Great interviews in this story:
BBC NEWS | Special Reports | 'They thought I was cursed': "Obstetric fistula, a hole linking the vagina with the bladder or rectum, occurs when women - often in their early teens - are in labour for days. Campaigners at a global conference on maternal health in London this week, entitled Women Deliver, have emphasised that a simple and cheap operation can cure it [...]"
Saturday, October 20, 2007
Thursday, October 18, 2007
Feedback for Female Literacy, Women & Development
• Excellent – esp. in view of last minute solo performance. Dr. Kessler was her usual involved, thoughtful, informative self!
• Good participation by the class. Good discussion.
• Great with involving the class in discussion. Good time management. Extra props for being comfortable leading the class alone!
• Excellent presentation of a very broad set of topics; good class interaction and good contributions by class and professors.
• I enjoyed the presentation! She presented it very well. Slides need to have larger words though! Well-done.
• Given that the other presenter didn’t come, I think the presentation was good. It was nice having such extensive class conversation.
• Could have organized the slides a bit better.
• Very good presentation considering that you had to do it alone! I like the informal discussion set-up more than the lecture format in previous classes.
• Nice presentation. Good job getting group discussion going – putting good questions to the group. Nice job presenting on your own! Only suggestion – fewer words per PowerPoint slide.
• Great job! I enjoyed the balance of class involvement.
• “Empowered presentation” Excellent – raised may complex questions and good discussion – very good use of examples – very good relationship to other classes.
• Good participation by the class. Good discussion.
• Great with involving the class in discussion. Good time management. Extra props for being comfortable leading the class alone!
• Excellent presentation of a very broad set of topics; good class interaction and good contributions by class and professors.
• I enjoyed the presentation! She presented it very well. Slides need to have larger words though! Well-done.
• Given that the other presenter didn’t come, I think the presentation was good. It was nice having such extensive class conversation.
• Could have organized the slides a bit better.
• Very good presentation considering that you had to do it alone! I like the informal discussion set-up more than the lecture format in previous classes.
• Nice presentation. Good job getting group discussion going – putting good questions to the group. Nice job presenting on your own! Only suggestion – fewer words per PowerPoint slide.
• Great job! I enjoyed the balance of class involvement.
• “Empowered presentation” Excellent – raised may complex questions and good discussion – very good use of examples – very good relationship to other classes.
Women Deliver
A result of the Women Deliver conference to be held in London this week (http://www.womendeliver.org/) the Lancet is running a special issue dedicated to Maternal Health. It has some interesting articles etc... worth checking out (if you havent already)
Continuum of care for maternal, newborn, and child health: from slogan to service delivery
ScienceDirect - The Lancet : Continuum of care for maternal, newborn, and child health: from slogan to service delivery: "Summary:
The continuum of care has become a rallying call to reduce the yearly toll of half a million maternal deaths, 4 million neonatal deaths, and 6 million child deaths. The continuum for maternal, newborn, and child health usually refers to continuity of individual care. Continuity of care is necessary throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal period, and childhood) and also between places of caregiving (including households and communities, outpatient and outreach services, and clinical-care settings). We define a population-level or public-health framework based on integrated service delivery throughout the lifecycle, and propose eight packages to promote health for mothers, babies, and children. These packages can be used to deliver more than 190 separate interventions, which would be difficult to scale up one by one. The packages encompass three which are delivered through clinical care (reproductive health, obstetric care, and care of sick newborn babies and children); four through outpatient and outreach services (reproductive health, antenatal care, postnatal care and child health services); and one through integrated family and community care throughout the lifecycle. Mothers and babies are at high risk in the first days after birth, and the lack of a defined postnatal care package is an important gap, which also contributes to discontinuity between maternal and child health programmes. Similarly, because the family and community package tends not to be regarded as part of the health system, few countries have made systematic efforts to scale it up or integrate it with other levels of care. Building the continuum of care for maternal, newborn, and child health with these packages will need effectiveness trials in various settings; policy support for integration; investment to strengthen health systems; and results-based operational management, especially at district level [...]"
