Good morning, Hank. It's Tuesday.

So listen, I have some really good news, but to understand it, you need to know the really weird way we measure the burden of healthcare problems. We measure them per 100,000 people. So, for example, Hank, the kind of cancer you had is called Hodgkin lymphoma, and about 2.5 out of every 100,000 people are diagnosed with it each year. So you're very special, that's not the good news.

I find this way of measurement slightly unhelpful because I can't actually conceptualize what 100,000 people looks like, but I guess it does give us a point of comparison. Okay, then there's the mortality rate. Since, thankfully, the vast majority of people in the US survive Hodgkin lymphoma, the mortality rate is much lower than the diagnosis rate–it's only about 0.28 per 100,000 people. Curiously, this is very similar to the tuberculosis death rate in the United States. Several hundred people die of TB each year in the US for a mortality rate of around 0.22 per 100,000 people.

Meanwhile, in Lesotho, the TB mortality rate is around 213 per 100,000 people, meaning that you're a thousand times likelier to die of tuberculosis in Lesotho than you are in the United States. That, of course, is also not the good news.

Here is the good news. So last week, I was at the Partners in Health board meeting, which brought together global health leaders from Mexico and Rwanda and Peru and New Jersey and lots of places in between. And I got to meet up with Vicky Reed, who heads up Partners in Health Sierra Leone. Since 2019, this community has made a long-term, open-ended commitment to pay attention and raise funds for the maternal and child healthcare system in Sierra Leone. And Vicky, who is a nurse, came up to me and she was like, “I have really good news!” And I was like, “Great, I need some.” And this brings us back to the per 100,000 thing, because the way we measure maternal mortality is per 100,000 births. In Germany, for instance, the maternal mortality rate is about 4 per 100,000 births. In the United States, which has a weaker healthcare system and much more inequality of access, it's over five times higher at 22 maternal deaths for every 100,000 births. And then there is Sierra Leone, where in 2017, the maternal mortality rate was over 1100 per 100,000 births. And because of multiple pregnancies over the course of a lifetime, one out of every 17 women in Sierra Leone were dying in pregnancy or childbirth. But now the maternal death rate is 443 per 100,000 births. Still far too high, like 100 times too high. But the maternal death rate is down about 60%! A 60% reduction in seven years, Hank, but even that is not the good news.

The good news is that in Kono, the district where Partners in Health began working in 2019, the maternal mortality rate is even lower. Since 2019, Koidu Government Hospital has seen a reduction in maternal mortality closer to 80%. When I asked Vicky why this was happening, she said that even though the Maternal Center of Excellence is still under construction, the fruits of it are already showing. There are more community health workers. There are more obstetric nurses in the region with specialized training. The clinics in the region are better supported and so they are safer places to give birth. And there are more OB/GYNs and more being trained all the time because Koidu Government Hospital is serving as a teaching hospital.

As a result, about 2,000 more moms are surviving childbirth every year in Sierra Leone than were surviving back in 2019 when we started this project. Now, I want to be clear that our community is a tiny part of that story. Vicky and her colleagues would be the first to point out that this all only works because of deep partnership with the government, which is the main driver of healthcare quality in the country. But at the invitation of the government, PIH's model is now being recreated in five districts in the country with the hopes of eventually expanding to all 16 districts. We know that when moms survive childbirth, children are less likely to be stunted due to malnutrition and more likely to go to school, so this? This is a generational change. It's really encouraging to me to see this progress and I just want to point out that we're only able to see it because we've paid long-term attention to this long-term crisis.

So again, we're definitely not the main characters of this story, but we do get to be part of it, and that's something I think we should be really proud of. Whether you donate directly to this project at pih.org/hankandjohn or you've bought something through Good Store or, just as vitally, you've donated your attention and interest over the last five years, thank you. Thank you for giving Vicky and me and the world a bit of good news.

Hank, I'll see you on Friday.