T he u n iq ue j o y s a nd d a n g e r s of t he f i r s t 1 ,0 0 0 d ay s

Welcome to the

World!

MEDAIR | newsNo. 1 | 2019 | medair.org

Uplifting Mothers and Babies

A GIFT OF

$111can provide

acute malnutrition treatment

(5 weeks) for one child

Welcoming New Life“It’s a joyful feeling and a joyful moment,” says midwife Mama Elisa, describing the moment a child is born. She loves her work, knowing she is helping bring new life into the world to join a family.

Your support makes it possible for Medair's midwives in South Sudan to provide women with free prenatal and postnatal care in Abayok, Wonthow, and Aweil. Last year, more than 1,000 babies were delivered at the Abayok delivery center, which offers 24-hour maternity services. If Medair’s midwives weren’t there, women would give birth at home, often without a skilled birth attendant, and the lives of both mother and child would be at risk. Thank you!

What Do You Dream of for Your Daughter?“I want her to go to school and to be educated.” Atap is 20, malnourished, and has a fi ve-month-old daughter, Adhel. She comes to Medair’s clinic in remote Aweil County to receive nutrition treatment. Atap has many dreams for her daughter.

"She must not be like me. I was only able to do a little schooling and now I can only read a little bit. If the situation in this country changed, we could have a good life!”

Atap arrives at the clinic to receive nutrition treatment.

Midwife Adel Samuel listens to a baby’s heartbeat

A mother rests beside her healthy newborn daughter at Medair’s Abayok clinic in Renk, South Sudan.

Overcoming HungerOver six million people are suffering from food scarcity in South Sudan. At Medair clinics we teach mothers about the importance of exclusive breastfeeding—critical for infant survival in the country right now.

Mothers need to be well-nourished to properly breastfeed their children. Your gifts provide nutrition services to pregnant and breastfeeding women and to malnourished children under the age of five.

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Daniel XuDirector, Medair US

Welcome to Medair News 2019! This edition kicks off the new year by focusing on new life. We take a close look at Medair’s work supporting mothers and babies, in particular during the crucial fi rst thousand days of a child’s life. This is the critical time from conception to age two, when the health of the mother and child are most at risk and when help can have the greatest impact.

The joys of new life—whether your own child, a niece or nephew, or a good friend’s baby—are something to which most of us can aff ectionately relate. We often think of those fresh (when we’re lucky!) baby smells, the cuddles and cooing, the awesome tininess and perfection of a newborn. . . all of the joys. Yet there are challenges for parents and caregivers: lack of sleep, fear when something is not right, and nervous visits to the doctor. Now imagine there are no doctors or hospitals nearby. Imagine your beloved baby in a country devastated by confl ict or recovering from recent disaster. Imagine young mothers and their babies forced to fl ee from their homes and live hand-to-mouth in temporary shelters, in need of help, and in need of hope.

Thankfully, child and maternal mortality rates have decreased signifi cantly over recent decades, but they remain highest in fragile and confl ict-aff ected areas. These are precisely the places Medair works. Read about how our teams help ensure safe pregnancies and births for women in crisis-hit countries like South Sudan, Iraq and Afghanistan through comprehensive prenatal, delivery and postnatal care, nutritional assistance, and hygiene and health education.

We hope infant and maternal mortality rates dramatically decrease as we reach more vulnerable communities with quality care this year. Here’s to many more beautiful new lives in 2019!

Welcome to the World

Medair United StatesPO Box 4476 Wheaton, IL 60189-4476united.states@medair.orgmedair.org

W E L C O M E

Cover Photos: © Medair. Credits left to right, top to bottom: Nath Fauveau, Albert Gonzalez, Sarah Robinson, Diana Gorter, Sophie Niven, Diana Gorter.

