Transforming Maternal & Child Health in Myanmar

by Health and Hope UK
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar
Transforming Maternal & Child Health in Myanmar

Dear supporters,

Thank you so much for your continued support of Health & Hope. Especially at this time, your generosity is making a significant difference to the people in Myanmar who are tragically facing such challenging circumstances.

As you are aware, since the military coup took place on the 1st February, the people of Myanmar have faced a brutal and violent crackdown on human rights and liberties with over 800 civilians killed and thousands arrested. Daily life for many inside the country has become increasingly difficult without access to banking services and food supplies becoming extremely challenging.

Thankfully, Health & Hope staff are safe, but many are in hiding or have had to flee the country. As a result of all that’s happened, the operational environment for our work has changed significantly and so we have had to make the difficult decision to put some of our previous work on hold.  This includes the GlobalGiving fund for our Maternal Healthcare project. We hope to have this back up and running again as soon as we can, but currently are unable to continue this project in its current form. 

If you are currently giving to this project, we would be pleased to receive your support through our Freedom to Education Project (FEP), which provides scholarships for students from Myanmar to complete their education outside the country.  Funding for the FEP project will provide an essential lifeline for students unable to study inside Myanmar. You can find out more about this project on GlobalGiving by clicking on this link.

On behalf of all at Health & Hope, thank you again for your continued support and partnership at this difficult time.
 
Philippa
 

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Local women supported to become trainers
Local women supported to become trainers

In December, twelve local women who had completed our Trainer of Trainers (ToTs) course delivered maternal and neonatal training into twelve remote villages in western Myanmar.

The ToTs were paired up based on their ability to speak the local language, and to encourage a good skill mix. Each ToT pair went to two villages to support training of local Traditional Birth Attendants (TBAs) as well as assist in educating the local community in key health topics. The ToTs also supported pregnant women and in some cases were in the right place at the right time to assist in deliveries alongside the TBA. Twenty four TBAs and an additional 72 local women received training and support on a range of topics from health in pregnancy and complications in birth, to breastfeeding and post-natal care.

One of the ToTs recounted her arrival in the village:

“The village welcomed us so warmly. We stayed for 2 days running a training workshop with both theory and practical sessions. The workshop went very well and the training was gratefully received. We taught about the importance of kangaroo care after delivery which is when the baby is put skin to skin with the mother immediately after birth. We taught the TBAs the importance of waiting for the placenta to come out naturally and warned of the dangers of puling or pushing the placenta out which is common practice in the villages. We also explained the importance of putting the baby straight to the breast and ensuring that the first milk from the mother was not thrown away. The TBAs and local women who attended the workshop were very happy to learn about this and so keen to pass on their new knowledge and apply it to their work.

One night whilst we were there, there was a delivery and the TBA wanted to immediately apply all her new knowledge. Unfortunately the umbilical cord was very short and the TBA didn’t feel it was long enough to place the newborn on the mothers chest immediately. But I dried the baby, placed the baby in a warm blanket, cut the umbilical cord and then initiated kangaroo care by placing the baby skin to skin with the mother whilst waiting to deliver the placenta. The mother and her family were so delighted, thankful for our help and grateful for our encouragement and support for the TBA”.

This testimony reflects the incredible need for the ToTs to be physical present in the village to support the TBAs as they apply the skills and knowledge given to them during teaching workshops.

Follow up visits and ongoing support are just as vital, not only for continued professional development, but also to ensure the TBAs are supported in a wide range of situations.

The example given in the previous testimony shows how even with classroom knowledge, every pregnancy is unique and every birth experience is different. Despite the challenges that may present, in many cases it is still possible to meet an excellent standard of practice. Initiating skin to skin (kangaroo care) and putting the baby to the breast for the first milk can still be achieved despite unexpected challenges if the TBA has a good understanding and is able to adapt their skills and problem solve by looking for alternative solutions.

Shortly after outreach, the ToTs traveled to Lailenpi for a 3 day workshop with the Health & Hope medical team.

