Feb 5, 2019

A wonderful surprise...

Practising a breech delivery
Practising a breech delivery

It was a delight to accompany one of our specialist midwifes from the UK, Frances Barnsely, on her seventh visit to Myanmar (Burma) in December 2018.

We have been running Traditional Birth Attendant (TBA) training since 2013 from our base in Lailenpi, nestled in the jungles of western Chin State. As a result, many lives have been saved, with the local under-5 orphanage closing down in March 2018 thanks to the reduction in maternal deaths during childbirth.

With 166 women having received at least two trainings covering basic and advanced topics over the five prior years, there were now geographic challenges in reaching the more remote villages. To put this in context, some of the women had previously walked 5-6 days to participate in the week long training course, and on top of the return journey, it was proving too difficult to ask them to spend up to three weeks away from their families.

As such, at the beginning of 2018, we brought seven of the most experienced women together to take on new roles as local trainers. Each of the trainers were to visit 2-3 remote villages close to their homes to help expand the reach of the service. Key to the success of this new approach was how effective the local women would be at running their own training courses, in addition to whether they would be accepted in their local communities.

With support from the local women's association, the trainers were able to deliver training to 91 new TBAs covering ten core topics. In addition, birthing bags and clean delivery kits were distributed through the network of trainers.

During our visit, Frances undertook a review of the trainers work through visiting villages on the back of a motorbike. After a gruelling ride over rough mountain tracks, she arranged a three day assessment for the women who had received the local training.  In addition, Frances continued to up-skill and update the knowledge and professional practice of the trainers who attend a five day workshop at the Health and Hope clinic.

"I was so surprised how much the local women knew. I had never expected the trainers to be able to deliver so much of the course and so well. There were obviously differences between the villages, however overall, topics such as hand washing and knowledge of diet were excellent. There was still a need to support the women in greater understanding of the mechanisms of birth and they continue to need more practice in emergency drills, but this will come with time.

I think what struck me most was the impact of the training on the women's self-esteem. It was clear how the initiative had raised their status within the village which had a knock on effect on their confidence. Previously they were very insecure, lacking the self-belief that they had the ability to benefit from the training in Lailenpi. However, because they had the opportunity to practice with a local trainer and then meet us in person, they overwhelmingly expressed a deep desire to attend the full training course. The support of their local community is vital for this, and this was confirmed again and again by the village elders.

Overall, there was such excitement and joy in learning together, it was absolutely thrilling to be a part of it!"

We are so grateful for your ongoing support which has made all this work possible. Our next training takes place at the end of February 2019 and we look forward to updating you on the results of this work soon.

Thank you again for partnering with us.

Chris Jones

PS We’ve featured the above maternal and neonatal training in a new video that’s just been released on our website, if you have time, please do take a look: https://healthandhope.org/our-work/video

Empowering local birth attendants
Empowering local birth attendants
Infant resuscitation and bespoke resources
Infant resuscitation and bespoke resources
Practising mouth-to-mouth
Practising mouth-to-mouth
Assessing local teaching
Assessing local teaching
Out in the villages
Out in the villages

Links:

Feb 4, 2019

We're getting close, just the roof to go!

Almost there...
Almost there...

I've recently returned from visiting Lailenpi in western Myanmar (Burma) as part of our monitoring process, as well as launching a couple of new projects in health and education.  The training centre plays a pivotal role in these projects and it's incredible to look back to just one year ago and see how much progress has been made.

When the project started, the local tradesmen initially refused to dig foundations at 20' spans, asking us to hire 'professional builders' from outside the village.  They had never dreamed of being able to construct a building of this scale, nor did they feel they had the skills to do it.  But through the provision of field engineers and through careful supervision and encouragement, the training centre is now really starting to take shape.  Best of all, the local townspeople can look back at what they have accomplished with their own hands, standing tall and proud of their accomplishments. 

In fact, we were delighted to recently host our first week long training in the building, despite the fact that it has no roof, or even a coat of paint on the walls yet!  In December, twenty-eight Area Coordinators, who provide in-situ support for our network of Community Health Workers, gathered for the launch of our new healthcare project and took up residence in the training centre.  This has been followed by training for educators in January, and two further trainings of health workers and Traditional Birth Attendants in February.  

Whilst still incomplete, the training centre provides an incredible space for the ongoing work, whether training in health, education or agriculture.

As you can see from the photographs, we are nearly there with 85% of the funds raised.  We also have funding to furnish the classrooms, however we are now looking for around US $50,000 to put the roof on the training centre, as well as complete the plumbing, electrics and glazing before the monsoon rains start in May. 

We've just uploaded a video onto our website showcasing the latest work.  This includes an update on the rebuilding project.  If you would like to see the context of our work and some of the local community in action, please do follow the link below: https://healthandhope.org/our-work/video

It's been an amazing journey so far.