Program Funders Afghanistan: Global A� airs Canada through the Mennonite Central Committee of Canada, Swiss Solidarity, Common Humanitarian Fund, US Agency for International Development, UN Food and Agriculture Organisation, World Food Program, UN Childrens FundBangladesh: Swiss Solidarity, World Food Program, UN Childrens Fund, Mission Aviation Fellowship, World Relief, Tearfund New Zealand, International Organization for Migration, DRA Iraq: EC Directorate for Humanitarian Aid and Civil Protection, US Agency for International DevelopmentJordan: EU Civil Protection and Humanitarian Aid, European Union’s Madad Fund, German Federal Foreign O� ce, Swiss Agency for Development and Cooperation, Swiss Solidarity, UN O� ce for the Coordination of Humanitarian A� airsLebanon: European Union's Madad Fund, Global A� airs Canada, Lebanon Humanitarian Fund (administered by United Nations for the O� ce of Humanitarian A� airs), Swiss Solidarity, United Nations High Commission for RefugeesSomalia: TEAR Australia with support from DFAT, United States Agency for International Development, Ferster Foundation (CH), World Food Program, UN Childrens FundSouth Sudan: EC Directorate General for Humanitarian Aid and Civil Protection, US Agency for International Development, UK Aid from the UK Government, Swiss Agency for Development and Cooperation, Swiss Solidarity, SlovakAid

3 S O U T H S U D A NUplifting Mothers and Babies

8 W H A T ’ S N E W ?Innovations in Aid

4 1,0 0 0 DAY SThe First 1,000 Days Make All the Difference

9 A F G H A N I S T A NIf We Do Not Go, Who Will?

1 0 W H Y M E D A I R ?

6 J O R D A NPutting People First

7 I R A QBetter than Medication?

1 2 S O M A L I AWelcome to the World!

medair.org | March 2019 | Medair 3

S O U T H S U D A N

Sources: 1. 1,000 Days website. Retrieved from thousanddays.org  2. Christian, P., Mullany, L., Hurley, K., Katz, J., Black, R. (2015) "Nutrition and maternal, neonatal, and child health". Retrieved from https://www.sciencedirect.com/science/article/pii/S0146000515000567  3. UNICEF. (2018). "Levels and Trends in Child Mortality Report 2018". Retrieved from: https://www.unicef.org/publications/index_103264.html  4. WHO, UNICEF, UNFPA, World Bank Group, United Nations Population Division. (2015). "Trends in Maternal Mortality: 1990 to 2015". Retrieved from: https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/  5. Bhutta, Z., Jai, D., Ne� , W., et al. (2013). “Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?” Lancet Diarrhoea and Pneumonia Interventions Study Group, 381 (2013): 1417-1429.

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The First 1,000 Days Make All the Diff erence…

The fi rst thrilling days of life are also when mothers and babies are most vulnerable, particularly during the 1,000 days from conception until a child turns two.

It's Getting Better...Over the past 30 years, child and maternal mortality have rapidly declined around the world. Thanks to the eff orts of the global community—including NGOs like Medair and generous supporters like you—millions of women and children’s lives have been saved!

Child and maternal mortality rates remain highest in fragile and confl ict-aff ected countries, which is exactly why Medair works in high-need places. Think what we can achieve by 2030 if we focus our eff orts and work together!

8.8 million

4.1 million

Fewer than 2 million?

1990

2017

2030

GLOBAL INFANT MORTALITY (Age 1 year or younger)

532,000

303,000

Fewer than 100,000?

1990

2017

2030

GLOBAL MATERNAL MORTALITY

Medair’s Women and Children Fund provides a wide range of health and nutrition services to support the lives of mothers and children during the first 1,000 days:

Care for pregnant and breastfeeding women

Comprehensive prenatal, delivery, postnatal care

VaccinationsFree primary health careSupport for existing clinics

New and mobile clinics

Treatment of common illnesses and diseases

Mental health andpsychosocial support

Infant and young children feeding (IYCF) support

Malnutrition screening and treatment

Community-based teaching and support

groups to prevent illness

Disease outbreak detection and response

Training local health workers

   Regular prenatal care, including: supplements, vaccinations, and malaria prevention

   Identi� cation and referral of high-risk pregnancies

   Screening and treatment for malnutrition    Primary health care for treatment of illnesses during pregnancy

   Education on the importance of delivery attended by a skilled medical practitioner, exclusive breastfeeding, nutrition for mother and baby, vaccinations, etc.

