BLOG - CleanBirth - Saving Mothers and Babies in Laos

May 15 2012

My CBK: Development Laos, PFR and World Bank

The Poverty Reduction Fund (PRF), established in 2003 by the Lao government and funded by the World Bank (check out the great video), is making progress to reduce poverty.

From February 2003 to March 2011…

86 bridges have been constructed;

More than 668 villages have received access to clean water systems and 154 irrigation schemes have been developed;

3,042 km of rural access roads have been upgraded;

598 schools and 62 health clinics have been built in remote villages;

681 community members participated in the decision-making process (33 percent women and 95 percent non Lao-Tai speakers);

1,113 training programs were provided for approximately 68,000 community members at village clusters level;

181 training programs were provided for over 310,000 provincial, district, and cluster village facilitators.

May 15 2012

Women with Fistulas: “Lepers of the 21st Century” and Hope

Nicholas Kristoff wrote an article about Dr. Steven Arrowsmith and Dr. Lewis Wall, who had the dream of opening a hospital in Western Africa to treat women with fistulas. Thanks to the article, and the 500,000 raised, that hospital has opened in Niger. Here’s more from a May 12 article about the need for this hospital.

The hospital has also started an outreach program to provide prenatal care, family planning and other help for maternal and child health. The aim is to save lives as well as prevent fistulas.

Fistulas are suffered by an estimated 2 million women and girls.

Left untreated, women and girls with fistulas become pariahs. Their husbands divorce them, and they are moved to a hut at the edge of the village. They lie there in pools of their waste, feeling deeply ashamed, trying to avoid food and water because of the shame of incontinence, and eventually they die of an infection or simple starvation.

May 15 2012

Reducing Maternal Mortality: It Takes a Village and a HUGE grant

I just read A Mother’s Day Lament: Why Has Improving Maternal Health Been So Elusive? by Anne Goddard, President and CEO, ChildFund International, in the Huffington Post. The lament is that progress toward keeping moms healthy and safe in childbirth and reducing maternal mortality has been the slowest of all the Millennium Development Goals (MDGs).

Her organization is doing huge, meaningful, effective work in Africa, India, Southeast Asia, and Latin America. She writes of the org’s health work in Senegal:

Thanks to a grant from the U.S. International Development Agency (USAID), and working collaboratively with other partners, ChildFund has implemented a large-scale community health project that we believe will ultimately reach virtually the entire country over the next four years. A network of community-based health huts and outreach sites is being created so that virtually everyone — those in both rural and urban areas — will have convenient access to trained healthcare.

She goes on to write about the important role of education and engaging women themselves in the solutions:

In tandem with the centers themselves are additional educational efforts at the community level, particularly addressing some of the cultural traditions that can impact a woman’s health, such as the practice of female genital cutting. There are other cultural aspects that also are informing our strategy. We understand, for example, the vital role that grandmothers and godmothers play as mentors to the younger women in their communities, and so we are training these community elders as birth attendants and community health volunteers, integrating them into this system of healthcare built at the community level.

May 14 2012

Training Workshop for Birth Attendants: Hygiene, Cord Care, Referrals

This is an informative article about a training held in Nigeria for traditional birth attendants. The training focused on: hygience, cord care and referral to a health facility. This training outline seems like it would be applicable to many countries in the developing world.

HYGIENE: Wherever labour and delivery are managed, cleanliness is the first and foremost requirement. Nails must be short as well as clean and hands must be carefully washed with soap and water. Attention should be paid to the personal hygiene of labouring women and TBAs. As well as to the cleanliness of the environment and all materials used during birth. Positive effect of three cleans – hands, perineal area, and umbilical area. The TBAs must make sure that there is clean water at hand. There is need for careful hand washing – clean hands, clean delivery surface, clean cord cutting and care prevents puerperal sepsis (infection after delivery). Some measures should be taken during all deliveries to prevent possible infection of the woman and / or the TBAs. These measures include the avoidance of direct blood /direct contact with blood and other body fluids by the use of gloves during vaginal examination, during delivery of the infant and handling the placenta. Surgical gloves are latex gloves there are sizes to fit the hand. Sterile surgical gloves should be worn for each vagina examination.

UMBILICAL CORD CARE: Minimal handling of the umbilical cord should be done. The cord if not handled properly, can be the portal of entry of bacteria and other infective organisms. Therefore, ensure good cord care: Cut with clean new freshly opened razor blade, tie tightly to avoid bleeding. Ensure that the tie is sterile and keep clean and dry until it falls off.

REFERRAL TO A HEALTH FACILITY: TBAs should refer a woman to a higher level of care if complications arise which requires interventions, which are beyond the competence of the TBAs… Some cases requiring referral to a health facility are prolonged labour, prolonged second stage of labour, retained placenta, cord presentation, cord prolapse, antepartum, and postpartum haemorrhage, scarred uterus such as a woman with previous caesarean section or previous myomectomy, eclampsia and obstructed labour^{16, 18}.

May 10 2012

AYZH Birth Kits for Laos: Quality, Low Cost, Empowering

Yesterday, I spoke with Zubaida Bai at AYZH, which manufactures clean birth kits (AYZH instruction manual: http://bit.ly/JUnu2b) in India. Our conversation changed my way of thinking about the quality and assembly of the clean birth kits for Laos.

Before the conversation I had planned to buy the supplies in Thailand and arrange assembly once in Laos. Other organizations source inputs in the developing world and the inputs are simple. Or are they?

Talking to Zubaida, I realized that the quality and quality control of the products matters a great deal. For example, the AZYH kit contains a plastic clamp instead of a cotton cord ties — easier to keep sanitary. The sheet is not cut from a plastic roll but of padded, blood absorbing quality for comfort and easy clean up. The soap is medicated, the razor a sterile surgical blade with steel handle. Further, items are contained in a stylish jute bag, which encourages women to appreciate/use them, and is biodegradable.

The high quality makes it possible for AYZH in India and other organizations in Africa to charge a small fee for the kits, increasing user buy-in to utilizing the clean birth kits and creating sustainability.

Beyond the product being more effective and attractive, items are hospital grade and completely sanitized. The plastic cord clamp means blood/dirt isn’t absorbed into the cord tie, as with cloth ties. The kits are made by women with years of experience in packaging these kits in a totally hygienic manner. This had the most impact for me: it took years for AYZH to develop best practices for selecting products and assembly.

Before the conversation, I expected that I would engage community members to make the kits. However, talking to Zubaida, with her years of experience, I understand more clearly that distribution and education should be the focus. That is where I need to spend my time — not searching out the right items and locating a sterile place and team to assemble kits. Not at first anyways.

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