The continuum of care has become a rallying call to reduce the yearly toll of half a million maternal deaths, 4 million neonatal deaths, and 6 million child deaths. The continuum for maternal, newborn, and child health usually refers to continuity of individual care. Continuity of care is necessary throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal period, and childhood) and also between places of caregiving (including households and communities, outpatient and outreach services, and clinical-care settings). We define a population-level or public-health framework based on integrated service delivery throughout the lifecycle, and propose eight packages to promote health for mothers, babies, and children. These packages can be used to deliver more than 190 separate interventions, which would be difficult to scale up one by one. The packages encompass three which are delivered through clinical care (reproductive health, obstetric care, and care of sick newborn babies and children); four through outpatient and outreach services (reproductive health, antenatal care, postnatal care and child health services); and one through integrated family and community care throughout the lifecycle. Mothers and babies are at high risk in the first days after birth, and the lack of a defined postnatal care package is an important gap, which also contributes to discontinuity between maternal and child health programmes. Similarly, because the family and community package tends not to be regarded as part of the health system, few countries have made systematic efforts to scale it up or integrate it with other levels of care. Building the continuum of care for maternal, newborn, and child health with these packages will need effectiveness trials in various settings; policy support for integration; investment to strengthen health systems; and results-based operational management, especially at district level [...]"
Let Men Do Their Bit
The Pioneer > Columnists - Let Men Do Their Bit: "For 30 years, vasectomy has been a political taboo, and the entire burden of family planning has been on women. But modern vasectomy techniques are a success in the West. India needs to try them"
NY Times article on new malaria vaccine
New Malaria Vaccine Is Shown to Work in Infants Under 1 Year Old, a Study Finds
The world’s most promising malaria vaccine has been shown to work in infants less than a year old, the most vulnerable group, according to a study being published today.
The study, being published in The Lancet, a British medical journal, was small, comprising only 214 babies in Mozambique, and intended to show only that the vaccine was safe at such young ages. But it also indicated that the risk of catching malaria was reduced by 65 percent after the full course of three shots.
“We’re now a step closer to the realization of a vaccine that can protect African infants,” said Dr. Pedro Alonso, the University of Barcelona professor who leads clinical trials of the GlaxoSmithKline vaccine.
If it passes much larger clinical trials set to start in seven countries next year, and if it is accepted by national regulatory agencies, it could be ready for distribution by 2012, said Dr. W. Ripley Ballou, Glaxo’s vice president for international clinical trials.
In 2004, Dr. Alonso showed for the first time that the vaccine could protect children against infection or death. That study of 2,022 children aged 1 to 4 showed protection from infection about 45 percent of the time.
Such a relatively low level of protection would not be acceptable in a vaccine in the West, but malaria is a leading killer of African children, so even imperfect coverage is a major public health victory.
The vaccine, presently known as RTS,S and tentatively brand-named Mosquirix, is made by fusing a bit of outer protein of the deadly falciparum strain of the malaria parasite with a bit of hepatitis B virus and a chemical booster — the latter two added to provoke a stronger immune reaction.
At least nine malaria vaccine candidates are in development, but Mosquirix is the furthest along. Glaxo has been refining it for 20 years and expects to have spent up to $600 million on it by the time it comes to market. About $100 million has been paid by the Bill and Melinda Gates Foundation through the PATH Malaria Vaccine Initiative.
No decision has been made about the price to be offered to poor countries and international health agencies. But “if a child will benefit, price will not stand in the way,” said Dr. Christian Loucq, director of the vaccine initiative.
The vaccine is given in three injected doses. That is an obstacle in poor countries, which have difficulties immunizing even against polio — done with oral drops requiring no medical skill.
But even one dose has some protective effect, the Lancet study found.
It is unknown how long protection lasts. But because the youngest children are the most vulnerable, Dr. Alonso said, vaccination buys them time to build up natural immunity, which is acquired by surviving multiple mosquito bites.
Tuesday, October 16, 2007
NY Times article on Widow-Cleansing
AIDS Now Compels Africa to Challenge Widows' 'Cleansing'
Dr. Brown talked about the practice of widow cleansing in class and I equated it to 'wife-inheritance'; however after doing some reading it seems like widow cleansing and wife-inheritance are separate practices, though both involve having sexual relations with the dead husband's relatives.