   Access to comprehensive primary health care, including vaccinations and treatment of illnesses

   Access to safe water   Screening for malnutrition and access to treatment, if needed

   Education on infant and young child feeding, health, hygiene, nutrition, healthy child development, etc.

   Access to family planning for healthy birth spacing

   Clean and safe delivery with skilled practitioner, including newborn resuscitation, if needed

   Immediate and regular postnatal care

   Exclusive breastfeeding   Treatment for malnutrition, if needed

T H E F I R S T 1 ,0 0 0 DAY S

6 MONTHSBIRTHPREGNANCY

M A K E A L L T H E D I F F E R E N C E

Day 1 Day 280 Day 462 Day 1,000

2 YEARS

Pregnant women and new mothers need health facilities with skilled staff and essential medicine and equipment. Yet in crisis situations health facilities are often damaged or destroyed.

Support existing health facilities whenever possible. When no other options are available, establish fixed or mobile clinics to bring relief to mothers and children who have nowhere else to turn.

Use a community-based approach to health, hygiene, and nutrition because it has the longest lasting impact for the lowest possible cost. Care Group networks are a great example of this: Mothers educate other mothers on vital topics like exclusive breastfeeding, hygiene, and nutrition.

H O W D O W E R E AC H W O M E N A N D C H I L D R E N I N C R I S I S ?

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830 women die each day from preventable causes related

to pregnancy and childbirth.

1  in  3 child deaths

is linked to malnutrition.

11,181 children under the age of one die

every day, mostly from preventable causes. 62% of these children will die

within their fi rst 28 days of life.

          A lot of what Medair does is targeted at the first 1,000 days because many of the things that put the lives of mothers and newborns at risk can be prevented or responded to within that time frame. People often think that you have to provide in-patient pediatric care in a hospital to save the lives of children, but that just isn’t true.             

— Dr. Lois Fergusson, Medair Health Advisor

          In his fi rst week, everything was going well. But in Khaled's second week, he started to get ill. He threw up his breast milk after every feeding. The doctor told me that Khaled had an intestinal obstruction and needed surgery as soon as possible.

That was the worst day of my life.

The surgery was going to cost 450 JOD ($634). I didn’t know what to do, or how we would be able to pay for the surgery.

I sat in front of the hospital with Khaled and cried. I called my husband and asked him to borrow money from anyone he could, so he did. We were able to pay for the hospital, but we were not able to pay back our debt.

Then some people from Medair came and visited us. We showed them all our bills, and nine days later, they helped us pay our debt back.

This was the fi rst time we’ve been helped. Shukran!

Laila lives on Sinjar Mountain, where she and thousands of Yazidis fl ed for their lives in 2014. Attackers destroyed their homes and communities, leaving people like Laila displaced to this day.

When Laila became pregnant, she visited Medair’s mobile health clinic, which provides high-quality health services for people in the Sinjar area who have nowhere else to go. There she met Hadia, a Medair midwife, and the two formed a bond of trust that strengthened as Laila returned for regular check-ups.

Due to events outside Medair’s control, our clinic had to relocate to a different village while Laila was in her final trimester. “I still wanted to see Hadia and make sure I had my medication,” Laila said.

When she was nine months pregnant, Laila's neighbor drove her to the new clinic location.

When Hadia and Laila saw each other again, their faces broke into wide smiles as they hugged. “Hadia looks after me,” said Laila. “The care I get from Medair is very good.”

“I love being able to provide care for pregnant women,” added Hadia. "I can see they are comfortable with me and happy to see me. Sometimes they come to hug me, and sometimes they call me to talk. Sometimes they say, 'Speaking with you is better than any medication.’ I just love it.”

“It feels like they are celebrating my baby with me,” said Hannah, who received her free baby kit with essential supplies like diapers, diaper cream, a towel, footie pajamas, baby soap, and shampoo. “It is a very nice surprise.”

