Transforming Maternal & Child Health in Myanmar

In December, twelve local women who had completed our Trainer of Trainers (ToTs) course delivered maternal and neonatal training into twelve remote villages in western Myanmar.

The ToTs were paired up based on their ability to speak the local language, and to encourage a good skill mix. Each ToT pair went to two villages to support training of local Traditional Birth Attendants (TBAs) as well as assist in educating the local community in key health topics. The ToTs also supported pregnant women and in some cases were in the right place at the right time to assist in deliveries alongside the TBA. Twenty four TBAs and an additional 72 local women received training and support on a range of topics from health in pregnancy and complications in birth, to breastfeeding and post-natal care.

One of the ToTs recounted her arrival in the village:

“The village welcomed us so warmly. We stayed for 2 days running a training workshop with both theory and practical sessions. The workshop went very well and the training was gratefully received. We taught about the importance of kangaroo care after delivery which is when the baby is put skin to skin with the mother immediately after birth. We taught the TBAs the importance of waiting for the placenta to come out naturally and warned of the dangers of puling or pushing the placenta out which is common practice in the villages. We also explained the importance of putting the baby straight to the breast and ensuring that the first milk from the mother was not thrown away. The TBAs and local women who attended the workshop were very happy to learn about this and so keen to pass on their new knowledge and apply it to their work.

One night whilst we were there, there was a delivery and the TBA wanted to immediately apply all her new knowledge. Unfortunately the umbilical cord was very short and the TBA didn’t feel it was long enough to place the newborn on the mothers chest immediately. But I dried the baby, placed the baby in a warm blanket, cut the umbilical cord and then initiated kangaroo care by placing the baby skin to skin with the mother whilst waiting to deliver the placenta. The mother and her family were so delighted, thankful for our help and grateful for our encouragement and support for the TBA”.

This testimony reflects the incredible need for the ToTs to be physical present in the village to support the TBAs as they apply the skills and knowledge given to them during teaching workshops.

Follow up visits and ongoing support are just as vital, not only for continued professional development, but also to ensure the TBAs are supported in a wide range of situations.

The example given in the previous testimony shows how even with classroom knowledge, every pregnancy is unique and every birth experience is different. Despite the challenges that may present, in many cases it is still possible to meet an excellent standard of practice. Initiating skin to skin (kangaroo care) and putting the baby to the breast for the first milk can still be achieved despite unexpected challenges if the TBA has a good understanding and is able to adapt their skills and problem solve by looking for alternative solutions.

Shortly after outreach, the ToTs traveled to Lailenpi for a 3 day workshop with the Health & Hope medical team.

The workshop provides the ToTs with the opportunity to share birth stories, discuss the training delivered, reflect on best practices for working in a community setting and identify ways in which they can improve the service they offer.

At the workshop, the ToTs also stocked up on essential supplies, such as clean delivery kits, gloves, soap, monitoring equipment, vitamins and pregnancy supplements.

Your support for this project is so important as it continues to equip local women with the skills to respond to the challenges of child birth within remote rural communities in the jungles of Myanmar. The knowledge and practice change as a result of this work has a radical impact on both the wider family as well as the new-born child, impacting health outcomes and saving lives.

Thank you so much for your continued support!

In our last update, we reported on the visit in March by two UK midwives, Frances & Maaike. Alongside running training workshops in Maternal and Neonatal care for Community Health Workers (CHWs), part of the trip involved assessing the effectiveness of the local ToTs (Trainer of Trainers). Feedback was conducted with twelve women trained from the rural villages. This was followed up by visits to the local communities to assess the quality of their training. 

The ToTs had each visited two remote villages in the last six months and had received overwhelmingly positive responses. Each village was provided with a Birthing Bag for the TBAs to use, alongside a set of Clean Delivery Kits. As a result of these outreach visits, 47 TBAs were trained who could not attend the course at the Health & Hope training centre. In addition, 113 village women joined the training. This provided an excellent opportunity for health education and promotion on essential topics including hand washing, nutrition, normal and abnormal situations in pregnancy and breastfeeding. 

The village visits gave Frances and Maaike an opportunity to see the ToTs in action:

"On arrival Mimi, the ToT, introduced us to the 10 TBAs that she has been training over the past year. They are all currently active and have been delivering babies either with Mimi or the local ambulant midwife. The trained TBAs are a great resource to the local community, as prior to Mimi’s training there were no trained TBAs and Mimi mainly had to work alone. She could not always be there when a woman went into labour, which brought additional risks." 

The TBAs were so enthusiastic about Mimi’s support: "Yes! She is a good teacher. We are so thankful because now we have confidence to manage normal pregnancy and birth as well as the difficult ones. We used to be scared of problems, but now we have practiced the emergency drills and know what is normal and what isn’t. As a result we are no longer afraid that women will die.”

During the COVID-19 outbreak, TBAs have become increasingly important. Our recent COVID-19 study conducted in the villages, found that ambulant visits from government midwives had stopped and villagers were also unable to leave the village for healthcare needs due to the lockdown. Without the trained TBAs, most women would not receive antenatal support and would have to give birth at home without a trained practitioner.  

Despite the ongoing challenges posed by the Coronavirus, we have been able to gain government permission to travel out to villages to provide health education and support to local health workers. In April, we reached 135 villages and four camps for internally displaced people. Our aim for the coming year is to continue to reach out to communities in need. Under this project, we will provide support to expand the ToTs work to a further 24 rural villages. The local trainers will be equipped to deliver a bespoke training package to TBAs, whilst our staff team will provide Maternal and Neonatal health services to women across a larger geographical area through outreach services from our local clinic. 

Thanks to your financial giving, we have been able to train and develop a strong local staff team to support this work. Do click through to our website here to see a short update on the amazing team serving their local communities as a result of your support.

With thanks for your continued generosity,

Hannah