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 Health  Myanmar Project #27216

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
Local trainers receiving materials for outreach
Local trainers receiving materials for outreach

At the beginning of November, two volunter midwives made the four-day journey from the UK to Laillenpi in Chin state, Myanmar. This is the 8th visit to the township, where training and practical support has been provided to Traditional Birth Attendants (TBAs) and other community healthcare workers with the aim of improving maternal and child health outcomes in the rural communities. 

Since the start of this project over 180 TBAs have been trained.  In 2017 the project was expanded to provide Training of Trainers to local women, who then provide training to TBAs in more remote villages. An additional development of this trip, was the opportunity to provide support to three nurses who have recently graduated through the support of Health & Hope's Freedom to Education Project (FEP) as well as provide training and support to local government midwives. 

Due to ongoing conflict in the region, it wasn't possible for the volunteers to travel to more remote villages as planned. Instead, two days of clinics were arranged in the town, where almost 150 mothers & babies were seen and treated!  Following this, the UK midwives conducted a week-long workshop with 36 TBAs, 5 government midwives and 2 trained nutritionalists, who were keen to receive training so that they can deliver health advice for pregnant women and new mothers. 

As always, it was wonderful to receive feedback from the TBAs who have been able to put the training they've had over the years into practice. One TBA revealed how she had delivered a breeched baby 12 years ago and the baby had died because she did not know what to do. Since coming to the training, she has been able to get over her fears and recently deliver a breech baby successfully. She said:"I knew what to do because of the training I had received, and the mother and baby are well. It was the best day of my life!"

As part of the project, the team distributed birth bags, which contain essential equipment and clean birth kits, as well as training and distribution of basic medicines. The result of this continued work has been a clear improvement in conditions, skills and expertise provided by the TBAs. The assessment at the end of the training week showed that the TBAs have grasped a good understanding in critical practices such as handwashing & hygiene, initial assessment of the mother, manoeuvres of breeched births, and immediate post-natal care of the newborn, including skin-to-skin contact and first breastfeed. As well as these basic concepts, the TBAs also now have a good understanding of how to deal with complications and emergencies in delivery such as  bleeding. 

This visit also created an opportunity for the three graduate nurses to gain further training and experience in maternal and neonatal health. The nurses, who are now part of the Health & Hope Myanmar team in Lailenpi, were translating during the clinics and training sessions, giving them the chance to deepen their knowledge and grow in confidence. As a result, Hope Clinic, based in Lailenpi, and our other health projects, will now benefit from the enhanced skills and experience of these trained staff. 

All of this is thanks to your generosity and continued support. We are so grateful for your partnership and look forward to updating you on the progress of this project again soon. 

Breastfeeding training for Health & Hope nurses
Breastfeeding training for Health & Hope nurses
TBA Training Group Photo
TBA Training Group Photo
Training of local trainers
Training of local trainers
Suturing training
Suturing training
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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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Emma, volunteer doctor, treating a burn wound
Emma, volunteer doctor, treating a burn wound

Last time we updated you on this project we were planning to launch our next training for Traditional Birth Attendants. Unfortunately, due to an escalation of fighting between the Myanmar Army and the Arakanese Army in the border regions, we had to postpone our plans until after the monsoon.

We were however, able to provide training to Area Coordinators and Community Health Workers, which focused on the management of childhood illness. This included training in emergency first aid, suturing and the management of burns. 

Emma was one of the volunteer doctors from the UK, who ran the practical training, while also seeing patients at Hope Clinic in Lailenpi.

“I was struck by how grateful all the patients were, despite me seemingly doing very little. One elderly lady shook my hand so hard I thought it would fall off!  She said she would remember my visit all her life. All I had done was look in her ears! I found it difficult to understand the depth of gratitude that the people showed, until someone explained that it was our presence that gave them hope.  Hope that their little town was not forgotten by the rest of the world and that we cared enough to come all the way from the UK to see them, besides any medical skills we could offer. The people were so generous in their appreciation, and we left the clinic with vegetables, pineapples, bananas and a multitude of eggs!”

You can read more about Emma’s trip in her blog post on our website.

The team had a tremendous time delivering the course based on the World Health Organisation's Integrated Management of Childhood Illnesses.  Over the next few weeks, this course will be followed up by providing training for Health and Hope staff on care of the unwell newborn.  

Three young women who will participate in this training, have been supported by Health and Hope through six years of study and will this month graduate from university after completing their nursing degrees. After the training, they will support the delivery of the maternal and neonatal programme, in addition to working in Hope Clinic and responding to emergencies through a newly established mobile medical service.

We are so grateful for your ongoing support which has enabled the development of this programme of work. Your partnership is making a difference to the lives of hundreds of mothers and their children in the remote regions of western Myanmar. 

Area Coordinators training workshop
Area Coordinators training workshop
Practical training workshop
Practical training workshop
Graduate nurses working with Health and Hope
Graduate nurses working with Health and Hope
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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

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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

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Organization Information

Health and Hope UK

Location: Chorleywood - United Kingdom
Website:
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Project Leader:
Chris Jones
Chorleywood, United Kingdom
$26,657 raised of $56,198 goal
 
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