Dr. Brown talked about the practice of widow cleansing in class and I equated it to 'wife-inheritance'; however after doing some reading it seems like widow cleansing and wife-inheritance are separate practices, though both involve having sexual relations with the dead husband's relatives.
Friday, October 12, 2007
Uneven progress in maternal health worldwide but some countries setting good example
Uneven progress in maternal health worldwide but some countries setting good example: "The authors say: The continued scarcity of progress in maternal health over the past two decades in several parts of the world is disturbing, The little progress is especially of concern for south Asia and sub-Saharan Africa, which have consistently presented the worst maternal health in the world. They add that the connection between maternal mortality, poverty, and status of women is no coincidence, and as such countries which have improved their investment in education and employment for women have also improved their investment in maternal care. They say: Thus, the examples of countries like Thailand and Malaysia suggest that MDG5 is achievable with appropriate financial and political commitment."
Event
I thought the class may find this interesting.....
The Heilbrunn Department of Population and Family Health Fall 2007
Seminar Series
Presents:
Nassim Assefi, MD
Physician and Author
Discussing:
"Maternal Mortality in Afghanistan"
Description:
Afghanistan has one of the highest rates of maternal mortality ever
measured: on average one in six-to-nine women die of pregnancy
related causes. This talk will focus on:
- How we measure mortality in a country with no vital statistics,
insecurity, and destroyed infrastructure;
- The causes of maternal mortality in Afghanistan;
- Associated socioeconomic risks; and
- Solutions.
The speaker is a women's health specialist who spent 2004 and 2005
in Afghanistan constructing programs to decrease maternal and child
mortality.
October 15, 2007
12:30 PM - 1:45 PM
60 Haven Avenue, B2 Conference Room
Drinks will be provided. Please bring your own lunch.
The Heilbrunn Department of Population and Family Health Fall 2007
Seminar Series
Presents:
Nassim Assefi, MD
Physician and Author
Discussing:
"Maternal Mortality in Afghanistan"
Description:
Afghanistan has one of the highest rates of maternal mortality ever
measured: on average one in six-to-nine women die of pregnancy
related causes. This talk will focus on:
- How we measure mortality in a country with no vital statistics,
insecurity, and destroyed infrastructure;
- The causes of maternal mortality in Afghanistan;
- Associated socioeconomic risks; and
- Solutions.
The speaker is a women's health specialist who spent 2004 and 2005
in Afghanistan constructing programs to decrease maternal and child
mortality.
October 15, 2007
12:30 PM - 1:45 PM
60 Haven Avenue, B2 Conference Room
Drinks will be provided. Please bring your own lunch.
Action needed on maternal deathsAction needed on maternal deaths
Experts have condemned the "appalling" lack of progress made in reducing the number of women worldwide dying during pregnancy and childbirth.
Analysis in The Lancet medical journal shows half a million women die every year - little change from 20 years ago.
And 20 million unsafe abortions - a major factor in maternal deaths and illness - are done annually.
Read the article here: http://news.bbc.co.uk/2/hi/health/7039647.stm
Wednesday, October 10, 2007
Vaccine-linked polio hits Nigeria
Nigeria is fighting a rare outbreak of a vaccine-derived form of polio, says the UN's World Health Organization.
It says 69 children in the north have caught the paralysing disease from others who had already been immunised.
The WHO says such rare outbreaks have occurred where immunisation campaigns did not reach enough of the population.
In 2003 Islamic leaders brought a temporary halt to the vaccine campaign in the north saying it was a Western conspiracy to sterilise Muslim women.
The WHO says this rare outbreak of vaccine-derived polio demonstrates the need for more vaccination, not less.
But the concern is that the cause of the outbreak could be misinterpreted by people here and reinforce their scepticism of the whole vaccine campaign.
Scare stories
The WHO says the outbreak occurred when some of those who had received the oral polio vaccine excreted a mutated form of the virus which infected those who were not immunised who had not completed the vaccination programme.
It says the outbreak is ongoing but slowing because of the continuing vaccination campaign, and the last reported case was in August.
The WHO says the outbreak occurred because not enough people were receiving the polio vaccine in the first place.
