September 08

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Circle of Life

As promised I would like to share some of the stories my colleagues have come back with from their field trip. To be clear, the following comments are my opinions/interpretations and are not a reflection of CHAI or GSK.

Baby girl delivered in a tuktuk with the support of my colleagues

The most exciting story was that two of my young colleagues helped with a delivery, both their first experience of child birth! As they left a Traditional Birth Attendant’s (TBAs) house they saw a woman limping towards a ‘keke napep’ (tuk tuk), they thought she was injured. As they approached her and asked if she was ok, her waters broke. Fortunately the member of the state ministry of health accompanying them on the trip was a midwife. She asked the driver to drive the keke napep to a nearby school for privacy; he promptly threw the keys on the floor and ran away! Luckily they managed to find someone else to drive her. Meanwhile my colleagues and the TBA ran back to the TBA’s house to collect (CHAI provided!) sterile gloves and a razor to cut the umbilical cord. The mother gave birth to a daughter in the tuktuk. The baby was then taken to the TBAs house to clean her up and administer chlorhexidine gel to the umbilical stump to sterilise it. Both mother and baby are well. The driver came back and was very upset about the state of his keke napep!

The three states CHAI are working in are in the north of Nigeria. A lot of communities are extremely remote, which makes it very difficult for pregnant women to reach facilities for check-ups/antenatal classes/deliveries. This combined with the large Muslim population mean home births are as high as 90% of deliveries. TBAs usually have no medical training, but support community births. Nigerian policy is for TBAs to purely refer women (or clients as they are called) to a healthcare facility. However, evidence has shown (particularly in the north) this is not happening. Therefore, the program I am supporting CHAI with is to actually equip the TBAs with skills, tools and some drugs necessary to identify risk, stabilise and refer the clients to medical facilities.

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Rural Landscape

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Traditional Birth Attendant with her backpack for the clean delivery kit and her training handbook

The intent of field trip was to go and audit the TBAs; to check that they are practicing what they were taught in the CHAI didactic training, that the focal TBAs are mentoring their TBA mentees, they are using the commodities CHAI equipped them with appropriately and very importantly they are completing the data logs properly (many TBAs are uneducated). The trip confirmed to the team the reasons why CHAI have taken this course of action; many communities are extremely remote – hours off main roads that even CHAI 4x4s struggled to access, even if women did make it to the rural facilities they can be ill-equipped to support a child birth, and if a capable facility was on a women’s ‘doorstep’, the feedback we received was she would still give birth at home. Therefore, we need to utilise the TBAs to support these women.

There were many anecdotes shared by the TBAs. The one that has stuck with me was where a TBA delivered twins, one of which was not breathing. Those at the birth assumed the baby was dead. The TBA having had her training and been provided with a neonatal suction bulb, began using the bulb to extract the mucus from the baby’s mouth. After some time of doing this she saw the umbilical stump start pulsating and shortly after the baby started breathing. The horrifying alternative is reality for a lot of families in these states. While the team were travelling one of their drivers shared that his wife had delivered a baby that week who was not breathing and before he knew it the baby had been taken away by his brother to be buried. When asked by my colleagues if the staff tried to help the baby breathe by clearing the airway he did not think so.

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Rural Healthcare Facility

Although I was disappointed to not be able to join my colleagues on the field trip (they really did travel to remote places in the north!), their stories and commentary have given me an insight that I did not have before. It was an extremely worthwhile exercise as it reinforced the work we are doing, enabled us to course correct a couple of things to ensure the final 4 months of the grant are utilised as best as possible to be successful in reducing maternal and newborn mortality rates by 40% in these areas.