Putting People First

Elsa Groenveld is a pediatric nurse who works as a Health Project Manager with Medair in Jordan: 

            I think it’s really important to spend time with the people we serve. To pay a hospital bill is an easy thing to do: you have money, you pay for the bill, and that’s it. But our team goes further—we sit with people and listen to what they have gone through, what it feels like to be a refugee. Some of them are

here alone, they don’t have anybody, and they have suff ered through horrible situations. They need somebody just to listen to their story. Lifting the burden of a hospital debt is a huge benefi t, but taking the time to listen to people can be even more important.

medair.org | March 2019 | Medair 7

Better Than Medication?

At 40, Nasra is raising nine children in a tent in Jordan, far from her home in Syria. When her youngest, Khaled, was born last year, her troubles escalated quickly.

Cash for Health Services

Health care in Jordan is very expensive for Syrian refugees. Your gifts provide fi nancial support to refugee families to help cover urgent health care and to support pregnant women before, during, and after delivery.

When Medair fi rst started providing cash for health

services, no one else was doing it. We pioneered a new way of delivering humanitarian aid. The project is eff ective because, in addition to the funds, teams of community mobilizers visit refugee families in their homes to sit with them and deliver vital health messages, including the need for exclusive breastfeeding, nutrition, and vaccinating children.

Our health team had a problem to solve. Very few mothers were returning for postnatal exams after giving birth in Iraq's Laylan 2 camp for displaced people.

"We want mothers and newborns to get postnatal care as soon as possible after the birth,” said Dr. Fergusson, Medair Health Advisor. “That's how you catch serious problems that could threaten their lives.”

The team came up with the creative idea of giving away a free kit of baby supplies as a "welcome to the world" gift for all mothers who came in for a postnatal exam. “The response has been amazing!” said Damaris, Medair Health Project Manager. “The baby kit looks like something small, but it honors the mother and the family for their dedication to giving birth in an unstable situation.”

New Ways to Save Lives

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Hadia (left) and Laila reunite at Medair's new clinic location.

Dr. Zainab (left) gives Hannah her free baby kit.

I R A QJ O R D A N

Nasra holds baby Khaled.

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Elsa (left) values time spent with mothers and babies.

Your work can make a life-saving difference for people in need. Join the journey today at jobs.medair.org

If We Do Not Go, Who Will?

Latifa shrugs off her white nursing jacket, readjusts her hijab and sits down with a smile. For the past four years, she has worked in southern Afghanistan with one of Medair's 15 mobile nutrition teams serving children and pregnant or breastfeeding women suffering from acute malnutrition.

           Medair is the only organization working in these faraway places. If we do not go, who will? It is not the first time I’ve worked in dangerous areas; this is Afghanistan and security is always a problem. If I say I will not go, then who does the responsibility get passed on to? When I see the children I am helping, I know it is the right thing to do.

I tell people there is no difference between you and me. You are human, I am human, and we must help each other. I see malnourished children every day. I think they could be my baby and they don’t have any services, so I must provide the best care. And then, when they are treated and we see them grow like a flower, it is a very good achievement!

People see our actions and the way we treat other people, and they have learned to trust us and the messages we bring. Often they start by bringing one child, then they bring two, and then they start telling other people in their village to come. They market the treatment program for us!

A woman and her baby wait to receive cash assistance to purchase urgently needed food in Afghanistan’s drought-stricken Central Highlands.

A MIRACLE IS HAPPENING TO MY CHILD!

At seven months, Fatima was severely malnourished. Anoosha, her mother, wasn't able to produce enough breast milk to feed her, and the family could not afford formula. “We thought we were going to lose her, but there was nothing we could do,” Anoosha said.

One day, Anoosha heard about Medair’s mobile nutrition clinic and brought her daughter for treatment. Fatima was given Plumpy’Nut, a nutrient-dense supplement, and clinic staff spoke with Anoosha about infant feeding techniques and ways to improve hygiene at home. On their second visit to the clinic, Anoosha arrived with a big smile on her face: “I applied what you recommended and now I have breast milk!”

Over time, Fatima's health improved as she gained weight. “My family is impressed at how quickly she has recovered. We are amazed, it is as though a miracle is happening to my child!" said Anoosha. “I am going to give information about this clinic to the whole village and I will teach everything I learned here to whomever I meet!”

