Sierra Leone
Sierra Leone is a beautiful country on the coast of West Africa. MOMS' work is currently centered in the Kailahun District. We started in Pellie in the Jawei Chiefdom, then moved northwest to the Jokibu area and to Daru which is the capital city of the Jawei Chiefdom. Pellie does not appear on any commercial map we have found, but Jokibu is on one map, and Daru is on most maps.
Some of you may associate Sierra Leone with movies like "Blood Diamond", which is about the civil war that ended about eight years ago. While the war has ended, the destruction of the country is still apparent in the burned-out buildings, lack of infrastructure, lingering trauma, and the maternal and child mortality rates: the worst in the world.
Maternity care in Sierra Leone
While birth is a normal part of a woman's life, if she is malnourished or ill, she can face serious problems. A trained birth attendant supports women during pregnancy, connects women with the health-care system, and reacts quickly and appropriately if something does go wrong. In a country where the maternal mortality rate is about 2% and women have a one in eight chance of dying in pregnancy or birth, birth attendants need more skill.
The statistics are terrible - of course women are going to die of infection when the water is contaminated and the birth attendants don’t have gloves! When malaria is rampant, women are going to suffer from terrible anemia and are more likely to hemorrhage at birth. Malnourished girls grow up to be malnourished women, with compromised bone structure and immune systems.
A woman who is rejected by her husband, mother-in-law, or co-wives is likely to suffer from problems ranging from violence to being the last in the family's "pecking order." For the TBAs to be aware of risks like these and to sensitively and succesfully intervene is vital to improving maternal outcomes.
Our first classroom in Pellie was a dirt-floored “barrie”, village gathering place.
MOMS’ Work
We have worked with over 130 Traditional BIrth Attendants (TBAs) from 35 villages so far. When they successfully complete our course, we provide a certificate identifying them as “MOMS TBAs”.
In Jokibu, the women told us they had never heard of providing postnatal care - even in the government-sponsored training! As a result of our session on how to provide postnatal care, one of our learners, Fatmata, went to the women she had tended in the previous week. In checking one of them, she was concerned about symptoms of infection. Fatmata took to woman to the clinic, where the Maternal/Child Health Care Aide diagnosed an infection and gave antibiotics. The MCH Aide said that Fatmata’s action likely saved the woman’s life.
This is exactly the kind of results we want to see! We want the TBAs to do more than simply deliver babies. The TBAs are uniquely positioned in their villages to improve the health and life of the women and their families.
For a TBA to become a “MOMS TBA”, she must develop this broader perspective about women’s health, and become the bridge from the villages to the health system, as well as providing skilled maternity care. The MOMS TBA is a professional working to improve maternal and infant health
Women in rural Sierra Leone are intelligent and experienced - and illiterate. So our program leverages their ability to memorize, sing, and act. The program includes hands-on practice and rotations in the clinic, under supervision. This helps them learn to keep pregnancy and birth normal, and what to do if things do go wrong.
We tested the classes in summer 2007, with great success. Based on our findings, we are developing the program to meet needs most effectively. In July 2008, we taught another cohort with the revised program and are gathering impressive statistics and stories. In January of 2009, we trained 37 women in Daru, who have made a solemn commitment to protecting the health of all women in their area.
We will train trainers and administrators to continue the program independently. We will then work in other rural areas nearby, so the provision of skilled care is available and consistent across the region. We will stay until the people manage the program well, then cheerfully travel to other areas of need. We expect the process to self-sufficiency will take between five and ten years.
Pellie MCH Aide, Veronica Foday, congratulates one of MOMS’ new TBAs!
MOMS’ Curriculum
Our mission is to improve maternal and infant health and maternity outcomes. To do this, we created a 3-week course that provides the learners with the fundamental knowledge and skill they need to be effective Traditional Birth Attendants (TBAs). We include lengthy discussions of...
- risk factors
- referral mechanisms
- nutrition and hydration
- sanitation
- family planning
- breast-feeding
- reproductive anatomy and physiology
- comfort measures in the childbearing year
- prenatal care
- postnatal care
- techniques to support healthy birth
One of the modules may be a bit unexpected: Organizing for Change.
The purpose of this module is to galvanize the women to think creatively about how to make a difference in their villages. They enter the course planning to learn about attending births. But this is only one part of the solution to the world's worst maternal and infant mortality rates.
We saw cases where a skilled attendant at delivery was a good thing. What would have been better is some prenatal care, which would have included identifying problems like malnutrition, stemming in part from bad family dynamics. What would have been better yet would have been to add postnatal care to the package, to help prevent infection, to support breastfeeding, and to prevent infant death. Yet the provision of prenatal and postnatal care require significant changes in the thinking of both the TBAs and the women they serve.
In Organizing for Change, we create a forum for discussing problems like these and possible solutions. Included is a method and demonstration of techniques for solving problems. We suggest they find ways to work together to influence the leadership and families to provide more effectively for women who struggle most.
The women in the Pellie session created three groups (Sentia Clubs), based on geography, to take action. Each group has a structure, and requires dues of its members. With this and a micro-grant from MOMS, they are buying seeds to plant a garden, which will provide food for hungry mothers. They have talked to the village elders about these issues, and set expectations that the Santia Clubs will take action to serve their communities.
The TBAs pay about 60 cents per month in dues. This represents a hardship for many of them - per capita income is under $400. These women are not compensated for attending births. And when they go to a woman in labor, it means that their work on the farm will not get done. Their household will suffer because she is gone. The TBAs are respected in their communities, and making the commitment to be a MOMS-trained TBA can lead to hardship.
We will continue to work as their partners while they and their communities make the changes they need. Adding “change agent” to their role is a big shift the TBAs self-view, but they are committed to these changes for their women and for themselves.
