Traditional birth attendants learn their skills through on-the-job experience and the advice of old songs passed down to them by their mentors. Working with GHEI and our partner UCLA pediatric residents, their trainings are rooted in discussions emphasizing an understanding of the local context and how to work best within it. Being realistic is a priority in encouraging better healthcare and the use of modern practices and facilities while simultaneously acknowledging local resources and desires. Traditional birth attendants are key healthcare providers in this community and last week, proved themselves to be extremely capable.
GHEI welcomed back local traditional birth attendants for a refresher training and continuation of the pilot we started last year. The goal for this year’s training was to refine our curriculum to more closely reflect the needs of the local community. UCLA pediatric residents Jay Joo and Andy Newcomer led the program, working to keep the training’s focus on the most appropriate topics.
Familiar faces entered the room and proudly came around to greet each of us there. It was the same women who attended our training last year, and they were clearly excited to be back. Traditional birth attendants are part of a long-established practice that is still commonly relied upon. They learn how to deliver through apprenticeships, and now for the second year, have worked with GHEI staff and UCLA pediatric residents to broaden their education. Our training is focused on administering neonatal resuscitation, identifying danger signs during a delivery, and most importantly, knowing when to refer to a health facility. Based on conversations throughout the training and an oral evaluation the women took at the beginning, it is clear that last year’s training was successful. The TBAs retained a lot and had even incorporated much of it into their practice.
Our trainings work to genuinely integrate the knowledge and resources of two very different groups to improve health. The residents spent a lot of time asking the TBAs questions like “have you ever referred a woman to the hospital and she has refused to go?” They opened the conversation to better understand the position of the TBAs, then tailored their lessons accordingly. They created a workshop environment that fostered a fruitful and productive discussion about how to best attend to home births in a place like Humjibre.
Similar to last year, they had few difficulties communicating, joking around, and learning to trust each other. At one point, Andy held the doll low and asked one of the ladies “What if the arm comes out first?” She shook her head and waved her hands as if to say “I don’t want it!” Jay chimed in “That is correct. Refer!”
There was discussion of not training the TBAs on using the bag and mask to stimulate breathing. This piece of equipment is needed in about one in ten births, and many of the TBAs only do a couple of deliveries each month. They will not need the bag and mask often, and may never fully be in practice using it. However, without any prompting, every TBA showed up to the training with the bag and mask she was given last year in hand. Not everyone had used it, but they always kept it ready and many were excited to share their experiences with it in the past year.
The women paid close attention during their bag and mask refresher training, and then each took turns acting out what they would do in various scenarios presented by the residents. The TBAs each knew their procedures well, and according to the residents, could “use the bag and mask as well as anybody.” At the end of each scenario, a small noise maker was used to imitate crying, signaling that the baby was properly breathing. Each first set of squeaks from the noise-maker was greeted with a smile and cheers from around the room.
A few weeks ago we blogged about GHEI’s new Health Facility Delivery Incentive Program which is designed to increase skilled birth attendance and facility-based deliveries. This program is designed to draw women away from home deliveries and the use of TBAs. If nothing goes wrong, a TBA can provide a comfortable, caring and affordable delivery. However, TBAs are not well prepared to handle complications and there is never an ambulance waiting nearby. In 2011, about 33% of deliveries in our region of Ghana took place in the home, according to the most recent survey.[1] With such common use of TBAs, the two programs complement each other; GHEI encourages delivery at a health facility, but also provides for the best possible care for those women who will inevitably choose to deliver at home.
[1] Ghana Statistical Service, 2011. Ghana Multiple Indicator Cluster Survey with an Enhanced Malaria Module and Biomarker, 2011, Final Report.
GHEI welcomed back local traditional birth attendants for a refresher training and continuation of the pilot we started last year. The goal for this year’s training was to refine our curriculum to more closely reflect the needs of the local community. UCLA pediatric residents Jay Joo and Andy Newcomer led the program, working to keep the training’s focus on the most appropriate topics.Familiar faces entered the room and proudly came around to greet each of us there. It was the same women who attended our training last year, and they were clearly excited to be back. Traditional birth attendants are part of a long-established practice that is still commonly relied upon. They learn how to deliver through apprenticeships, and now for the second year, have worked with GHEI staff and UCLA pediatric residents to broaden their education. Our training is focused on administering neonatal resuscitation, identifying danger signs during a delivery, and most importantly, knowing when to refer to a health facility. Based on conversations throughout the training and an oral evaluation the women took at the beginning, it is clear that last year’s training was successful. The TBAs retained a lot and had even incorporated much of it into their practice.
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| Cards distributed to the TBAs early in the training |
Similar to last year, they had few difficulties communicating, joking around, and learning to trust each other. At one point, Andy held the doll low and asked one of the ladies “What if the arm comes out first?” She shook her head and waved her hands as if to say “I don’t want it!” Jay chimed in “That is correct. Refer!”
There was discussion of not training the TBAs on using the bag and mask to stimulate breathing. This piece of equipment is needed in about one in ten births, and many of the TBAs only do a couple of deliveries each month. They will not need the bag and mask often, and may never fully be in practice using it. However, without any prompting, every TBA showed up to the training with the bag and mask she was given last year in hand. Not everyone had used it, but they always kept it ready and many were excited to share their experiences with it in the past year.
A few weeks ago we blogged about GHEI’s new Health Facility Delivery Incentive Program which is designed to increase skilled birth attendance and facility-based deliveries. This program is designed to draw women away from home deliveries and the use of TBAs. If nothing goes wrong, a TBA can provide a comfortable, caring and affordable delivery. However, TBAs are not well prepared to handle complications and there is never an ambulance waiting nearby. In 2011, about 33% of deliveries in our region of Ghana took place in the home, according to the most recent survey.[1] With such common use of TBAs, the two programs complement each other; GHEI encourages delivery at a health facility, but also provides for the best possible care for those women who will inevitably choose to deliver at home.
Be sure to check out our Facebook where more photos will be posted in the next few days.
[1] Ghana Statistical Service, 2011. Ghana Multiple Indicator Cluster Survey with an Enhanced Malaria Module and Biomarker, 2011, Final Report.
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