The three of us, Sophie, Sara and Florence visited the villages of Sabaki, Moi, and Msabaha. All the meetings with the TBAs were started by a word of prayer. All together more than 110 were in attendance.
TBAs are not ministry of health staff nor do they receive a monthly salary for their work. They are paid small amount between ksh. 300 to Ksh. 800 or given a chicken, a piece of leso 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 coast present the first line of care to about 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.
The meetings in the villages with the TBAs is always an interaction with skilled health workers of where we discuss freely without intimidation and this allows them to be free to speak the truth. We gathered a lot why women in the village do not like going 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.
- With TBAs apart from listening to them, they will give a cup of porridge or tea after delivery to give her energy.
- When doctors and nurses use abusive language the mother gets too discouraged 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 raise up children”. Therefore, they decide to give birth at home and most of the times assisted birth by unskilled person.
- “You are not the only patient here for me to handle” push for yourself.
I know what happens in the hospital because I work there. This usually happens because of shortage of health workers and sometimes apathetic attitude.
The aim of teaching more organization supporting Kenyan coast 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 are attending 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 ranging from: immunization, family planning, nutrition during pregnancy, and preparation for childbirth.
- TBAs knowledge
- Advice for ANC care
- Pregnancy outcome
- Referral behavior
- Obstetric complications
- Management of PPH
- Health promotion
- Disease prevention
- Prevention of mother to child HIV transmission, where HIV prevalence is remarkably high.
- Parental HIV counseling for women and partners
- Supervising treatment of mother and infant with nevirapine
- Advice on women on reducing the risk of HIV transmission.
Training includes basic knowledge to encourage women to attend clinics for pre- and post-natal care and practice of handling labor with clean equipment. Training conducted by skilled health care workers from district level in conjunction and support from Teaching More organization.
In the 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 trained to use the photo 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 demonstration done. They are trained in recognizing many different STDs because they are very common.
TBAs face challenges in the village
- Refusal of the referral.
- Financial limitation
- Lack of transport
- Patient fear of painful treatment from formal health workers
- Lack of training
At the end of the training, all the TBAs are supplied with a birth kit, each containing (at least and usually more than the following)
- Clean gloves
- Cord clamps
- Clean blades
- Alcohol swabs
- Exercise book
- Teaching more papers
- Female and male condoms
There is an urgent need to train more TBAs and make TBAs realize how much better; their services would be if they adopted practices that are more modern. Their tendency is to see themselves as providers of essential services can be built on here to ensure that they learn new methods and principles.
Even though many TBAs actively participate in monthly implementation of 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 consider 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 is 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.