One woman's justice

The Rose Project has had remarkable impact in just six years. Meet its dynamic founder, Mary Donohoe

The Rose Project has had remarkable impact in just six years. Meet its dynamic founder, Mary Donohoe'Transmission of HIV from mother to child is the second most common form of transmission of the disease in Africa. It's so preventable'

Rose Atieno died of Aids-related complications. Her husband and young daughter were also HIV positive and at the time of Atieno's death they were being cared for by her seven-year-old son, Curtis.

After Atieno died, her daughter Harriet was taken in by her aunt. She is now nine years old. Atieno's husband, Bonavice, lost his sight as a result of an Aids-related tumour. A Love and Hope team, which was funded by the Rose Project for four years, provided the funds in 2006 for Bonavice to attend an intensive course to facilitate his independence.

Curtis still lives with his father. He is now 14 years old. The Rose Project will ensure that both Harriet and Curtis will receive a full education.

THE PICTURE ON the wall is of a young woman. Her hair is scraped back from her face, braided into a short ponytail at the top of her head. She is smiling, looking straight at the camera, but she looks tired. This is a photo of 32-year-old Rose Atieno. She was HIV positive and by the time she and Dubliner Mary Donohoe met, Rose was very ill indeed.

Donohoe was a nurse and had a long-held interest in development issues. "When I qualified, I remember thinking I'd like to go out to the developing world working with Concern or some other organisation. Then, I suppose, romance got in the way, but when my daughters had started university I said I'd go over," she says.

It was on a two-week visit to Kenya in 2003 that she met Atieno. A mother of two, Atieno was HIV positive and by that stage she was dying. "She was so sick and dehydrated," Donohoe recalls. "She was in a rat-infested hut. She had nothing - no drugs, nowhere to lie."

Horrified at the situation and acutely aware that Atieno needed a hospital bed and a drip, Donohoe left the hut in a vain attempt get the young mum admitted.

"I couldn't get a bed," she says. "When we came back to the hut, we started to put up a drip. I just remember I saw the absolute terror in Rose's eyes. She knew she was dying. Her daughter was lying nearby on the floor, the rats were visible. We were trying to put the drip into her abdomen and her little boy was in the corner, terrified at this intervention. The whole thing . . . " Donohoe pauses at the memory. "I just had to step out of the hut for a while. I remember thinking, what is it about humanity that makes this okay?"

Seven years later, Rose Atieno's portrait hangs in the offices of the organisation that bears her name. The Rose Project is an NGO that funds programmes that address maternal and child healthcare in Malawi. Since that fateful day in 2003, it has funded healthcare clinics, first in Kenya, then in Malawi; it is running mother-to-child HIV transmission prevention programmes and late last year it opened the New Bwaila Maternity Hospital in Lilongwe, Malawi's capital. It has been a busy and challenging seven years.

"I never for one moment intended to do anything like this," Donohoe says. But when she got home from Kenya, the fundraising took off. "Whatever way I told the story . . . Anytime I'm speaking about Rose, there's always the sense that tears are never that far from me because there were so many Roses out there. I think it struck a chord with people."

There is a distinct undertone of outrage when Donohoe speaks about Atieno and the other injustices she witnesses. "As a society, we're still okay to describe this work as charity," she says. "We still think that giving to the Rose Project, or whatever, is a charitable act. But this isn't about charity. It's about justice. This is about equal distribution of the world's resources. This is about equity."

Offers of money and expertise poured in. "At one stage it was almost hard to stop the ball rolling," says Donohoe. "We were making such huge progress and so many people were offering their help."

Healthcare was the focus. The Rose Project began by opening a community healthcare centre in Nakuru, Kenya, the area where Rose Atieno lived. Just a year later, however, a chance meeting led Donohoe further south to Malawi. "I was asked to come and visit Malawi," Donohoe says. "Malawi just doesn't have anything at all. It's not even on the first step of the ladder. We were shown around some hospitals. It was horrific, the number of patients lying on the floor, on balconies with the rain coming down on them, no facilities - I realised that this was even more needy than Kenya."

Work started by building an Aids clinic in Malawi. Anti-retroviral drugs had just arrived in the country and a facility was needed to test individuals and bring them into the system. Almost immediately, the sheer prevalence of mother-to-child HIV transmission came to the fore. A full 30,000 babies are born HIV positive in Malawi each year.

"Transmission of HIV from mother to child is the second most common form of transmission of the disease in Africa," Donohoe says. "It's so preventable. We don't have a vaccine to prevent HIV transmission but if we get pregnant women placed on treatment, it's as good as a vaccine for their babies."

