MITCHELL BESSER

South Africa,

Mitch Besser has developed a groundbreaking program to support programs that prevent mother-to-child transmission of HIV by encouraging mothers living with HIV to become peer educators and provide support to similarly affected pregnant women and new mothers.

This profile below was prepared when Mitchell Besser was elected to the Ashoka Fellowship in 2008.

INTRODUCTION

Mitch Besser has developed a groundbreaking program to support programs that prevent mother-to-child transmission of HIV by encouraging mothers living with HIV to become peer educators and provide support to similarly affected pregnant women and new mothers.




THE NEW IDEA

Mitch’s response to the HIV/AIDS pandemic is a determined approach to ensure that HIV-positive pregnant women deliver HIV-negative children. As a medical doctor working in Cape Town, Mitch saw pregnant women come into clinics for their first antenatal visit and receive their first test for HIV. In a system managed by overburdened healthcare workers, the pregnant women who received a diagnosis of HIV would leave the clinic alone and terrified. Mitch’s organization, mothers2mothers, is a simple but powerful program that tackles this problem on a local level: New HIV-positive mothers who had recently been through the Prevention of Mother to Child Transmission process (PMTCT) are hired for one to two year periods to educate and support pregnant women in similar situations.

mothers2mothers provides education and psychosocial support to pregnant women and new mothers living with HIV/AIDS. The program is driven by its mission to reduce the number of babies born with HIV, keep mothers healthy and alive, empower women as caregivers, and reduce the stigma associated with HIV infection. To achieve these goals, it employs mothers living with HIV to work as “mentor-mothers,” assisting doctors and nurses in the care of pregnant women and new mothers attending antenatal clinics for maternity care. In this way, mothers2mothers has redefined the healthcare system by reducing the burden on existing and overwhelmed medical staff. This comprehensive and holistic service for women living with HIV/AIDS is having a significant impact on these women, their children, and, indeed, the broader healthcare system in Africa.




THE PROBLEM

Mothers attending antenatal care services in South Africa are faced with myriad challenges. Even before the HIV/AIDS pandemic, the public health care system had grown increasingly ineffective under the weight of growing populations and understaffed health care facilities as doctors and nurses migrated in large numbers to better work and living prospects in resource-rich countries. Then the HIV/AIDS pandemic added an entirely new set of challenges, primarily the needs of millions of women who require the additional attention and care that accompanies a diagnosis of HIV/AIDS.

An astounding 30 percent of women of childbearing age are living with HIV/AIDS in South Africa. Without medical interventions, 25 to 40 percent of the children born to these women will acquire the virus through mother-to-child transmission (MTCT). Medical interventions to prevent MTCT are simple and effective if administered correctly. A simple dose of appropriate medication to a mother during labor and to her newborn baby is enough to cut transmission in half. Two pills per day in a woman’s final twelve weeks of pregnancy can reduce the transmission rate to 2% percent at birth.

For a variety of reasons, less than a third of pregnant women living with HIV/AIDS receive the necessary treatments, leaving hundreds of thousands of babies unnecessarily exposed to the consequences of HIV/AIDS infection. Doctors and nurses are overwhelmed with medical service provision and have little time to educate or provide support to women diagnosed with HIV/AIDS during pregnancy. Medical practitioners acknowledge that post-natal care is also a neglected area due to a lack of education and reluctance on the part of mothers to return to a healthcare system that is often viewed as hostile.

In part because of this lack of education and care, there is a very strong and negative stigma associated with an HIV diagnosis, even among some healthcare professionals. Moreover, stigma-related issues make it difficult for women living with HIV/AIDS to find employment and access resources after childbirth.

Needless to say, the emotional impact of an HIV diagnosis during pregnancy and the inability of the healthcare system to adequately support these vulnerable women does very little to protect babies from acquiring HIV, much less the mothers from emotional duress and social stigma.