Thank you for your ongoing partnership,

Chris Jones

Beneath the night sky
Beneath the night sky
Training centre in use
Training centre in use
Training Area Coordinators
Training Area Coordinators
Rendering the inside of the building
Rendering the inside of the building
Starting work on the roof terrace
Starting work on the roof terrace
A year ago...
A year ago...

Links:

Oct 5, 2018

Reflections From Training TBAs

Megan giving a practical demonstration to TBAs
Megan giving a practical demonstration to TBAs

It is a truth universally acknowledged that a country in possession of a high maternal and neonatal death rate, must be in want of more midwives. Indeed the World Health Organisation has declared that the best investment into healthcare services is in the midwifery workforce since midwives can provide 90% of the essential care needed for women and newborns and contribute towards ending preventable maternal and neonatal deaths. And yet in many countries women are still dying in childbirth as they have no access to midwives. In the remotest mountain regions of Myanmar (Burma) whole communities are born, live, give birth and die without the support of healthcare, hospitals, doctors or the much needed midwives. Instead these women rely on the bravery and courage of their fellow village women, their Traditional Birth Attendants (TBAs) to safely monitor them through pregnancy, support them to birth their babies and guide them through the fragile early days of motherhood helping them to nourish and sustain their babies. These TBAs provide a lifeline for the most desperate women, and yet many of them are illiterate, uneducated and have received no training. Knowledge, combined with cultural tradition, is passed down through the generations of TBAs and they learn their skills from village elders or their own mothers. Whilst their experience is huge, their knowledge and practice is not evidence based and can be unsafe.

In April 2018 I travelled out to Burma with 2 midwives to deliver a TBA training programme. Four days of travel navigating the almost impassable dramatic mountain passes of Chin State brought us to Lailenpi, a sprawling mountain village clinging to the dusty slopes, deep in the jungle and overlooking the border with India. A village little known to the outside world, and yet entirely alive with a vibrant Christian community.

Forty TBAs had gathered in Lailenpi. They had come from 12 different villages. Some of them arriving on the back of motorbikes, some of them walking for several days over the mountains, such was their eagerness to come and be trained by the ‘English midwives’. 

Over the 10 days we delivered a dynamic and interactive series of lessons from education on reproductive health, family planning, protection and prevention of sexually transmitted infections, antenatal health and care of the pregnant woman, postnatal care, recognising the unwell mother or baby and the importance of referral into the healthcare system. Teaching could be as simple as the importance of handwashing for the prevention of the spread of infection, or how to encourage and support upright, active birth to the complexities of managing obstetric emergencies of a shoulder dystocia, a postpartum haemorrhage and neonatal resuscitation. Each lesson was carefully chosen for its potential for impact. We were teaching the skills that transcend language barriers and are transferable across international borders.

As the week unfolded the team of disparate women formed a sisterhood, sharing their experiences of birth and death. Together we laughed and cried and as they saw our respect grow for their extraordinary wealth of experience so their trust in us grew and friendships formed. With mutual appreciation for one another the teaching and learning was powerful. These women are used to learning by rote, not to question, just to accept. By the end of the week they were all probing for answers in order to further understand the anatomy and physiology of birth mechanisms and how their actions could help to prevent morbidity and mortality. Watching the enlightenment on their faces as they grasped a new concept was the best reward we could ever ask for. One TBA said at the end of the training ‘Rote learning is what we have always done. These topics are so great because we can see, hear, touch and ask any questions we want to. The practical sessions are so helpful because you can really imagine and practice.’

What did we achieve? If the effects of this training reach no further than these 40 women, we know that there now exist 40 women empowered with knowledge and understanding, with skills of communication, team work and the realisation that their contribution to maternal and neonatal health is so greatly valued. 

Yet we know that this training programme has much greater effect than individual empowerment. Since the TBA training programme launched in 2013 no mother in the town where the project was started has lost her life in childbirth, thanks to the skills that the TBAs have been equipped with. As such they have now closed the under 5’s section of the orphanage in Lailenpi. What greater testament could there be to the power of education, knowledge, midwifery skills and the contribution of TBAs, than the closing of an orphanage?

However, far greater than what we were able to give, was what we gained from living amongst these open and kind women. Received into their homes and lives we became engrained in their culture and traditions. Every night we were visited in our wooden house on stilts by a small group of TBAs bringing us gifts and offerings of eggs from their hens, bananas and papaya fruits, wild honey they had harvested from the jungle, small fish from the river and fabrics they had woven. These people of Chin State, who have very little themselves, were unendingly generous in sharing everything with us, from food to friendship, in order to show their gratitude for what we had come to teach them. The experience was humbling and inspiring and I can’t wait to return to them.

Teamwork
Teamwork
TBA Training Participants
TBA Training Participants

Links:

 
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