WUNRN
MYANMAR/BURMA - MOBILE OBSTETRIC
MEDICS IMPROVE MATERNAL
& CHILD CARE IN CONFLICT AREAS
Photo: Courtesy of
courtesy of the Karen Department of Health and Welfare
Obstetric care has long been a challenge in the east
MAE SOT, 17 October 2011 (IRIN) - In conflict-afflicted eastern
When labour pains began, traditional birth attendants routinely pushed the
woman's stomach, sometimes injuring or killing the baby; others used sharp
slivers of bamboo, which had been cleaned with charcoal, to cut the umbilical
cord, leading to deadly infections.
"Services were very limited. Maternal deaths, pregnancy-related issues
like anaemia and infant mortality, were very high," Nay Htoo, programme
director for the Burma Medical Association, a Mae Sot-headquartered
community-based organization (CBO), told IRIN.
In parts of eastern
At the same time, the maternal mortality rate is 721 per 100,000 live births,
three times the country's national rate of 240. In neighbouring Thailand, that figure
stands at 48.
With high levels of conflict, forced labour and human rights abuses, such
health indicators are particularly dire, but ignorance and dangerous traditional practices are
also at fault.
Training
To address these problems, in 2005 several CBOs, the Center for
Public Health and Human Rights at Johns Hopkins University, and the Global Health
Access Program launched the Mobile Obstetric Medics (MOM) project -
dramatically boosting access to care.
The MOM project brought community-based maternal and child health workers from
Myanmar's Shan, Mon, Karen and Karenni states - unstable regions where ethnic
militia and Burmese troops for decades have waged war - to Thailand for
training in ante-and postnatal care, sterile deliveries, treatment for
complications, as well as family planning services.
These maternal and child health workers would then pass on their new knowledge
and skills to village health workers and traditional birth attendants, making
sure that if complications arose, this triumvirate would cooperate and
coordinate to provide care.
In the year after the MOM project began, only 5.1 percent of deliveries were
attended by a skilled provider, according to research published in
2010.
By 2008, births attended by health providers trained to deliver emergency
obstetric care had increased to 48.7 percent.
"The MOM project was a huge success," Luke Mullany, an associate
professor at Johns Hopkins Bloomberg School of Public Health and lead
author of the 2010 paper, said.
"Our collaboration and the work of our implementing partners produced a
three-tiered network of community-based providers who were able to provide
elements of basic emergency obstetric care at high coverage," Mullany
explained.
Dangerous practices
Integer, a former maternal and child health worker in Karen state's Kler Lwee
Htoo District, who like many Burmese goes by just one name, said some
traditional birth attendants kept long nails in case of difficult deliveries,
to fatally puncture a baby's head, releasing tissue to shrink the head,
allowing the baby to be delivered.
"Before, they didn't know sterile methods or even the stages of delivery
and when to begin the delivery," said Integer, now reproductive health
programme coordinator for the Karen Department of Health and Welfare, a CBO involved in the
MOM project.
"After training, they got that knowledge, and they also learned about
high-risk pregnancies. When they see a high-risk pregnancy, they can send the
patient to the nearest clinic for further examination."
The maternal child health worker travels around her area to train, supervise
and assist the traditional birth attendant twice a year.
Older birth attendants
Each year, about 25 health workers illegally cross the border into
One challenge, say Nay Htoo, is passing on these lessons to older traditional
birth attendants.
"Some still lack the skills to follow the protocol, step by step,
especially the very old traditional birth attendants. Most are illiterate, so
you have to use symbols to train them," Nay Htoo said.
"The traditional birth attendant is a stakeholder in the community. If
they don't trust you, they will not join the programme, and you cannot
implement the programme successfully. To change people's ideas, especially the
older people, is not easy."
Health workers in the MOM project are given traditional birth attendant kits
that include gloves, scissors, gauze, cotton as well as dietary supplements and
medicines.
Because of ongoing tensions between ethnic groups and the Burmese government,
ethnic Burmese CBOs try to improve care in their home country from
"Even though we are based in
"Every time we bring people back and forth for training and project
re-supplying purposes it's very difficult, but we know how to deal with local
authorities in