Northern Nigeria still has a low coverage rate for the vaccination campaign, a legacy of a temporary halt to the programme in 2003.
Those scare stories built on existing traditional scepticism of Western medicine.
But more recently the vaccination programme has made some progress.
Polio cases as a whole are down on last year, in part because of a new programme of polio victims accompanying immunisation teams to demonstrate to parents the risks of not having their children vaccinated.
http://news.bbc.co.uk/2/hi/africa/7037462.stm
It says 69 children in the north have caught the paralysing disease from others who had already been immunised.
The WHO says such rare outbreaks have occurred where immunisation campaigns did not reach enough of the population.
In 2003 Islamic leaders brought a temporary halt to the vaccine campaign in the north saying it was a Western conspiracy to sterilise Muslim women.
The WHO says this rare outbreak of vaccine-derived polio demonstrates the need for more vaccination, not less.
But the concern is that the cause of the outbreak could be misinterpreted by people here and reinforce their scepticism of the whole vaccine campaign.
Scare stories
The WHO says the outbreak occurred when some of those who had received the oral polio vaccine excreted a mutated form of the virus which infected those who were not immunised who had not completed the vaccination programme.
It says the outbreak is ongoing but slowing because of the continuing vaccination campaign, and the last reported case was in August.
The WHO says the outbreak occurred because not enough people were receiving the polio vaccine in the first place.
Northern Nigeria still has a low coverage rate for the vaccination campaign, a legacy of a temporary halt to the programme in 2003.
Those scare stories built on existing traditional scepticism of Western medicine.
But more recently the vaccination programme has made some progress.
Polio cases as a whole are down on last year, in part because of a new programme of polio victims accompanying immunisation teams to demonstrate to parents the risks of not having their children vaccinated.
http://news.bbc.co.uk/2/hi/africa/7037462.stm
Tuesday, October 9, 2007
Can We Acheive Millenium Development Goal 4?
A very interesting, but controversial article.
http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607614780.pdf
http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607614780.pdf
Who's Making Money From Microcredit? . NOW | PBS
Dr. Brown asked me to post this episode of NOW. If you go to this page you can either listen to or watch the full story:
Who's Making Money From Microcredit? . NOW | PBS: "Microcredit has been hailed as a breakthrough in combating global poverty by giving small loans to impoverished people in the hopes of transforming their lives. But one very profitable Mexican lending program is now under intense scrutiny. NOW takes a close look at Compartamos bank, which started as a nonprofit organization lending small sums of money to poor indigenous Mexican women to help them start their own businesses. Today, it's a for-profit bank with more than 600,000 Mexican clients, often paying very high interest rates. Interviewing both grateful loan recipients and vocal critics-like Nobel prize-winning microcredit pioneer Muhammad Yunus-NOW investigates if Compartamos is truly serving the poor, or exploiting them."
Who's Making Money From Microcredit? . NOW | PBS: "Microcredit has been hailed as a breakthrough in combating global poverty by giving small loans to impoverished people in the hopes of transforming their lives. But one very profitable Mexican lending program is now under intense scrutiny. NOW takes a close look at Compartamos bank, which started as a nonprofit organization lending small sums of money to poor indigenous Mexican women to help them start their own businesses. Today, it's a for-profit bank with more than 600,000 Mexican clients, often paying very high interest rates. Interviewing both grateful loan recipients and vocal critics-like Nobel prize-winning microcredit pioneer Muhammad Yunus-NOW investigates if Compartamos is truly serving the poor, or exploiting them."
Feedback for Maternal Health, Family Planning, and Safe Birth
• Excellent presentation covering a very broad set of issues. Over dependency on PowerPoint at times. Good class discussion with issues and questions, well handled. Jeopardy game was great fun!
• We did great – What else am I supposed to say?
• Good balance of student participation, professor commentary and presenter facilitation.
• Very well planned and thought-out. Good responses with own knowledge to questions and inquiries.
• Awesome presentation!
• Well thought out and presented. C-section discussion strayed towards domestic (developed countries concerns) but overall excellent. Game was fund and involved the class.
• Great presentation.
• Presenter #1: Excellent delivery – defined key concepts, engaged class and I think did a great job of connecting comments made to her slides (throughout). A bit graph heavy, but that said appropriately picked graphs.