The workshop provides the ToTs with the opportunity to share birth stories, discuss the training delivered, reflect on best practices for working in a community setting and identify ways in which they can improve the service they offer.

At the workshop, the ToTs also stocked up on essential supplies, such as clean delivery kits, gloves, soap, monitoring equipment, vitamins and pregnancy supplements.

Your support for this project is so important as it continues to equip local women with the skills to respond to the challenges of child birth within remote rural communities in the jungles of Myanmar. The knowledge and practice change as a result of this work has a radical impact on both the wider family as well as the new-born child, impacting health outcomes and saving lives.

Thank you so much for your continued support!

Local trainers deliver course to women in villages
Local trainers deliver course to women in villages
Learning a hand washing dance!
Learning a hand washing dance!
Local trainers arrive for refresher workshop
Local trainers arrive for refresher workshop
Packing bags to take supplies to the villages
Packing bags to take supplies to the villages
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Reviewing local women's practice in the villages
Reviewing local women's practice in the villages

In our last update, we reported on the visit in March by two UK midwives, Frances & Maaike. Alongside running training workshops in Maternal and Neonatal care for Community Health Workers (CHWs), part of the trip involved assessing the effectiveness of the local ToTs (Trainer of Trainers). Feedback was conducted with twelve women trained from the rural villages. This was followed up by visits to the local communities to assess the quality of their training. 

The ToTs had each visited two remote villages in the last six months and had received overwhelmingly positive responses. Each village was provided with a Birthing Bag for the TBAs to use, alongside a set of Clean Delivery Kits. As a result of these outreach visits, 47 TBAs were trained who could not attend the course at the Health & Hope training centre. In addition, 113 village women joined the training. This provided an excellent opportunity for health education and promotion on essential topics including hand washing, nutrition, normal and abnormal situations in pregnancy and breastfeeding. 

The village visits gave Frances and Maaike an opportunity to see the ToTs in action:

"On arrival Mimi, the ToT, introduced us to the 10 TBAs that she has been training over the past year. They are all currently active and have been delivering babies either with Mimi or the local ambulant midwife. The trained TBAs are a great resource to the local community, as prior to Mimi’s training there were no trained TBAs and Mimi mainly had to work alone. She could not always be there when a woman went into labour, which brought additional risks." 

The TBAs were so enthusiastic about Mimi’s support: "Yes! She is a good teacher. We are so thankful because now we have confidence to manage normal pregnancy and birth as well as the difficult ones. We used to be scared of problems, but now we have practiced the emergency drills and know what is normal and what isn’t. As a result we are no longer afraid that women will die.”

During the COVID-19 outbreak, TBAs have become increasingly important. Our recent COVID-19 study conducted in the villages, found that ambulant visits from government midwives had stopped and villagers were also unable to leave the village for healthcare needs due to the lockdown. Without the trained TBAs, most women would not receive antenatal support and would have to give birth at home without a trained practitioner.  

Despite the ongoing challenges posed by the Coronavirus, we have been able to gain government permission to travel out to villages to provide health education and support to local health workers. In April, we reached 135 villages and four camps for internally displaced people. Our aim for the coming year is to continue to reach out to communities in need. Under this project, we will provide support to expand the ToTs work to a further 24 rural villages. The local trainers will be equipped to deliver a bespoke training package to TBAs, whilst our staff team will provide Maternal and Neonatal health services to women across a larger geographical area through outreach services from our local clinic. 

Thanks to your financial giving, we have been able to train and develop a strong local staff team to support this work. Do click through to our website here to see a short update on the amazing team serving their local communities as a result of your support.

With thanks for your continued generosity,

Hannah

Training the local team in mother and baby clinics
Training the local team in mother and baby clinics
In-situ training for community TBAs
In-situ training for community TBAs
A local trainer leading the TBA training programme
A local trainer leading the TBA training programme
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Maaike & Frances, volunteer midwives
Maaike & Frances, volunteer midwives

Thank you for your continued support of this project. 

