Showing posts with label maternal mortality. Show all posts
Showing posts with label maternal mortality. Show all posts

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!



Sunday 13 June 2010

Life, birth and death: The horror of poverty

This video from Time, on Maternal Mortality in Sierra Leone, the story of Mamma - one woman's journey from pregnancy to death is a heart wrenching portrayal of what is happening to too many women in
impoverished circumstances.

The Time photo montage shows a photo of young woman with a glazed, far away look on her face, intravenous therapy in her hand, lying on a trolley bed, a baby on a chair beside her.  The photo's caption says:
"Birthing Room
Forced to marry at age 14, Mamma Sessay first gave birth when she was 15. Three years later, at the age of 18, she gave birth to the first of a pair of twins near her village, but when the contractions ceased for the second child, she traveled by canoe and ambulance to the Magburaka Government Hospital, where she waits, in the photo above, to deliver".
Read more at Time Photos: Maternal Mortality in Sierra Leone

The video of Mamma Sessay's life and death experience is recorded and reproduced here:

Video: Maternal Mortality in Sierra Leone

Poverty and the associated lack of clean water, sanitation, good food, contraception, respect for women, education, family planning, antenatal care, being married too young, having babies too early - the list goes on and on, is the real problem. The other real problem is social apathy and feelings of helplessness about women's lot in disadvantaged situations. Labour and birth are peak and demanding activities. Women do best when they are well nourished, well hydrated, informed, have good midwifery care during pregnancy, labour and postnatal period, are having babies when they want to, have been well prepared for labour and birth, are able to labour and birth with loved ones around and able to access good medical care if and when required.

The article in Time, called The perils of pregnancy is horrific, but the emphasis is wrong. The emphasis should be on the perils of poverty.


Why are our governments spending our hard earned tax dollars on war for oil, when we could spend our money on making life better for our brothers and sisters across the world. With a different way of looking at world affairs we could save the lives of women like Mamma.

There are some good signs. According to Dr Margaret Chan, Director-General of the World Health Organisation, in her opening address on behalf of eight organizations at the Women Deliver 2010 Ministers Forum Washington, DC, USA  on the 7th June 2010

"Domestic resources and donor funds are making a real difference to the lives of millions. The number of children dying before reaching their fifth birthday has been falling for several years. We are now seeing early signs of progress in reducing the number of women dying in pregnancy and child birth, in addition to the achievements in HIV, TB and malaria".
and added

"This progress is most welcome, but is fragile, uneven, inequitable and inadequate. Far too many women and children continue to die needlessly"

calling for a world wide, coordinated effort and finances, including:

"government leadership of inclusive partnerships at country and global levels to design, implement and monitor the commitments and promises of all stakeholders".

Letter writing and political activism required. 

What do you think?