Thursday, 8 September 2011

Strengthening Midwifery in PNG

Giving birth and being born is dangerous in Papua New Guinea.

According to the National Department of Health Ministerial Taskforce on Maternal Health in Papua New Guinea the staggering rate of maternal mortality in PNG is a national emergency.

Every day, at least five women die of preventable childbirth related causes. Sixty per cent of childbearing women do not have access to skilled birth attendants and because there are only 270 registered midwives in the whole country, outside of the understaffed and under resourced regional hospitals, maternity and newborn care falls on the shoulders of community health workers and nurses.

In  September 2000, Papua New Guinea committed to combat poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women and signed the United Nations Millenium Declaration, along with the other 190 UN member states. Eight Millenium Development Goals  were derived from this declaaration with specific targets and indicators. The PNG National Department of Health is targetting the 4th (reduction of infant mortality) and fifth goal (reduction in maternal mortality).

Midwives are internationally recognised as the number one primary health care professional for optimal safety for mothers and babies at birth. Even though there is recogntion of the vital role of midwives in optimising maternal and infant wellbeing and thereby reducing maternal mortality and morbidity in Papua New Guinea, the capacity to produce midwives too low and the number of midwives has remained stagnant. The midwifery workforce is aging and the registered midwives, few as they are, are rapidly approaching retirement.  Over the last five years, reports on the state of Midwifery Education and Maternal Health together with the National Health Plan have all focussed on increasing the midwifery workforce with the aim of having a midwife in every health centre and a skilled birth attendant for every childbearing women.

The reality is harsh. Too many women. A failing health system. Not enough midwives.

A sobering article in the Sydney Morning Herald in 2009 captured the issues and conditions succinctly on this date two years ago. Those issues and conditions are unchanged or worse.

Against this backdrop, the National Government of Papua New Guinea has partnered with the Australian Government to strengthen midwifery and capacity build the existing educational systems. Eight midwives started a month ago to work in pairs in four university programs with the educators and students to ensure the PNG National Standards and Competencies are achieved.

I'm fortunate to be one of the midwives, based at Pacific Adventist University (PAU) and working clinically with students and educators in the women and babies wing of Port Moresby Hospital.

The midwifery facilitation team, minus one and plus two!
From right to left Sue Englend (visiting Port Moresby), Lois Berry (based at Madang) Tarryn Sharp and her daughter Willoughby (PAU), Marie Treloar (based at Goroka) Alison Moores (University of PNG at Port Moresby), Glenda Gleeson (Mandang) Annie Yates (the Kiwi: University of PNG) and yours truly (PAU).  Missing from the photo is Heather Gulliver, who is also at Goroka with Marie.

Today, there was another big step in the right direction of strengthening midwifery in PNG.

The PNG Midwifery Society had their inaugural meeting in the conference room of the women and babies wing of the Port Moresby Hospital.

Fifty one midwives, nurses with midwifery education (unregistered) and student midwives crowded into the conference room to discuss professional midwifery matters.

Student midwives from PAU.
We booked a bus to bring the students and educators from PA University (about 30 minutes away from the hospital) and take them home again after the meeting. The students loved the experience. A very new experience for everybody.

The students are great fun and keen to learn. The educators are amazing people who are very welcoming and want their programs to meet the profession's needs and the Council's regulations. The midwives are appreciative of the students' work on clinical days as the midwifery workforce is scanty and the workload is huge. There is a lot to do to get things right in PNG.

Following the business of the meeting, the buzz was electric as the society member's shared food and conversation
As part of the Australian College of Midwives committment to supporting and strengthening midwifery in our closest neighbour nation, four members of the society, two from Port Moresby and two from Goroka have been sponsored by the College to attend the Biennial Australian College of Midwives Conference in Sydney. Another initiative in strengthening midwifery in PNG is the  International Midwives Twinning Project. Two members of the PNG society are being sponsored by the Australian College of Midwives to go to the Hague, with two Australian College members to discuss and explore professional matters at the end of the month.

We know that when there is a strong and autonomous midwifery profession, mothers and their babies do well. The PNG Midwifery Society has the potential to play an enormous role in strengthening midwifery and creating a proud and powerful professional group for midwives, which in turn, creates a safety net for the  mothers and newborns of PNG.

Judging by today's conversation and the turn out for the meeting, the Society is well and truly up for the job!


Anonymous said...

It sounds as if there is such a long way to go. It seems that the right team is on the job though!
I enjoyed the photographs as they gave a real sense of the birth community in PNG. I particularly liked the photos of the sharing of food- it seems universal in midwifery that strengthening collegial bonds and developing plans for the future occur over the sharing of something delicious.

Christine Catling-Paull said...

Fantastic work everybody!

Carolyn Hastie said...

Thanks Christine. Everyone is doing a wonderful job, despite the severe constraints. And Jules, you are right, midwives all over the world love sharing food and conversation! Interestingly, with the immense workload and the abysmal lack of even the most basic resources, the conversations are as passionate and as meaningful as midwifery conversations everywhere. We are all the same under the skin, no matter how different we look or how different our cultures. Midwives care about women and their babies.

Pam said...

It would be great Carolyn to get a sense of your own planned contribution to the process and a sense of deeper reflection as to how the experience is contributing to your own midwifery experience. it would also be great to hear whether you plan to get some feedback on how others view your contribution.

I'm writing a module on reflection for students and I've come across a great article on weblogs and how they should be used for reflection. One of the purposes in advocating for the use of blogs in reflecting is the opportunity to be challenged into a deeper reflective process by feedback from your readers!

Carolyn Hastie said...

Thanks Pam for your comments. The project is heavily evaluated from all the angles you could imagine. We have very clear TOR and targets to meet. We have rigorous evaluation processes in place. All good though. Already, impressive things are happening and the students tell me they are very happy we have come; they are really enjoying our clinical and academic support. I'd love a copy of that article you mentioned, sounds really good!

Lois B said...

What a privilege it is to be here working alongside the women, the students, the educators and the midwives. I am humbled by their strength, their resilience and their desire to make a difference.
I am aware daily of how much I have taken for granted when I hear birthing stories from the students. Of the 14 student midwives at Madang 2 of them lost their own mothers in childbirth. Their determination brings me hope for a very differnt future for birthing women in PNG.