THE STRATEGY

Mitch’s program, mothers2mothers, uses an innovative approach to support HIV/AIDS-infected pregnant women by educating them about and supporting their use of the interventions that prevent mother to child transmission of HIV and keep mothers health and alive to raise their children. Through peer education, Mitch has helped women overcome the fear and lack of understanding that often obscure the benefits of antiretroviral medication.

mothers2mothers (m2m) provides service in antenatal clinics, postpartum wards, and post-delivery clinics, and extends service into communities to reach women in their homes. mothers2mothers also provides support for the medical services delivering PMTCT care. m2m’s staff, mentor-mothers living with HIV/AIDS, are able to engage similarly affected women and provide initial emotional support when the HIV/AIDS diagnosis is first made. They assist with disclosure and provide education on HIV/AIDS medication during pregnancy to prevent HIV transmission to infants and sustain the health and life of the mother.

mothers2mothers services start during pregnancy, continue during delivery, and are sustained after birth when mothers are encouraged to come back to postpartum groups and learn about appropriate infant feeding practices and on-going HIV/AIDS care. In their role as peer mentors they guide other mothers over the social and emotional hurdles encountered when pregnant and newly diagnosed with HIV/AIDS. Mentor-mothers assume professional roles within the healthcare team and are paid a salary for their efforts. By providing a nurturing social environment, serving a nutritious meal to everyone in attendance, and creating a network of support that allows a woman to “live positively” with HIV, mothers2mothers attracts clients back to the healthcare system and supports them in ways that over extended medical professionals cannot.

Women who have gone through the program serve as mentors for one to two years. This approach allows m2m to build an ever-greater supply of trained health promoters, armed with powerful knowledge as they go out into the community.

Apart from its impact on the lives of HIV+ mothers, mothers2mothers has helped to relieve the pressure on South Africa’s overburdened healthcare system. Thanks to mothers2mothers, patients receive the education they need to achieve the best medical outcomes, while breaking the cycle of overwork and despair that overcomes too many healthcare providers. mothers2mothers is a replicable, scalable, accessible service designed to support existing healthcare services. By embracing, training and employing new mothers as mentor-mothers they are both uplifting a cadre of women who have traditionally been unemployed and disempowered and educating and supporting new mothers to promote behaviors that will contribute to their and their babies’ health.

Mitch is now working in seven provinces within South Africa, and has developed a robust expansion strategy. Currently, mothers2mothers provides services in over 500 facilities in seven countries: South Africa, Lesotho, Swaziland, Malawi, Rwanda, Kenya, and Zambia with plans to expand into Mozambique, Tanzania and Uganda in the coming year. It reaches more than 150,000 women each month and employs more than 1500 people in this effort. Despite its size, mothers2mothers is culturally sensitive and uses local context as a basis for change. By being adaptable, it is responsive to the many communities in which it is locally owned and driven.




THE PERSON

The son of an OBGYN, Mitch was drawn to the medical field from an early age. He spent a year living in Cape Town, South Africa as an American Field Service exchange student in 1971, and was profoundly uncomfortable with the privileges of white society under the apartheid period. He returned to southern Africa in 1974 to work in mission hospitals in Zululand and Swaziland, where he saw firsthand what life was like for South Africa’s black population.

Mitch returned to the U.S. and chose to follow in his father’s footsteps, receiving his medical degree from Harvard Medical School and pursuing a career in Obstetrics and Genecology. Beyond addressing the immediate medical needs of his patients, Mitch was committed to helping patients and their families confront the emotional impact of illness, and likewise completed a certificate program in Clinical Pastoral Education. This training proved invaluable during his experience as an OBGYN in Micronesia and later in San Diego, where he was part of a practice serving Mexican women. In both roles, he provided psychosocial support for the healthcare staff as well.

His interest in HIV/AIDS sprung from a life-long friendship with a doctor who had started a clinic for obstetric care for pregnant women living with HIV/AIDS. When the friend fell ill, Mitch took over clinical care and worked with a multi-disciplinary team to meet all the needs of the infected mothers. After the death of his friend, Mitch found that he had discovered a strong desire to become further involved in the care of HIV/AIDS infected women and, in particular, mothers and pregnant women.

Mitch returned to South Africa in 1999 to support the health sector of the post-apartheid government. mothers2mothers grew from his belief in the need for holistic medical care that addresses more than just the provision of life-saving medication.




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