Music for Maternal, Newborn and Child Health (M4-MNCH)
Lib Yaleh: If you have heart
Zeritu Kebede and Tadele Gemechu
Producer - Tommy T
Director - Daniel Tamirat
A project of the Ethiopia-Canada Maternal, Newborn, and Child Health Program
Dr. Roger W. Turnell, Director
Dr. Khalid Aziz, Associate Director
Janet Summerhayes and Ashton James, Project Managers
Dr. Wendmagegn Gazehegn, Project Co-Director
Mr. Abrham Getachew, Project Manager
With support from Unicef Ethiopia, Ethiopian Ministry of Health, and funding from Global Affairs Canada
"Tragically, in Ethiopia over 1 in every 250 pregnancies results in the death of the mother, and 1 in 30 the death of a newborn baby. The Ethiopian government is working to ensure access to skilled care during childbirth by increasing the number of hospitals and health centers across the country. Health facilities provide staff with the technical capacities, supplies, medicines, and equipment needed to manage complications and prevent deaths. But due to lack of knowledge in their communities, many expectant mothers don't make use of these facilities. With greater community awareness most of these senseless deaths can be prevented....If You Have Heart."
Lib Yaleh is a song, and an attempt to ameliorate this harsh reality by raising awareness, through music.
Over the past twelve years I’ve been developing a concept and practice I call “Music for Global Human Development” (http://m4ghd.org), applying insights from ethnomusicology (the study of music, culture, and society) to harness music’s vast social power, towards positive social change around the world.
Musical strategies are particularly effective for promoting global health, where technical solutions are often ineffective unless accompanied by appropriate behavioral change. Such change requires an attitudinal shift, but attitudes are not easily altered, being deeply rooted in emotion and culture.
Music, drawing on culture and transmitting powerful emotion in its lyrics and melodies, has the power to transform attitudes by fusing thoughts and feelings, addressing hearts together with minds, and by mobilizing people around health issues. Music is also capable of diffusing rapidly through society, via popular participation, celebrity singers, or the mass media. In sum, music is a powerful, relatively inexpensive, and highly sustainable development tool for positive social change.
My ethnomusicological research in Ghana in 1988 led—much later — to a study abroad program I launched from the University of Alberta in 2007. During that inaugural year I learned of Ghana’s severely overcrowded Buduburam Liberian refugee camp. Surprised to discover an active musical scene there I led an initiative to produce an audio CD, “Giving voice to hope”, with extensive liner notes designed to raise global awareness about the refugees’ predicament, to promote musicality in the camp, to raise musicians’ profiles, and to provide them with a stream of royalties, easing their transition back to Liberia...giving voice to hope. (See http://bit.ly/buducd .)
Afterwards I continued to work with several of the Liberian musicians to develop and promote popular songs for better health, including awareness of HIV/AIDS and Ebola, as well as a music video supporting better sanitation practices in Monrovia (http://bit.ly/sanitationtitles). Subsequently I developed a project in Ghana aimed at improved sanitation and anti-malaria practices through live traditional dance-drama performances, in collaboration with a UofA colleague, Professor David Zakus, then Director of Global Health in the Division of Community Engagement, Faculty of Medicine and Dentistry, and Ghana’s Youth Home Cultural Group (see http://bit.ly/sngdnc4h).
Around the time David and I began working together he was directing a major 5-year MNCH project in Ethiopia ($6.1m) funded by Global Affairs Canada (then DFATD), the Ethiopia-Canada Maternal, Newborn and Child Health Project. As many as 25,000 women in Ethiopia die in childbirth each year, and almost three times that many new newborns do not survive the first 28 days of life. Maternal-mortality trends particularly affect women in rural and remote communities. In Ethiopia only 10 percent of women give birth in health facilities (though great strides are being made to deal with this by both the government and NGOs). A major factor contributing to this problem is the shortage of midwives and skilled birth attendants.
The project aimed to improve childbirth outcomes in Ethiopia, and save lives of mothers and newborns by improving birth attendance and referral procedures, in collaboration with St. Paul’s Hospital Millennium Medical College in Addis Ababa, the Ethiopian Ministry of Health, the Ethiopian Midwives Association (EMA), the African Medical and Research Foundation, the Ethiopian Public Health Association (EPHA) and Addis Ababa University. Associated organizations included UNICEF, UNFPA, WHO, CARE, and the Hamlin Fistula Hospital (and Midwifery Program). In Canada the partnership extended to Mount Royal University of Calgary, home of Alberta’s only degree program in midwifery.
The project addressed needs by focusing on three key areas:
- Increasing the availability, access to and use of skilled birth attendants across the country;
- Increasing access to and use of higher levels of expertise and hospital infrastructure for emergency births; and
- Enhancing institutional environments to support sustainable, equitable and gender sensitive maternal, neonatal and child health services.
Through a collaboration among Canadian and Ethiopian colleagues the project aimed to reduce an appalling, medically unnecessary toll by building up the clinical and teaching skills in the country’s rapidly expanding corps of midwifery instructors, and by targeting gaps in the referral system for difficult childbirth cases.
However, these solutions would not be fully effective without accompanying behavioral changes in the population at large. The crucial goal was getting expectant mothers to deliver in an available healthcare facility staffed with trained healthcare providers. Realizing this goal, in turn,required attitudinal changes--not only among the mothers-to-be but their entire families as well - and especially their husbands, since data showed that they were often determining where their wives gave birth. For cultural reasons, many preferred a home birth, despite the dangers to mother and child.
In 2013 I proposed the idea of a song motivating requisite behavioral changes to project director David Zakus, who immediately enthused. Division director Dr. Jill Konkin was likewise encouraging. An ethnomusicologist colleague then teaching at the University of Alberta, Professor Jon Kertzer, put me in touch with acclaimed Ethiopian music producer and bassist Thomas Gobena, based in Washington DC. Together, Thomas, David, and I began to discuss a possible musical collaboration. After mulling the production of an entire album we opted to focus our limited resources on a single song aimed at getting mothers to give birth in a health facility.
After Dr. Zakus left the UofA in 2015 I introduced the song project to the new MNCH project director, Dr. Roger Turnell, who was very supportive, as were project team members Dr. Khalid Aziz, Ashton James, Janet Summerhayes and Amy Fowler, as well as our partners in Ethiopia, especially Project Manager Abrham Getachew. Together we finalized details of budget, contracts, and timeline.
Thomas forged ahead, drawing upon his enormous talent, experience, and extensive networks to produce the song itself. As a means of maximizing impact, he enlisted two huge Ethiopian stars, one female and the other male, to write the lyrics and sing a duet in the country's two primary languages: Tadele Gemechu, in Oromo, and Zeritu Kebede--who also composed the melody--in Amharic. Thomas arranged the song, assembled a stellar ensemble of Ethiopian musicians to record the music, contacted an experienced director (Daniel Tamirat) to produce the accompanying video, and completed the mixing and mastering.
As Unicef’s Ambassador for Ethiopia, Thomas also kindly introduced us to Unicef staff, who supervised the final stages of subtitling and editing, as well as producing the crucial concluding scene for a more positive ending. Together we conducted a few final rounds of review and editing, with input from all sides, and the final video was approved by all parties, including the Ministry of Health.
We now eagerly await the song’s official release, hoping for broad distribution, enthusiastic uptake, and positive impact throughout Ethiopia, towards healthier deliveries and longer lives for mothers and infants, across the country.
-- Michael Frishkopf
12 September 2019