Azerbaijan Interviews: Susan Rathe
8 June 1999
From a collection of Azerbaijan Interviews, April 1999. Susan Rathe is responsible for Reproductive Health Programs
Been in Azerbaijan 3 and a half years
Working for MSF in Azerbaijan since November, 1995
Can you outline some key points about your work, which you consider
valuable for the people of Azerbaijan?
All kinds of health issues concerning women still present a difficult
situation in Azerbaijan. Access to medical care is not obvious
everywhere. And maybe due to their Muslim backgrounds, women are kept
at home and it is not obvious that they would be taken to the doctor.
Because of the economic crisis, it is very often difficult to be able
to afford to go to the doctor, and when I came here there was
practically no modern family planning available in the country. What
women mostly used was abortions and very often back-door abortions,
because they cost less than the official ones - it's legal to go for
an abortion in Azerbaijan, but it costs quite a lot if you have it
So this is what we begun with - we tried to offer alternatives to
these abortions. Then we gradually extended - trying to improve all
the obstetric practices at a village level in order to offer better
services for the women in the villages. And then we extended to other
Under the old Soviet system, it was arranged so that there was some
kind of medical person in every village. On average, you would find
one midwife per one thousand inhabitants. Those were the people who
were sought out for medical help, not just for obstetric help, but for
other things as well, as they were the only person who had some
medical training in the village. So this system was established, but
these people worked without equipment, no drugs, no supervision, no
additional training or these women could not attend the training as
they were wives, mothers and farmhands as well and they also had the
village to look after. So if you took them away for a refresher
course, everything in the village would have collapsed.
So, given these circumstances, we thought to introduce regular visits
to these midwives for supervision, for training and supply of
equipment to allow them to be able to do what they were supposed to do
under better conditions.
Can you think of a specific example during your work where you really
thought to yourself that it is worthwhile?
This happens regularly. We have built up this reproductive health
system in 2 districts - it's now under the supervision of 2 local
doctors, and it works. All the midwives are participating. They are
coming for the seminars and we have regular outreach consultations of
the governmental gyneacologists going to the villages to do
consultations for women who cannot afford to go to the central
hospital - and these are things that did not happen before, and they
now work automatically. It is also integrated into the functioning of
the governmental services.
The biggest challenge for me was to encourage the government staff to
care for their population and to take initiative. For example, the
Chief Gyneocologist of the Imishli region. I first made contact with
her as I wanted to work with her developing a family planning program.
When I first met with her, she was a frustrated woman who had worked
for 20 years in a maternity department with staff who were difficult
to work with - very corrupt, not listening to their chief - so she had
practically retired to her room and had as little to do with her staff
So we started to talk about family planning, and gradually she agreed
that something may be possible. And then we got permission from Baku
to undergo training together so that afterwards we would have the
authorisation to build up a program in the region.
After some hesitation, she did come to this training, and she went
back very enthusiastic after seeing a sample of a family planning
clinic. She went back to Imishli, and she talked with the chief doctor
of the region and she said 'I want a family planning clinic in this
hospital as well.' And under their own initiative, the two doctors
together gathered the money needed and they used part of the maternity
wing of the hospital which they weren't using anyway, and they
installed a new family planning centre. This centre was more beautiful
than many houses in the region! They made all the publicity about it
and she opened the family planning centre. And when the Ministry of
Health at the central level heard of it, and called and complained,
they said we have opened it, we see a need for it and we will
definitely not close it again. So you'd better accept it.
So this shows the change. And she used to stay, and she still says, if
you Susan have come from so far to care about the women of my region,
I should be ashamed if I don't do as least as much as you. And now
she is motivated, she likes her work and she does a great deal of news
things that she never did before.
How has speaking Azeri helped in your work?
That it helped was quite obvious for the work with midwives in the
regions. This work would never have been possible with a translator,
because these are very personal relationships. We not only talk about
pure work, but about their houses, children etcetera. It took a while
to build up trust and a feeling these talks would be confidential. In
the very beginning I tried to find out something about abortions in
the region. I made conversation with some midwives and asked 'how many
abortions happen in your village in a year?'. After 5 minutes the
midwife told me that it is about 2, after 10 minutes she said 15,
after 30 minutes she said 50, and the next time she said 200. They
have to be sure that you won't tell another person about it and will
keep it confidential.