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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
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
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:

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:

Overseeing training: Traditional Birth Attendants
Overseeing training: Traditional Birth Attendants

“We have only ever done rote learning in the past, but this training you have given us is so great because we can see, hear and touch.  We can ask any questions we want to. The practical sessions are so helpful because you can really imagine it and practice it with your hands!”  Traditional Birth Attendant (TBA) feedback from our recent workshop in western Myanmar. 

Thanks to your generous support we ran our first "Train the Trainer" workshop for Traditional Birth Attendants (TBAs) in a rural village in western Chin State, Myanmar at the beginning of April.

Our TBA training programme started in 2013 and has, to date, equipped over 166 local women with the skills to support mothers and babies through pregnancy, birth and early infancy. Our workshops focus on reducing the rate of neonatal and maternal deaths and the incidence of infant and maternal illness. The training has been so successful in one village, that the under-5 orphanage has now closed with no maternal deaths in the last five years!

To reinforce the expansion and sustainability of this training, we  have recently piloted a ‘Train the Trainer’ initiative, equipping our most experienced indigenous health workers with the skills to proactively pass on their midwifery knowledge to new trainees themselves, rather than relying on outside expertise. 

Our first ‘Train the Trainer’ workshop was run by three UK midwives during Easter, two of whom have made six prior trips to the region, having also supported the development of a bespoke training course for local women.

Following the six-day workshop, the new TBA trainers headed out to practice their skills in rural villages by training small groups of women across the region following a three-day curriculum. It was anticipated that they would each train up to four new TBAs. However, in the first village, sixteen women joined the training and in the second nineteen took part, so eager were they to participate and improve their knowledge.

"In Zo Ma village, sixteen women attended the training even though they only invited five! During the time in the village, there was one woman who could not do any work and was lying in a flat position throughout her pregnancy.  When the TBA Trainer arrived she was able to help reposition the baby and the woman has been able to stand and start work again.  At the end of the training she came to give us a chicken to say thank you!

Another woman was told by a villager that she had cancer in her bladder because they did not know she was pregnant. The TBA Trainers examined her and found out she was four months pregnant!  She was so delighted she praised God and was so thankful to the TBAs.

The women were so excited that other villages were calling to them saying, please come to our village, we will send a motorbike to pick you up.

In each village they went to, there was always more women than invited.  They asked for help with vitamins and better nutrition.  They also said the time was too short being just three days and the villagers were not satisfied and wanted more!" Extract from our Programme Officer's report, April 26th 2018

The trainers and trainees had another surprise too. While conducting the training they were able to use their skills during a real birth, with mother and baby well looked after by all. The perfect training opportunity!

Our UK midwives will return to Chin State at the end of 2018 to review progress and receive feedback. They will also assess the extent of the knowledge passed on to the new TBAs through practical and theoretical appraisal and deliver additional training during their time there.

We're delighted with the impact of this project and it's all down to your support.  It couldn't have happened with your financial backing.  Thank you so much for partnering with us to bring health and hope to mothers and babies in western Myanmar!

We have, however, spent all of the funds raised over the last year and are now looking to secure further funding to enable the project to continue after the monsoon.

Can you help?  If so, please do share the link to our project page to enable this vital work to continue and if you are able, please do consider donating again.  

Thank you once again, 
Michelle

Providing expert guidance and advice
Providing expert guidance and advice
TBA Trainers training local women
TBA Trainers training local women
TBA Trainers using visual aids
TBA Trainers using visual aids
Equipping indigenous leadership
Equipping indigenous leadership
Out in the villages
Out in the villages
Trained TBAs in action!
Trained TBAs in action!
Local women arriving for training
Local women arriving for training

Links:

Some of our amazing Traditional Birth Attendants
Some of our amazing Traditional Birth Attendants

Thanks to your generous support we are just a month away from running our first ‘Train the Trainer’ workshop for Traditional Birth Attendants.

The workshop is part of a new pilot project, expanding our maternal and child health programme by equipping our most experienced indigenous health workers with the skills to proactively pass on their midwifery knowledge to new TBAs. The new indigenous trainers will also be taught how to support and monitor the work of our growing team of TBAs, allowing us to record our impact in a more effective way.

Over time this project will reduce the dependency on international trainers to run workshops and improve sustainability and community ownership. It will also provide evidence of the impact of the TBAs which can be used to improve the initiative going forward.

At the first workshop in March 2018, we will be training seven of our most experienced TBAs. The workshop will be run by three UK midwives, two of whom have made six prior trips to the region, in addition to running a successful training project in Mongolia.

Following the workshop in March the newly trained TBA Trainers will each teach a bespoke curriculum to seven new TBAs from local villages. 

In November, the UK midwives will return to Chin State, meeting with the original seven trainers to receive feedback on their experiences and to evaluate the progress of the pilot. The UK midwives also aim to:

  • run hands-on training for the new TBAs
  • assess the extent of their knowledge through practical and theoretical assessments
  • provide additional advanced practical training 

We are so grateful to you for partnering with us to bring health and hope to mothers and babies in western Myanmar. 

Do look out for photographs and stories of the training shortly after Easter!

UK midwife teaching essential midwifery skills
UK midwife teaching essential midwifery skills
TBAs learning to stitch wounds
TBAs learning to stitch wounds
TBAs receiving UNFPA dignity kits
TBAs receiving UNFPA dignity kits
 

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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
$20,972 raised of $56,198 goal
 
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$35,226 to go
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