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May 2009: 82 Matrones trained in essential newborn care
In May of 2009, Mali Midwives collaborated with local health officials to provide a continuing education event for 82 of Koutiala’s matrones. This was Mali Midwives pilot project and was made possible by the generous donations of over 80 individuals. The May event was a true pilot and the results were astounding. We worked closely with the medical director in Koutiala, the city where the event was held. He mobilized three of his staff to facilitate the training. These included Madame Diarra, a sage-femme in Koutiala, Madame Berthé, a sage-femme from Sikasso, and Dr. Coulibably, a gynecologist who lives in Koutiala. Together, the team adapted a USAID training called “Essential Newborn Care” for the matrones’ literacy and skill level. Two groups of 41 matrones were trained over a 6 day period. The event was so successful and generated such excitement among the matrones that plans are underway to repeat the event. This time the focus will likely be on the Active Management of the Third Stage of Labor (AMTSL).
Read more about how Mali Midwives got started and the details of May’s pilot project as described by Mali Midwives founder and president Nicole Warren in the Johns Hopkins University School of Nursing Magazine.
Upcoming Project:
AMSTL is technique to prevent postpartum hemorrhage, the major cause of maternal mortality in the world. The use of AMTSL is expected to reduce PPH by X. To read more about PPH and AMTSL, visit pphprevention.org/amtsl.php. Preventing PPH is particularly important in high maternal mortality contexts like Mali because it is extremely difficult to treat PPH without some degree of long term morbidity and/or mortality. Previously, Mali’s matrones were not permitted to use AMSTL because it involved the use of a uterotonic agent. There was concern that such a powerful drug could be abused. PATH conducted a small pilot study that demonstrated that Mali’s matrones can apply the technique as effectively as other more highly skilled workers. This study provided such powerful evidence to Mali’s MOH that training matrones to use AMTSL is now national policy. It is now a national priority to train all Mali’s matrones on the use of AMTSL (abtassociates.com/Page.cfm?PageID=40931).
During Mali Midwives’ May 2009 event, we had the opportunity to discuss this new policy with rural matrones. They are anxious to learn the skill that can help them save women. However, MOH officials told us that is extremely unlikely that enough funds will be available to train every matrone in the koutiala region, the area where Mali Midwives is focusing its initial efforts. Instead, MOH official estimated that only 20 of the 85 rurla matrones would receive training. Therefore, the current Mali Midwives effort is aimed toward augmented the MOH’s existing support of matrone training in AMSTL.
Since AMTSL and several elements of Essential Newborn Care are, in practice, both performed in the few moments after birth of the baby, providers must be able to integrate the two skill sets.
Based on our pilot project success and the existing MOH priorities and resources, Mali Midwives next project will support AMTSL/ENC training in Koutiala. In addition to the training, we propose to include follow up, team-based sessions facilitated by a content expert. This way, matrones have an opportunity to review the content they learned at the AMTSL/ENC training and ask questions of a more experienced colleague. This model of reinforcing training content in small peer groups has been used successfully elsewhere.
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