Despite the current global COVID-19 outbreak, the Health & Hope team in Myanmar are still supporting the most vulnerable communities in the region. Delivering services such as maternal and neonatal care remains essential. With government health service provision even more restricted during the present crisis, locally trained, specialist birth attendants play a critical role in remote rural communities.

Two midwives from the UK, Maaike and Frances, were in western Myanmar working in the villages prior to the restrictions put in place in March. In this report, Maaike reflects on the situation for women and health workers in the villages and the achievements in local care as a result of your support for this project.

 

Maaike:

“Since 2013 we have engaged with Health & Hope in Chin State, to deliver education to Traditional Birth Attendants (TBAs) working in the most rural and unsupported areas of the region. Around 200 TBAs have now participated in our 5-day education programs on pregnancy, birth and immediate post-natal care and also on managing emergency situations. 

In order to extend the reach of this work, in April 2018 we introduced a ‘Train the Trainer’ program. Eight experienced TBAs were trained to deliver essential education to other TBAs in the most inaccessible villages. This meant the equipping of volunteers can continue year-round, rather than waiting for another visit from the UK. They also have capacity to travel further into remote areas than a time-restricted visitor from overseas would be able to manage.

We were glad to be able to return in March 2020, and evaluate how the local trainers are already getting on. It was clear that they have been active and successful in rolling out the program in remote villages as tasked. This voluntary role requires a lot of commitment. When we asked them what practical/domestic difficulties they experienced from being away from home for up to six days at a time, they said they are well supported by their husbands, and that other village women help out, too. They feel proud of what they do and believe passionately in its value. This gives them confidence to press on.

The numbers of TBAs who have received training in locations that had not been accessed before is hugely encouraging. During just four months, 47 TBAs had received training for the first time. In addition, many villagers have had the opportunity to learn basic health knowledge such as hand washing, personal hygiene, nutrition and sexual health by joining in with the training. 

In all the villages, great interest was shown in the work of the local trainers by the Village Elders. This has raised respect for the importance of the work of TBAs, and strengthened the goodwill and trust placed in the services offered by Health & Hope. It is clear that the local trainers’ work has generated proactive support to enhance the safety of childbearing women, and boosted the ‘buy-in’ of communities to the public health education that the team is rolling out alongside.

Of the training provided in villages, one Trainer of Trainers reported: “The town administrator came to our training and he was so impressed that he said all women should come, and the men should also learn. He then gave us a chicken to take home in appreciation of our work!“

During this visit, 18 Area Co-ordinators (16 men and 2 women) also joined the programme to receive training, specifically covering emergency situations and how to deal with complications during birth. These Area Co-ordinators (ACs) are an established group who have been trained together initially as Community Health Workers (CHWs) and  are now responsible for overseeing up to 15 CHWs in their region. In many village situations, where there is no TBA present, they may be the only person available to support a woman in pregnancy.  We also became aware that they are often the only trained healthworkers attending births.

Our programme of training is off to a great start, and we are so grateful for your support. There is still much more to be done to continue to deliver this vital, life-saving training, and to equip local volunteers with the skills they need to support women through child-birth and ongoing childcare. Thank you for your generous help which is enabling our work.”

Looking forward to the coming year, the project will shift to focus more on the local trainers' work in remote villages, enabling them to conduct more training workshops with only one monitoring visit from the UK-based midwives.

During this time we are continuing to deliver critical services to vulnerable communities in addition to a COVID-19 Prevent, Detect, Respond strategy in 143 villages across Chin State. If you would like to find out more about this project, please click here.

Thank you once again for your committed support to these essential projects.

Training workshops
Training workshops
COVID-19 response
COVID-19 response

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Childhood screening
Childhood screening

Thank you so much for your continued support of our Maternal & Child Health project.

In our last update, we shared with you about the workshops conducted with Area Coordinators earlier in the year. We also mentioned that due to the escalation of conflict in the region, we were unable to conduct the planned training for Traditional Birth Attendants (TBAs) that was due to take place in February.

