Elizabeth Howell: How we can improve maternal healthcare -- before, during and after pregnancy
إليزابيث هاول: كيف يمكننا تحسين العناية الصحية بالأمهات .. قبل وخلال وبعد الحمل.
Elizabeth Howell is working to address maternal mortality in the United States. Full bio
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as a resident physician
of doctors and nurses
من الأطباء والممرضات
to save a woman's life.
إنقاذ حياة امرأة.
a few hours before I arrived.
قبل بضع ساعات من مجيئي.
became unresponsive,
and the patient was lifeless.
وكانت المريضة قد فارقت الحياة.
tried to bring her back to life,
was the father's piercing cry.
صرخة الأب الداوية.
and the heart of everyone on that floor.
the happiest day of his life,
هذا اليوم أسعد أيام حياته،
to be the worst day.
was an isolated incident,
كهذه كانت مجرد حادثة مُفردة،
is actually higher
أعلى من
for women of color.
العرق المختلف أسوء بكثير.
actually increased over the last decade,
في العقد المنصرم،
than any other country in the world.
من أي دولة في العالم.
that this new mother lost her life,
عندما توفيت هذه الأم،
and training in the field,
by how little attention was paid
maternal health care.
not just for myself
was a civil rights attorney
كان محامي في مجال الحقوق المدنية
for what we believe in.
were born in Jamaica,
في جَامَايكا،
the American Dream.
women of color were treated
الفقيرات ذوي لون البشرة المختلف
I felt a responsibility to stand up,
مسؤوليتي للدفاع،
by our healthcare system.
يُهمشون بوساطة نظامنا الصحي.
on improving maternal health care.
على تحسين العلاج الصحي الأُمُومي.
causing seizures and strokes,
جلطات ونوبات،
of maternal mortality in this country.
is only the tip of the iceberg.
صغير لمشكلة أكبر.
suffer a severe complication
إمرأة حالات تعقيد كبيرة
having one of these events.
إمرأة كل سنة لإحدى هذه الحالات.
called severe maternal morbidity,
بالإعتلالات الأمومية الشديدة
and they're life-altering.
وتكون مُغيرة لحياة الأم.
between 1.5 and two percent
that occur every year in this country
تحدث كل عام
having a blood clot, a seizure, a stroke,
يتعرضن لتخثف الدماء أو نوبة أو جلطة
such as kidney failure,
داخلي كلفشل الكلوي،
that's frankly unforgivable
of these deaths and severe complications
الموت هذه و التعقيدات
and standard procedures
وإجراءت نمطية
these bad outcomes from occurring
fancy new technology.
between hospitals.
in labor has really high blood pressure
من ضغط دمٍ مرتفع
antihypertensive medication
blood loss during delivery,
الدم التي فقدته خلال الإنجاب،
and save a woman's life.
الدماء بوقت أقرب وإنقاذ حياتها.
of these catastrophic events tomorrow,
هذه الحالات الكارثية بِدءًا من الغد،
the quality of care
to what is supposed to be the standard,
عمّا هو عليه،
and severe complications way down.
الوفيات والتعقيدات بشكل كبير.
actually adopted these standards,
of Obstetricians and Gynecologists
للأطباء والأمراض النسائية
healthcare organizations,
and community organizations.
standard care practices
معايير ممارسة العلاج
throughout the country.
is a program called
in Maternal Health, the AIM program.
(مراقبة الأمراض المتقدمة)
and severe maternal morbidity rates
وفيات الأمهات ونسبة حالات المرض المعقدة
across the country.
والآمان عبر الدولة.
a number of safety bundles
من الحزم الأمنية
preventable causes of a maternal death.
منعُها في التسبب بوفاية أم.
has the potential to reach
في الولايات المتحدة.
protocols, procedures,
these conditions.
of a hemorrhage bundle.
might need in an emergency:
أو طبيب في حالة طارئة:
to measure blood loss:
collect these sponges and pads
بجمع هذه الإسفنجات ولبادات
assess how much blood has been lost.
بدقة من كمية الدم الذي فُقد.
crises protocols for massive transfusions
أزمات في حالات نقل الدماء الكبيرة
in the use of these types of bundles,
هذه الأنواع من الحزم،
saw a 21 percent reduction
this bundle in the first year.
هذه الحزمة في أول عام.
across the country is spotty or missing.
يبقى متقطعًا أو مفقودًا في باقي البلد.
of evidence-based practices
for women of color in the United States.
المختلفات البشرة في الولايات المتحدة.
اللواتي يُنجبن عندنا
to suffer a pregnancy-related death
بالإنجاب بثلاث إلى أربعة أضعاف
who deliver in this country,
النساء السوداوات لدينا.
in the United States
drive these disparities,
يُعود إلى الاختلافات في الدخل،
as compared to a white woman
مقارنة مع امرأة بيضاء
to suffer a severe pregnancy complication
السوداء تتضاعف من الثلاث إلى الأربعة مرات
that education was our salvation,
perinatal health measures,
الطرق الصحية المستخدمة،
are even more pronounced
more likely to die
مرة لموت امرأة سوداء
than is a white woman.
