An educated approach
Addressing issues of maternal health are an increasing focus of
AVI's Cambodia and Thai / Burma Programs. The number of women dying
at childbirth and infant mortality rates in these environments are
among the highest in the world.
AVI Country Manager Eleanor Loudon and two AVI volunteers write
about the challenges of strengthening maternal health care in
Cambodia and on the Thai / Burma border.
AVI Midwifery Educator
Adrienne White's work in dusty outposts along the Thai / Burma
border is improving midwifery training in an effort to enhance the
support available to birthing mothers.
AVI Midwifery Preceptor Adviser Jill Moloney and AVI Midwifery
Course Adviser Ping Bullock are working at a pre-eminent university
in Phnom Penh to improve the quality of midwifery education in
Cambodia.
While working in two completely different environments, these
volunteers are addressing very similar issues.
Strengthening midwifery education, improving curriculum and
training educators in the sector is at the heart of the work of
these three volunteers. In both environments, the delivery of
midwifery education varies from teacher to teacher and from
provider to provider.
On the Thai / Burma border a common curriculum has not been
decided amongst organisations delivering training in the camps. In
Cambodia the accredited curriculum is interpreted according
to the provider and then according to the teacher's interpretation
of the text.
Following are stories highlighting the contribution of AVI
volunteers Adrienne White and Jill Moloney to improving midwifery
support in two very different settings.
Reducing Cambodia's infant mortality rate
By Jill Moloney
It's difficult to get ahead even for the most dedicated
midwifery students in Cambodia. For a country that has emerged from
a turbulent period of history, the
problem for students is not only accessing higher education, but
also receiving a
standard of education which then enables them to enter the
workforce and make a
significant contribution to maternal-infant health.
Champa Munny is a student I have worked with who is facing both
of these challenges. Her family is too poor to finance her
education, and so to support
her studies in the day time, she also works a night duty shift to
meet her university fees and basic living costs. She is graduating
this year and is determined to play her role in meeting the
challenge of reducing maternal-infant mortality rates through safe
motherhood and birthing.
However, her impressive commitment needs to be matched by the
ability of the
university to provide a high quality of education as new midwives
start their
careers.
Cambodia's health sector is committed to addressing the
challenges of improving
services for maternal-infant care. The low number of midwives is a
recognised
obstacle and there is a strong commitment to see more midwives
trained. However, a key resource issue is the lack of skilled
trainers and lecturers in the universities and support staff for
students, as they get their first experience in the hospitals and
clinics. This is, of course, a country where the genocide in the
1970s targeted the educated, and recovering from that huge loss in
terms of restoring the standard of the education that children
receive at primary school all the way up to higher education is,
inevitably, a very long process.
I am working on a joint Australian Volunteers International
(AVI) and AusAID
project that is supporting the University of Health Science -
Technical School for
Medical Care (TSMC) to implement a new three year course for
midwives. Working
with qualified midwives in the maternity department, the Cambodia
Midwives Project is endeavouring to support a more effective
preceptorship program. This
involves students getting significant and relevant support to
improve clinical skills
whilst learning to become skilled midwives.
As an AVI volunteer in Cambodia, I am a committed member of a
team that is
helping students like Champa Munny to enter the workplace with the
skills and
professionalism to improve maternal-infant services in Cambodia
and reduce
maternal, newborn and infant mortality across the country.
Safer childbirth choices for Burma's refugees
By Adrienne White
Refugees and migrants have crossed into Thailand from Burma for
the past 20 years to escape military rule and find safety, health
care and paid employment.
These communities face a range of challenges, including maternal
mortality rates that are approximately 40 times higher than in
Australia.
The Shoklo Malaria Research Unit (SMRU) in Mae Sot on the
Thai/Burma border has provided maternity services and midwifery
training to refugee and migrant
communities for more than 20 years. As many skilled refugees have
been resettled to third countries and more leave every year, there
are fewer experienced midwives to provide maternity care and teach
new staff.
In response to this problem, my role as a Midwife Educator at
SMRU is to develop
and teach a midwifery education program and mentor a local midwife
to continue this training once I have completed my placement.
Most of SMRU's students are refugees and are of the Karen ethnic
minority, who live and work with the women to whom they provide
maternity services. Having access to skilled local midwives in
their communities and accurate information
about antenatal care, nutrition, screening for malaria and place
of birth will hopefully influence safer childbirth choices for
women.
Three midwifery students are mature-aged traditional birth
attendants. They are
respected members of their villages with significant influence on
women's health
and birthing practices.
Training started in October 2009 and the first 20 SMRU midwifery
students will
graduate in October 2010 after completion of a six-month theory
and one year clinical teaching program. To support my activities I
have developed informal links with an Australian university. My
colleagues and I are hoping to formalise this
collaboration to provide future recognition of the training
program.
I now face another challenge of overcoming language and
communication barriers, as I cannot (yet!) speak more than a few
sentences of either Burmese Karen or
Thai languages. Most students speak English as a third, fourth or
even fifth
language or not at all. However, I am very fortunate to have a
Burmese
medical colleague who co-teaches with me and translates
theoretical and practical sessions.
Find out more about the Shoklo Malaria Research Unit at www.shoklo-unit.com