We can't understate the seriousness of how the conflict has left some of our health workers isolated and vulnerable.  One of them reported to us:

"Around the village there is active fighting.  We're not allowed to travel and there are curfews in place.  We've been unable to harvest the remaining crops due to the fear of landmines.  I tried to visit other health workers near my home, but I was stopped three times and questioned by rebel groups, the army and the police.  They asked me; 'are you a spy?', 'why are you carrying medicines?', 'are you treating the rebels?'.

After being questioned for six hours I had to return home.  I was able to visit only four villages in June and July, since then I was sent back by the army. The internet connection was shutdown, so this is the first time that I am able to share what has happened."

Despite the ongoing challenging situation, our staff team have been able to conduct a number of outreach visits to remote villages, as well as running some mobile clinics in IDP camps where communities have had to flee their homes. Below is an extract from a trip report written by Dr Pahu, one of the project leaders:

It took us 24 days to travel through four areas and 13 villages. In some areas, the travel was so difficult and in some areas we were unable to travel because of the curfews.

We saw more than 700 patients, met with village administrators and Village Health Committees.  We were able to check on the activities of the Community Health Workers (CHWs) and TBAs. We were also able to undertake childhood screening for over 270 children in schools in some villages. The main medical conditions were gastritis, gynaecological problems for women, acute respiratory disorders, suspected anaemia and eye health. 

We were also able to carry out the baseline survey of the communities we are supporting. Together we carried out 96 interviews and also distributed many health education leaflets, helping to explain to the villagers how they can better take care of their own health needs.”

As a result of these outreach visits and surveys, we have also been able to assess the impact of previous years' work. For example, we found that almost 70% of the population assessed now know how to treat a child under 5 who is suffering with diarrhoea, which sadly is still a common cause of death for young children in the region. Simple post-natal practices such as breastfeeding within 1 hour of birth and exclusively breastfeeding up to 5 months, are also being adopted in order to improve the early chances of survival for newborns. 

The quote below is from one CHW, who has seen the direct results from their training:

"My name is Khai and I am from Tlopi village in Chin State.  I was chosen by my village to be trained as a health worker under Health and Hope and at the time I went to the India border to join six months training. Since I have returned home, many things have improved thanks to the health knowledge that was shared.  We have reduced the mortality rate of children under 10, and not one has died from diarrhoea thanks to the way we have been instructed to care for them.  Also, there have been a lot of snake bites in my village, and many people used to die.  However, I learnt some knowledge about managing snake bites from the health training and I shared this with my village.  I am so happy that I have been able to save two people’s lives thanks to the knowledge I learnt from training at Health and Hope.

Sometimes it is very difficult for us in the villages.  It is so remote we have not been able to participate in further training.  So it was an unexpected joy when the doctors from Health and Hope came to visit my village and offer clinics for patients and training. I know that resources are so limited and there are so many villages, but I was amazed and so thankful to them that they came. I really appreciate Health and Hope's love for us and all that they have sacrificed to help us. I pray that they will be able to return regularly to help us."

Although there is still plenty of work to be done, it is encouraging to see the positive impact of our work to date through the training and support of TBAs and CHWs in the region.

As the monsoon rains clear, the team in Lailenpi are starting to plan the next phase of training workshops for local TBAs and Area Co-ordinators who will be involved in bringing maternal and child health care to remote communities across the region. 

We are so grateful for your ongoing support. We currently have a real need to top-up funding for this project to enable two workshops to run over the course of the next six months.  If you are able to support our work financially, please do click below to give via Global Giving.

Thank you again for you interest in our work. Our next update will follow the journey of two midwives from the UK visiting the jungles of Myanmar, conducting training for the local women and also government midwives in the region. 

Mobile clinics
Mobile clinics
Childhood screening
Childhood screening
Inside the IDP camps
Inside the IDP camps
Transporting medicines to remote communities
Transporting medicines to remote communities
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Organization Information

Health and Hope UK

Location: Chorleywood - United Kingdom
Website:
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Twitter: @_healthandhope
Project Leader:
Chris Jones
Chorleywood, United Kingdom

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