In 2016 our Team in Malindi, consisting of Sophie (nurse/project director), Skola (childbirth trainer/family planning counselor), Sarah and Florence (HIV testers-counselors) and Danielle (executive director of Teaching More), visited 10 villages reaching more than 350 Traditional Birth Attendants (TBAs). All of the meetings were started by a word of prayer.
TBAs are not ministry of health staff nor do they receive a monthly salary for their work. They are paid a small amount between ksh. 300 ($3) to Ksh. 800 ($8) or given a chicken, a piece of leso (fabric) when they deliver a baby as a word to say thank you. Some actually have nothing to give because they are very poor.
According to research, traditional healers and traditional birth attendants throughout the coast present the first line of care to an estimated 70% of the population. According to research, 18% of deliveries are conducted by TBAs and 40% by relatives or some other people, for example neighbors. This shows that TBAs role is very important to the community, despite lack of the modern knowledge and practices.
Our meetings in the villages with the TBAs are always an interaction by skilled health workers, where we discuss freely without intimidation, and this allows the TBAs to be free to speak the truth. We have begun to understand a lot more about why women in the village do not like to go to the hospital for childbirth.
- In the hospital they abuse women, only listen to the heartbeat of the baby, and do not care about the mother.
- The TBAs, apart from listening to them, will give a cup of porridge or tea after delivery to her energy.
- When doctors and nurses use abusive language the mother may get discouraged and not want to go back to the hospital for the next visit.
- In the hospital, they are told, “why do you give birth carelessly while you are poor and cannot rise up children?” “You are not the only patient here for me to handle. Push for yourself.” Therefore, they decide to give birth at home and most of the time, assisted birth by an unskilled attendant.
I know what happens in the hospital because I work there. This usually happens because of shortage of health workers and overall apathetic attitude.
The aim of Teaching More organization supporting Kenyan coastal villages is to try to reduce maternal and morbidity rates as well as improve the reproductive health of women and babies, and prevention of HIV transmission, family planning (especially long term methods), screening of cancer of cervix and breast.
We train TBAs because many of them attend as many as five births a month. TBAs also serve the women in many other ways, including taking them to hospital to be tested, registered, and treated. They provide antenatal and postnatal care, treat minor childhood ailments, and advise families and household on issues wide-ranging as immunization, family planning, nutrition during pregnancy, and preparation for childbirth.
Some of the many things we discuss:
- TBAs current knowledge/training
- Advice for Antenatal Care
- Pregnancy outcome
- Referral protocol
- Obstetric complications
- Management of Postpartum hemorrhage
- Health promotion/Nutrition
- Disease/HIV prevention
- Prevention of mother to child HIV transmission
- Parental HIV counseling/testing for women and partners
- Supervising treatment of mother and infant with nevirapine (a medication used to treat and prevent HIV)
Training includes basic knowledge to encourage women to attend clinics for pre- and post-natal care and practice of handling labour with clean equipment. All trainings are conducted by skilled health care workers from district level in conjunction and support from Teaching More organization.
For training, pictures that depict relevant images and portray recommended maternal behaviors were developed. Images, demonstration, and messages on cards are simple, clear, culturally relevant, and action oriented. TBAs are trained to use the photos as an educational tool during home visits and to encourage women and families to adopt one or more behavior, such as having a skilled TBA or selecting a family planning method after delivery.
TBAs are educated on proper use of female and male condoms and demonstrations done. They are trained in recognizing symptoms of STI (sexually transmitted infections) because it is very common.
TBAs face challenges in the village
- Refusal of the referral at the hospital
- Financial limitations
- Lack of transport
- Patient fear of painful treatment from former health workers
- Lack of training
At the end of the training, each of the TBAs are supplied with a birth kit containing:
- Clean surgical gloves
- Cord clamps (for clamping the infant side of the umbilical cord)
- Clean blades (for cutting the umbilical cord)
- Alcohol swabs
- Strings (for tying maternal side of umbilical cord)
- Elastoplasts (bandaids)
- Antibiotic ointment
- Exercise book (for tracking their births/outcomes)
- Teaching more papers (for tracking their attendance at trainings)
- Female/Male condonms
Even though many TBAs actively participate in monthly implementation of the TBA role, continuation to socialize, supervise, and promote the role of TBAs is required to address the constraints from the initiative as mentioned above. Therefore, it is recommended that effective implementation should contain regular communication between heath staff and community leaders in recruiting TBAs, and the use of supportive supervision. For these to work, more funds and health care personnel are required.
None of the work done above would be possible without the support from Teaching More organization. Thank you so much to the director of Teaching More organization Daniela Kellem and God bless you.