By Kristyn Zalota, founder, CleanBirth.org
In my last post, I wrote about the challenges mothers in rural areas face accessing prenatal and delivery care. The safe-delivery rate in cities in Lao PDR is six times higher than in rural areas, where my organization CleanBirth.org works.
The reasons for this disparate care of rural and urban mothers range from Mother Nature to infrastructure to a lack of information.
When it rains it pours.
“When the rains come, that’s when we have problems,” a nurse from Samouai District, Lao PDR shared at a recent CleanBirth.org nurses’ training. Her colleagues concurred. From May to September some clinics in Samouai and Taoi Districts are totally cut off from phone communication and supplies. While attempting to restock kits in one village, I received this response from my local partner:
“I asked our field staff to take the kits to the clinic but its impossible because of the bad road and rain but we will find a way to send the kits to the clinic as soon as possible.”
The challenges extend beyond washed out roads and downed phone service. Even on sunny days, distances from villages to clinics are great and transportation expenses very high. Expecting families must pay for medicine and supplies in the clinics. Further, nurses in clinics are often poorly trained and without sterile supplies.
Families often lack important information about warning signs in pregnancy and delivery. Mothers in certain villages give birth completely alone, without a spouse or mother, because of cultural beliefs about touching blood.
Empowering Nurses & Families.
While certain obstacles like rain and infrastructure are beyond the scope of what my organization can do, I am thrilled by the changes emerging since we began training local nurses. The benefits of this capacity-building have been two-fold: families are better prepared for births in villages and nurses are better prepared for births in the clinics.
CleanBirth.org trains nurses to counsel expecting families about hygienic birth and the proper use of the Clean Birth Kits that we provide. Nurses talk to families about the critical need for mothers to have a partner during labor.
To encourage family members to help laboring mothers, the nurses suggested adding gloves to our kits to help overcome the fear of touching blood.
We listened to the nurses and added gloves. It’s working.
More family members in areas traditionally opposed to helping mothers are acting as birth partners.
“So What Happens When…”
The nurses have so many birth-related questions that their previous education didn’t address. With the help of midwives from Yale University, we get them the answers they seek. They receive a thorough training in using, distributing and collecting data on the Clean Birth Kits. They learn about the WHO’s Essentials of Newborn Care and are able to ask any additional questions to help them better to do their job.
Keep it Local.
We believe that empowering local nurses and our Lao non-profit partner, ACD-Laos, is the only way to sustain the positive changes that we are seeing:
- 800 Birth Kits were used so far in 2015 from 0 in 2012.
- ZERO reported cases of infection in 2014-15.
- Birth Kits are now standard practice in all 31 clinics where we work.
We advocate local leadership of the project as it develops. In the most recent nurses training, ACD-Laos organized and conducted the entire training, with CleanBirth.org footing the bill. To me that level of local ownership is what will make the progress that we are seeing evolve into lasting change.