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C h a p t e r 5 Beyond Charity: The Central Importance of Accountability Charity is no substitute for justice withheld. —St. Augustine, as quoted in Sydney J. Harris, Majority of One I am not interested in picking up crumbs of compassion thrown from the table of someone who considers himself my master. I want the full menu of rights. —Desmond Tutu on the Today show, January 9, 1985 I was privileged to be able to help shape Amnesty International’s “Demand Dignity Campaign,” especially in relation to its work on maternal mortality. Launched in 2009, the Demand Dignity Campaign signaled a watershed in international human rights. Previously, Amnesty had eschewed ESC rights, focusing instead on a narrow slice of CP rights, involving, for example, political prisoners and freedom from torture.1 As the oldest and by far the largest international human rights organization, Amnesty International’s reticence with respect to ESC rights had ripple effects throughout the field. So when, under the leadership of then-Secretary General Irene Khan, the organization changed course and boldly embraced addressing poverty as a human rights imperative requiring accountability and not charity, it signaled a huge shift in the international human rights movement. With Amnesty including issues such as maternal mortality and slum dwellers—right to health and housing questions, respectively—as central to its mandate, the 132 Applying Human Rights Frameworks to Health entire human rights movement was presented with the opportunity to rethink itself.2 In 2009, while in Sierra Leone on a fact-finding delegation with Amnesty for the maternal mortality campaign, I met the family of Yerie Marah, who had died in childbirth the year before. In Sierra Leone, if a girl is especially diminutive, she may be called “Kinkini” in Krio, which connotes that she is petite. Yerie was like that. She was twenty-two when she died by the river near her home in Koinadugu district, in northern Sierra Leone. But judging from photos, she looked as though she had barely entered adolescence; a reality not uncommon for a country with widespread malnutrition. Yerie’s story was all too typical for Sierra Leone. She and her husband, Mahmoud, had been together for six years, since both of them were teenagers . Neither Yerie nor her husband had ever attended school. They were both Mandingo and came from the same community. Mahmoud and Yerie lived in a very small, one-room structure in the center of the village of Sokralla, amid relatives on both sides of the family. Yerie died of a postpartum hemorrhage, which was almost surely either caused or significantly exacerbated by malaria. Although the placenta was delivered intact, she began to bleed after the delivery. But according to Rebecca, the maternal child health (MCH) aide who attended her delivery, it seemed to be mostly lochia—the normal discharge from the uterus that occurs after childbirth—and by mid-afternoon, after a shot of ergometrine,3 Yerie had permission to go home with her baby. Mahmoud and Yerie walked home and everything seemed all right. Yerie took a nap and when she woke up she and Mahmoud were talking and joking about what to name the child. They decided to name the little girl Mariama Sawanah. But everything was not all right. Later that evening, Yerie went to the latrine and her mother, Sirrah, saw that she was bleeding heavily. Sirrah knew something was seriously wrong. The bleeding continued all night, and in the morning Yerie left for the river to try to wash some of the blood away. Finding her there, her uncle summoned Yerie’s mother and sister for help. They came running, but it was too late. Yerie’s antenatal record showed that she had been diagnosed during her second trimester with malaria, which can greatly exacerbate bleeding postpartum . Although the Global Fund to Fight AIDS, Tuberculosis, and Malaria was providing insecticide-treated bed nets (ITNs) to Sierra Leone to be distributed free of charge to all pregnant women and children, Yerie had never received one. Beyond Charity 133 It turned out that Yerie did not receive an ITN because Rebecca had (she admitted to us) sold the primary health unit’s (PHU’s) bed nets on the private market. According to Rebecca, Yerie had been referred to a district hospital for malaria drugs but had not gone because Mahmoud would not pay for the transportation; Mahmoud told us, however, that Yerie had never been referred. In any case, as there were no...


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MARC Record
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