مقارنة مع امرأة بيضاء.
are probably familiar with
of Dr. Shalon Irving,
who died following childbirth.
بالأمراض توفقيت عقب الإنجاب.
in ProPublica and NPR
وفي محطة الإذاعة الوطنية
of hearing her mother speak.
racial and ethnic disparities in health.
العرقية والعنصرية في مجال الصحة.
this was her first baby,
وكان هذا طفلها الأول،
a complicated pregnancy,
and was discharged from the hospital.
جيدة وأُخْرِجت من المشفى.
from complications of high blood pressure.
تعقيدات ناجمة عن إرتفاع ضغط الدم.
by healthcare professionals
ما بين الأربعة وخمسة مرات
was not recognized.
is just one of many stories
in health and health care
الموجودة في مجال الصحة
that the social determinants of health,
المعوقات الإجتماعية للصحة،
segregated housing,
والتفرقة العرقية في الإسكان،
an additional underlying cause:
على مشكلة أخرى مُضمَرة:
by clinicians in those three weeks,
شالون ضمن تلك الأسابيع الثلاث،
in the setting of childbirth
of racial and ethnic disparities
الاختلافات العرقية والعنصرية
and severe maternal morbidity
التعقيدات المرضية الشديدة
for a variety of reasons,
in a specific set of hospitals,
في نمط معين من المشافي،
outcomes for both black and white women,
لكل من النساء البيضاوات و السوداوات،
في كل الولايات المتحدة،
of all black women
من النساء السوداوات
deliver in those same hospitals.
من النساء البضوات في نفس هذه المشافي.
of having a life-threatening complication
امرأة لتعقيد مهددٍ للحياة
in one hospital than another.
are more likely to deliver
يُرجح لهن أن ينجبن
of the black-white disparity.
social determinants of health
equitable health care in this country,
بنظام صحي مبني على المساواة في بلدنا،
and they will take some time to resolve.
وستحتاج للوقت لتُحل.
we can tackle quality of care.
التركيز على مشكلة الجودة.
across the care continuum
and reliable contraception
منع حمل آمنة وموثوقة
providing preconception care,
العناية خلال مرحلة تَكون الجنين،
and optimize health.
المزمنة وتحسين الصحة.
high-quality prenatal and delivery care
عناية عالية الجودة قبل الإنجاب
postpartum and inter-pregnancy care
تشمل مرحلة الولادة وبعدها
to have a healthy next baby
between life and death,
after having an elevated blood pressure
معاناتها من إرتفاع في ضغط الدم
was her second pregnancy.
وكانت هذه وِلادتها الثانية.
that had happened two years earlier,
in the last few weeks of her pregnancy,
الأسابيع الأخيرة من حملها،
elevated blood pressures,
don't worry, you'll be fine.
ستكونين بخير.
You're a little nervous."
وأنت متوترة قليلًا."
for Maria last time.
لها في المرة السابقة.
the signs and symptoms of preeclampsia
if she was not feeling well,
sent her to the hospital.
ordered urgent lab tests.
إختبارات مخبرية بسرعة.
to multiple different monitors
to her blood pressure,
to prevent a seizure.
so high it put her at risk for a stroke,
لدرجة إمكانية حدوث سكتة،
blood pressure in 15 minutes
according to the latest correct protocol.
المناسب بحسب أحدث إجراء.
as a coordinated team
lowered her blood pressure.
a tragedy became a success story.
ينتهي بمأساة أصبح قصة نجاح.
were controlled,
from the hospital,
the signs and symptoms of preeclampsia,
أعراض وعلامات تسمم الحمل،
her blood pressure checked,
postpartum health and what to expect.
المولود وما يجب توقعه.
with her pediatrician
طبيب الأطفال الخاص بها.
her blood pressure,
as a new mother.
across the care continuum looks like,
يتواجد في كل المناحي،
standard care practices,
معايير العلاج القياسية،
maternal morbidity rates would plummet.
والأمراض التعقيدية الشديدة.
would no longer be an embarrassment.
of unacceptably high rates
من نسب ارتفاع غير مقبولة
complications during delivery
for moms, babies and families,
الأمهات وأطفالهن وعائلاتهم،
our poor performance on maternal mortality
في وقف حالات الوفاة
is within reach.
للأمومة مُمْكِنة.
pregnant women from every community?
الأمُهات الحوامل من كل مجموعة؟
to ensure that when we do,
ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformerElizabeth Howell is working to address maternal mortality in the United States.
Why you should listen
Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.
A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.
Elizabeth Howell | Speaker | TED.com