WUNRN
Uganda: For Traditional Birth Attendants, Extra Training Is A Matter Of Life & Death
February
9 2008
Uganda: Traditional birth attendant Josephine Achen attending to an expectant mother
Three months ago, sheltering from the blistering midday sun under a mango tree, eight women in homemade nursing uniforms showed off well-worn certificates that were the pride of their careers. They were dated January 16 1999. That was the culmination of the only training that this group of traditional birth attendants from Katine in northern Uganda had ever experienced in midwifery.
They have brought hundreds of babies into the world since then, but they know better than anyone that as time moves on there is more to learn.
"New things keep coming. We don't know much about those," said the youngest of the group, Rose Ayugi, 32. In rural Uganda the official death rate for babies is 97 per 1,000 live births, and for mothers one in every 200 births.
All the birth attendants said they badly wanted more training, as they sat in the dust talking about the craft they learned mostly from mothers and grandmothers. Ten days ago they got it. Nineteen of them, from across Katine sub-county, reported to health centres for a three-day course entitled: "Antenatal care: recognising pregnancy danger signs and delivery complications for urgent referral."
The training has been organised by the African Medical and Research Foundation (Amref), which is carrying out a three-year development project in Katine, sponsored by the Guardian and Barclays Bank. The traditional birth attendants (TBAs) are crucial to the health of women in the area, many of whom cannot get to the maternity ward of the Tiriri health centre when they go into labour. That's fine when the delivery is straightforward, but if there are complications they need to be referred for medical help as early as possible.
"The training was about when to refer," said Carol Idusso, interim project manager at Amref in Katine. "It covered different things, such as recognising pregnancy danger signs, complications and antenatal care. The TBAs were extremely excited about it."
Things are beginning to happen in Katine, which has had little development assistance until now. Clean water is a pressing need. Many wells and boreholes are polluted, and some have worms. Two new boreholes have been drilled and one rehabilitated, following discussions with local people about their needs. Water source committees have been set up and trained to monitor wells and boreholes and keep them in good condition.
This project is about sustainability, not just a quick fix.
Katine's schools struggle. Class sizes are too large - the government has just increased the legal maximum to 57, but many are bigger than that - and many children have no textbook or pen, which parents have to supply.
All the families are up at sunrise and working in the fields, so many children are tired before they begin school. It doesn't help that they have no lunch (and often no breakfast). Teaching standards are not high and good teachers are hard to retain because of a lack of good accommodation.
At Tiriri primary several teachers and their families live in curtained-off corners of high-vaulted empty classrooms.
Ten of the primary schools are government-funded. Three others, Amorikot, Ojago and Kadinya, were built from mud and straw by local parents. The teachers are untrained volunteers who happen to have O-level exams, as they are still known in Uganda.
Yet although the needs of the community schools are vast, Amref's assessment revealed that two of the government schools had no textbooks of their own. Those they were using were borrowed from other schools. So a first batch of 470 has gone to Ojama and Oimai government primary schools.
"We're going to provide textbooks to all the primary schools, but we decided to prioritise these two because they didn't have any at all," said Carol Idusso.
Training for the teachers in child-centred education comes next and is focused on Amorikot and Kadinya, two community schools, where the teachers make it up as they go along, recalling their own schooldays. Training was scheduled to begin last week but headteachers asked for a postponement because it clashed with the start of term.
Development is a slow business, because changes must be bedded in and owned by the community. But the excitement is growing in Katine, because everybody can see that things are starting to happen.
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