There has long been a major gap in humanitarian treatment for malnourished infants under six months of age. The only treatment option has been in-patient care at a hospital, which requires a lot of resources that are not always available in crisis situations.

In Bangladesh, over 700,000 Rohingya refugees live in crowded camp conditions, and malnutrition is a major health threat for children. Medair’s Astrid Klomp travelled to Bangladesh to set up Medair’s very fi rst Community Management of At-Risk Mothers and Infants (C-MAMI) clinic.

This innovative approach is possible because the London School of Hygiene and Tropical Medicine and a collaborative of NGOs developed a new triage and assessment tool that gives vulnerable mother-infant pairs an out-patient care option in crisis situations. Armed with this tool and her experience as a lactation consultant, Astrid spent months preparing to open the program as an extension to our existing nutrition clinics in a Rohingya refugee camp.

“As I arrived at the nutrition clinic on the fi rst day, women were waiting outside with their babies,” said Astrid. “For the fi rst time ever, we began screening mothers and infants together to assess whether as a pair they had malnutrition or were at risk of becoming malnourished.

"One week after opening our doors, we had enrolled 13 mother-infant pairs for treatment. We are following up with home visits and weekly check-ups at our clinic. Mothers receive individually tailored breastfeeding counseling and we refer them, when needed, to health facilities for medical complications or mental health care.

“Medair puts a great emphasis on innovation,” said Astrid. “By opening the C-MAMI clinic, we addressed a huge gap for Rohingya refugee families. We are also gathering data from the work, which we will share with the wider humanitarian community. I am proud to be a part of this new improvement in nutrition programing!”

MOTHERS AND INFANTS IN BANGLADESH

Our team had a difficult time getting permission for community midwives to work inside Lebanon's informal refugee settlements. When we finally got approval, the community was skeptical: "This isn’t how we do things."

COMMUNITY MIDWIVES IN LEBANON

Astrid (right) set up Medair's first C-MAMI clinic.

Yet we knew some women were not receiving prenatal or postnatal care. We recruited a team of community midwives to work in the settlements. The midwives started seeing many patients each day, while also sharing relevant messages about health and nutrition.

“This kind of programing is common in many countries, but it wasn’t being done in Lebanon,” said Dr. Fergusson, Medair Health Advisor. “That makes it a phenomenal innovation for this country because it has been incredibly effective.”

W H A T ’ S N E W ?

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A F G H A N I S T A N

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Your gifts help send nutrition teams to 37 diff erent locations around southern Afghanistan, providing life-saving emergency services. Since the project began, 62,997 children under the age of fi ve have been screened for acute malnutrition, with 12,608 children admitted for treatment.

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           We have supported Medair for almost a decade. Our contributions towards Medair allow us to follow Christ in loving our neighbors, particularly our neighbors who are experiencing dire circumstances in remote locations. We appreciate Medair’s transparency in its finances and in communicating the impact of its work, both in stories and in concrete numbers. We are so grateful for the opportunity to partner with Medair and look forward to supporting them for many more years.

— Jacob and Morgan FranzBirmingham, Alabama

           If you look at the money spent on the cost of a Care Group network, it is under one dollar spent per person served. The cost is negligible, but the impact is enormous. When you can alter behavior that determines a person’s health, that is a change that lasts beyond the end of a donor grant, beyond even the end of Medair being present in a country.

— Dr. Lois Fergusson Medair Health Advisor

Why I Work(ed) for Medair

Katie Gesto is a California-born and -based Nurse Practitioner with a heart for missions. As someone “open to adventure,” Katie has traveled to twelve countries, including Sudan, where she worked with Medair’s Southern Sudan program as a nurse on the tuberculosis and leprosy, health worker training, and maternal & child health projects. When not busy with work and various projects, Katie enjoys spending time in nature and riding horses at sunset.

How did you become interested in humanitarian aid work? Since I was a child I’ve had a heart for missions. After my Discipleship Training School in Dublin with Youth With A Mission (YWAM) in 1994, I learned about Medair and was impressed with its mission to reach the people living in the Nuba Mountains, Sudan. I thought, "I'll spend six months". . . I gave it a go, joined Medair and went to Southern Sudan in 1996 and stayed until 1998.