Within a year, the mother-to-child transmission prevention programme had been established. The programme has now moved out into rural areas. "It was a problem that we could approach in a very strategic way," says Donohoe. "You visit a woman and you see the difference the treatment has made to her and her family - it keeps you going."

After a short time in Malawi, the Rose Project received a request for help from the main maternity hospital in Lilongwe. "I felt that this was going to fit well with our strategy surrounding HIV," she says. It was decided to give a grant of €3 million to build and equip a new national maternity hospital there. Last October, the 146-bed New Bwaila Maternity Hospital was opened by former president Mary Robinson and the vice-president of Malawi, Joyce Banda.

Considering its achievements, the Rose Project is a surprisingly tiny operation. With a staff of just two full-time employees - one works in Ireland and another in Malawi - its overheads are tiny. If you haven't heard of the project, that is probably because it spends "practically nothing" on PR. Partners are key to its work and the organisation works with the likes of Irish Aid, Unicef, Cafod, the Clinton Aids Foundation and the Haukeland University Hospital (HUH) in Norway in bringing various projects to fruition.

Inevitably, as has been the way since the beginning of the Rose Project, one project leads to another. Now the maternity hospital is open but a huge challenge lies in the profound shortage of healthcare professionals in Malawi. Donohoe recounts a tragic encounter that happened last year.

"I was sitting in the old maternity hospital with a mum who was about to deliver her baby. She had a little English and we were talking. She got into difficulty and needed a Caesarean section. They brought her down to theatre - I went down with the midwife and I saw her into theatre.

"The following morning I went in and I couldn't find her. So I went up to the labour ward. She had had a section and she went back to the postnatal ward, but she had haemorrhaged, and there hadn't been enough nurses to check her pulse. She had literally died in a pool of blood. That was preventable. She should never have died. The midwife on duty was equally devastated but she was only one nurse on for 82 patients. She never got near the woman."

Addressing this shortage is the issue that Donohoe has decided to focus on. "We've built the hospital but there is just one obstetrician and three qualified midwives for 12,000 births. In Holles Street, there are 15 obstetricians and 138 midwives for 9,000 births. The lack of qualified midwives is the principal stalling issue around addressing maternal mortality. They desperately need midwives."

Why such a shortage? It comes down to healthcare workers being trained in Malawi and leaving to work elsewhere. Donohoe questions how developed nations can in good conscience recruit healthcare workers from countries such as Malawi. She argues that the Malawian government should be compensated for the training of that worker. She sees a golden opportunity for Ireland to help.

"Ireland has the lowest maternal mortality rate in the world," she says. "Malawi has the highest for a country that isn't at war. It is time for Ireland to become engaged in this issue. We have the best trained midwives, the most qualified obstetricians - they could really help in a meaningful way." Currently, 20 midwives are being trained through a partnership between the Rose Project and Norway's Haukeland University Hospital. They will qualify next year, but Donohoe is very keen for Irish nursing colleges to get involved. Working alongside people in-country is enormously important to what the Rose Project does. "I don't want it to be a colonial-style solution. It has to be Malawian-led," says Donohoe. "They have the local knowledge. They know what will work."

Throughout all of this, Donohoe and the board of the Rose Project have been careful to stick close to the original idea of helping communities. "It has been very, very challenging - making sure that all the time you are focusing on the greatest needs," Donohoe says. Funding community projects, however, probably provides her with her greatest sense of satisfaction about what the Rose Project has achieved. "I get engrossed in their spirit when I'm down there. Listening to the women talk about the challenges of their lives and knowing that our project is funding their various group activities, and is helping to alleviate their level of distress, probably gives me my greatest sense of achievement."

The generosity of people leaves her speechless. "One of the biggest challenges for me is thanking people. You can never thank people enough."

But the challenge of the downturn hangs ominously in the background. The Rose Project relies chiefly on private donations. One advantage of this is that is has been less affected by government cuts, but Donohoe is acutely aware of the difficulties.

"Our huge challenge down the road is bringing in money. While I understand that everyone is saying, 'No, sorry, we have to look after the needs around us', and I think it is important to look after those around us, I wonder, do we look at the most vulnerable first? This is not charity - you cannot separate health from human rights. We have to make that leap in understanding as a society if we are ever going to achieve global justice."

Mary Donohoe is receiving an honorary fellowship from the Royal College of Surgeons next Wednesday. roseproject.org.