• Presenter #2: Good delivery – very us focused when discussing requirements for clinical workers – would have been good to see comparison. Would have liked to hear a bit about the men’s role in family planning. Would have liked to also learn more about ways to incorporate post-natal and pre-natal care options (clinical & not).
• Presenter #1: Excellent overall delivery.
• Presenter #2: Great presentation, excellent delivery; however, too much medical info.
• Great speakers! Funny game too.
• We did great – What else am I supposed to say?
• Good balance of student participation, professor commentary and presenter facilitation.
• Very well planned and thought-out. Good responses with own knowledge to questions and inquiries.
• Awesome presentation!
• Well thought out and presented. C-section discussion strayed towards domestic (developed countries concerns) but overall excellent. Game was fund and involved the class.
• Great presentation.
• Presenter #1: Excellent delivery – defined key concepts, engaged class and I think did a great job of connecting comments made to her slides (throughout). A bit graph heavy, but that said appropriately picked graphs.
• Presenter #2: Good delivery – very us focused when discussing requirements for clinical workers – would have been good to see comparison. Would have liked to hear a bit about the men’s role in family planning. Would have liked to also learn more about ways to incorporate post-natal and pre-natal care options (clinical & not).
• Presenter #1: Excellent overall delivery.
• Presenter #2: Great presentation, excellent delivery; however, too much medical info.
• Great speakers! Funny game too.
Monday, October 8, 2007
Make Every Mother and Child Count
The full WHO report is full of useful background info and stats on maternal and child health. It's a free download here:
WHO | The World Health Report 2005 - Make Every Mother and Child Count
One useful grouping of stats to keep in mind for tomorrow's class is the top leading causes globally of maternal mortality: "severe bleeding/hemorrhage (25%), infections (13%), eclampsia (12%), obstructed labour (8%), complications of abortion (13%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it."
WHO | The World Health Report 2005 - Make Every Mother and Child Count
One useful grouping of stats to keep in mind for tomorrow's class is the top leading causes globally of maternal mortality: "severe bleeding/hemorrhage (25%), infections (13%), eclampsia (12%), obstructed labour (8%), complications of abortion (13%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it."
Distribution of Nets Splits Malaria Fighters
MAENDELEO, Kenya — Veronica Njeri, 45, says she has “never healed” since losing two of her six children to malaria 20 years ago, and she still feels vulnerable. While her oldest are adults or teenagers, and have presumably built up immunity to the disease, she worries about her youngest, Anthony, who is 4.
Would be interested to know what folks thought of social marketing vs. free nets...
Would be interested to know what folks thought of social marketing vs. free nets...
The Quiet Scandal of 10 Million Deaths
HEALTH: The Quiet Scandal of 10 Million Deaths : "...95 percent of all maternal and newborn deaths worldwide occur in 75 countries in Africa, Asia and Latin America [...]"
Home Births vs. Hospital Births
Here is some data for home births versus hospital births in the US and Australia - the data cover the entire country. The article is complaining about the lack of such data for Britain...
BMJ 1999;319:1008 ( 9 October )
BMJ 1999;319:1008 ( 9 October )
Letters
Data on babies' safety during hospital births are being ignored
EDITOR
Zander and Chamberlain state that "no evidence exists to support the claim that a hospital is the safest place for women to have normal births."1 They cite the report Where to be Born, published in 1994 by the National Epidemiology Unit.
In 1997 the Confidential Enquiry into Stillbirths and Deaths in Infancy published a survey of 19 348 deaths in Britain occurring during 1994 and 1995, including 873 deaths due to intrapartum events.2 At that time 98.16% of all deliveries occurred in hospital. The chance of a normal baby dying during labour at term was 1 in 1561. The Royal Colleges of Obstetricians and Gynaecologists and of Midwives regard this risk as unacceptably high and are working to reduce it still further.
Data on home deliveries in the United States were published in 1995,3 and data for home deliveries in Australia were published in 1998.4 In the American study (a retrospective review of 11 788 planned home births) the intrapartum and neonatal mortality among women intending to have a home birth at the onset of labour was 1 in 500. In a prospective American study of 1404 home births in 1994-5 the figure was 1 in 400, and the authors regarded this outcome as good.5 In the Australian study, which included 7002 planned home births during 1985-90, the risk of intrapartum fetal death was 1 in 371.