Why did you work for Medair? I asked if Medair was open to me since I was Catholic, and I still remember the response, "BECAUSE you are Catholic we want you; there are places/people who are Catholic and by you being on the team, you will build the bridge." And I was doubly impressed with the integrity of the mission!

Tell us about hardest part of your time working with Medair. The SNAKES! I had to deal with a total of eleven snakes while working with Medair—all which involved screaming and lots of drama. And the bugs . . . I'd never been camping before and, shortly after I arrived, a colleague told me (as I constantly swatted the fl ies), "Make friends with them, Katie!" It sounded nuts, but it worked.

What would you say to someone who is considering working for Medair? DO IT! JUMP IN! It's so worth it. You will build lifelong friendships, and will be changed forever by the people you serve.

What did you miss most about home when in the fi eld and vice versa? I don't remember missing anything from home except when my grandma died and I wasn’t able to return for the funeral—that was really hard. And I missed warm showers until we fi gured out how to rig one up.

When I was home, I missed the close team relationships, and the quietness and fewer distractions we had in the fi eld.

What have you been doing since returning from the fi eld? I came home in 1998 and completed a Nurse Practitioner degree before going back to Sudan to set up my own clinic in the Catholic diocese. I did that ‘til 2007, and later spent a year with IRIS Ministries in the Nuba Mountains and YWAM in Mozambique and South Sudan. Upon returning stateside, I led an inner city mission in Ohio from 2011-15 before returning to California where I work as an Integrative Medicine Nurse Practitioner.

Being part of Medair taught me many lessons: working as a team; leadership; the value of training health workers and local people to carry on the mission; and, that I can do hard things (with minimal complaining). People saw our actions and the way we treated others, and they learned to trust us and the messages we brought. Often they started by bringing one child, then they brought two, and then they started telling other people in their village to come. They marketed the treatment program for us!

Katie attends to a patient at a Medair clinic in Aburoc, South Sudan (1997).

Your gift helps save and sustain the lives of women and children who have nowhere else to turn. Join the journey today. Give to the Women and Children Fund at donate.medair.org

medair.org | March 2019 | Medair 1110 Medair | March 2019 | medair.org

W H Y M E D A I R ?

$50 1 year of life-changing Care Group

support for 5 families

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$333 Full nutrition treatment

(5 weeks) with Plumpy’Nut for 3 malnourished children

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$161 Safe delivery in a 24-hr

reproductive health clinic (care for 1 mother and child)

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JOIN THE JOURNEY!

Medair connects people in need with people like you who want to help.

What Our Donors Say What Our Doctors Say

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Welcome to the World!

Just after midnight on November 13, 2018, Halima Ali gave birth to a baby boy at a Medair-supported health facility in Somalia. “Alhamdulahi! My baby boy and I are in good health!” she said.

Halima had good reason to be thrilled. At age 25, she had already lost three children. Two were stillborn and one died after three days. Her first child had survived, but his first year of life was marred with illness. Halima had to stop breastfeeding him because she contracted cholera. “He was malnourished for the first eight months of life,” she said.

Halima has promised to exclusively breastfeed her new baby. “This is my fifth pregnancy,” said Halima, holding her child. “For the last three months I have been coming to this facility. I prefer delivering in the health centers rather than at home because home deliveries are not safe. If you face complications, like if you start bleeding, nothing can be done.”

On November 12th, Halima's labor pains began in the afternoon and she went directly to the health facility. "I have never seen such a kind midwife in my life. Whenever I felt labor pains, she was very supportive. I will never forget the way she supported me.”

Medair began offering 24-hour maternity services in Somalia in 2013. Before then, women in the area who went into labor at night had to give birth at home without the support of skilled birth attendants. “What makes this work interesting is the fact that we are saving the lives of mothers and children,” said Zienab, a Medair midwife. “Over the years we have noticed an increase in the number of women coming to the facility. The greatest thing that a person can do in this world is to save lives and assist vulnerable mothers!”

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Medair 1989-2019: Celebrating 30 Years of Saving Lives Together