision providing four criteria were met: updated letters of support were required from the Ghanaian government and the Ghanaian Conference of Bishops; letters of support from Canadian taxpayers; and a letter confirming MaterCare's contractor would not make any profit from the project.

Despite meeting all these provisions, MCI's request for funding was finally rejected by CIDA.

In a letter to Friends of MaterCare, after CIDA's rejection letter of June 27, Dr. Walley writes, "It is an international disgrace that hundreds of thousands of women should suffer the indignity of incontinence when treatment is possible and at low cost. By the very lack of action, Canada has become part of the international 'conspiracy of silence' in which the world simply ignores the suffering and deaths of millions of women."

Canada's golden opportunity to be a peacemaker

Dr. Walley talks about Canada's "golden opportunity" to do something good for the most vulnerable people-mothers and babies. "You know, I always think that Canada so desperately wants to be important. But it doesn't know how to. It kind of tags along with the Americans....But we have the opportunity of being key peacekeepers and, perhaps more importantly, peacemakers. We don't want to kill anybody. We just want to keep the peace. And we're good at it. Canadians founded the whole concept of peacekeeping for which Lester Pearson won the Nobel Peace Prize. We're saying, we can also be in peacemaking in terms of the people who are suffering. Who is suffering? Mothers! Mothers more than anybody else. They endure the guns and the bombs and all the rest of the violence. On top of that, they have to suffer disease which everybody else gets. And in addition to that they suffer the problems related to childbirth."

Dr. Walley and MCI continue their work to care for mothers and their babies. They are working on plans for a smaller birth trauma centre. They will look for other sources of funding and have received a small grant from a Canadian foundation. And they will look to their supporters to express their opinions about CIDA's decision to their MPs, to the Prime Minister, to the Minister for International Cooperation, the Honourable Susan Whelan, and to the president of CIDA, Len Good.

On a final note of optimism, Dr. Walley says, "MCI remains committed to its work on behalf of African women and has found a new door that God has opened now that the CIDA door has been closed."- BM

For more information on MaterCare International, visit www.matercare.org