It is disappointing that no similar recent audit of the safety of home delivery in Britain is available. The figures from the United States and Australia are, however, strikingly similar; in the absence of current data from the United Kingdom they indicate that, for a normal birth, hospital delivery is now three to four times safer than home delivery for the baby.
Women should be able to choose between home and hospital delivery. They also have a right to accurate and up to date information.
James Drife
University of Leeds, Leeds LS2 9NS j.o.drife@leeds.ac.uk
| 1. | Zander L, Chamberlain G. ABC of labour care: Place of birth. BMJ 1999; 318: 721-723 |
| 2. | Confidential Enquiry into Stillbirths and Deaths in Infancy. Fourth annual report: concentrating on intrapartum deaths 1994-95. London: Maternal and Child Health Research Consortium, 1997. |
| 3. | Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study. J Nurse Midwifery 1995; 40: 483-492[Medline]. |
| 4. | Bastian H, Keirse MJNC, Lancaster PL. Perinatal deaths associated with planned home births in Australia: population based study. BMJ 1998; 317: 384-388 |
| 5. | Murphy PA, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol 1998; 92: 461-470[Abstract]. |
World Leaders Address Lagging Maternal and Child Health Goals
I assumed this was on everyone's radar since CGI was here in NY, but I found a few of you that hadn't heard! Funding is one of this field's biggest problems, so last weeks' events are very big news:
World Leaders Address Lagging Maternal and Child Health Goals - Feminist Wire Daily Newsbriefs: U.S. and Global News Coverage: "Norwegian Prime Minister Jens Stoltenberg recently unveiled a new World Health Organization (WHO)-led collaboration of governments and organizations designed to improve maternal and child health worldwide. Deliver Now for Women Children aims to spur progress on UN%u2019s Millennium Development Goals 4 and 5, which call for a two-thirds reduction in child deaths and a three-quarters reduction in maternal mortality by 2015. Deliver Now was founded in reaction to slow progress on these goals, as well as those of the World Bank's Safe Motherhood Initiative of 1987. More than ten million women and children still die each year due to preventable causes%u2014more than the resulting deaths of AIDS and TB combined, according to the WHO."
World Leaders Address Lagging Maternal and Child Health Goals - Feminist Wire Daily Newsbriefs: U.S. and Global News Coverage: "Norwegian Prime Minister Jens Stoltenberg recently unveiled a new World Health Organization (WHO)-led collaboration of governments and organizations designed to improve maternal and child health worldwide. Deliver Now for Women Children aims to spur progress on UN%u2019s Millennium Development Goals 4 and 5, which call for a two-thirds reduction in child deaths and a three-quarters reduction in maternal mortality by 2015. Deliver Now was founded in reaction to slow progress on these goals, as well as those of the World Bank's Safe Motherhood Initiative of 1987. More than ten million women and children still die each year due to preventable causes%u2014more than the resulting deaths of AIDS and TB combined, according to the WHO."
Kano Records Low Maternal Mortality Rate in Two Years (Page 1 of 1)
great case study of successful program:
allAfrica.com: Nigeria: Kano Records Low Maternal Mortality Rate in Two Years (Page 1 of 1): "...Dr Sani Jibrin also said within the communities in the state Emergency Loan Funds Scheme had been introduced to assist pregnant women while taken to hospital for delivery of other pregnancy related problems. He said under the programme the communities are motivated to deposit funds so that when ever there is case of pregnant woman needing money for emergency treatment such funds would be used for the purpose [...]"
allAfrica.com: Nigeria: Kano Records Low Maternal Mortality Rate in Two Years (Page 1 of 1): "...Dr Sani Jibrin also said within the communities in the state Emergency Loan Funds Scheme had been introduced to assist pregnant women while taken to hospital for delivery of other pregnancy related problems. He said under the programme the communities are motivated to deposit funds so that when ever there is case of pregnant woman needing money for emergency treatment such funds would be used for the purpose [...]"
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