Monday, 8 November 2010

Technology Problems and Traditional Birth Attendant Training

It has been weeks now since I have been able to update my blog. I have had a series of frustrations with technology including problems with computer charging cables, generator and internet modems but am now back in the online world. It brought home to me how much I rely on the limited internet access we normally have here in Kamakwie to feel connected with friends, family and the wider world.

This year has flown by and I can’t believe I only have 5 weeks of my World of Difference Year left. Since writing last I have spent a week training midwives, nurses and doctors who work in faith based hospitals in Sierra Leone on emergency obstetric care. During October I was working with the hospital staff at Kamakwie to complete the work we have been doing on the maternity ward to improve documentation and clinical guidelines. During our final review meeting staff said although they were initially concerned about increased workload, the new system is helping them. They say it is especially useful having more comprehensive information about each woman and baby when shifts change and new staff take over and it makes it easier to detect problems earlier. Medical staff reported that improved recording of the condition of the mother and baby, including treatment and medications given make planning and evaluating care easier. One area that we are still working on improving is recording of care given to women during labour using a partograph – this is a tool used to record information about maternal and fetal wellbeing during labour, it also helps health staff identify prolonged labour. A colleague and I have spent some time teaching the Maternal and Child Health Aides to help them understand it.

In 2008 in Sierra Leone almost half of women gave birth with Traditional Birth Attendants and in the remote communities we work with the number of women giving birth with TBAs is higher still. In a drive to reduce the high maternal and child mortality rates in Sierra Leone the Government launched free healthcare for pregnant women in April this year and is now urging all women to give birth in a health centre. The Government is advising TBAs to refer labouring women to a health centre to give birth instead of helping them to birth at home. At Health Poverty Action we try to take a grass roots approach to improving health of women and babies. We believe strengthening links between the community and the health care system, increasing knowledge of healthy practices at community level and supporting women to access available services are important if the expected results of the free healthcare initiative are to be realised.

We have been working to design a training course and toolkit for Traditional Birth Attendants to enable them to work as Maternal Health Promoters in their remote villages to share maternal health messages to promote healthy behaviour including, seeking of appropriate care during pregnancy, birth and the postnatal period, exclusive breastfeeding and use of family planning. These women are almost all illiterate so we have developed a toolkit of pictorial flashcards which they will use to promote discussion and share health messages. These women will work closely with the health workers in the rural health centres, they will mobilise women to access skilled care during birth and offer them additional support and encouragement during labour. Part of this project is to ensure women in the remotest areas have equal access to health services; we are planning to pilot birth waiting homes close to 8 of the rural health centres we work with. Women living long distances from the health centre will be able to come and stay in these rooms to be close to the centre when labour starts. The Maternal Health Promoters will also give support and health information to the women who stay in the home.

The training was incredibly fun but we had a few challenges. Language was the biggest. During this training the trainees spoke Loko, Temne and some also spoke Krio. There was lots of translation needed to be sure everyone understood. The fun part was the singing; I think we now have a song for every part of the training. The culture of song and dance is incredibly strong here. I was in awe of these women who can rustle up a song on any topic at the drop of hat. I also enjoyed immensely talking to these women and hearing about their work. Many of them although unable to read and write have kept meticulous records of the births they have attended by asking community members such as a teacher who can write to help them. I feel lucky to have the opportunity to work with these women, who hold so much information on the culture and history surrounding childbirth in Sierra Leone.