http://www.malimidwives.org/blog.php Mali Midwives facilitates continuing education for rural midwives in Mali, West Africa. en-us Copyright 2012 Thu, 02 Sep 2010 23:05:38 -0400 http://www.rssboard.org/rss-specification I wanted to take a few moments and describe what research was going on related to the most recent AMTSL training. My day job is as a nurse-midwife, nurse educator, and researcher at Johns Hopkins in Baltimore. My research has, to date, been focused on rural midwives in Mali. This is how Mali Midwives got its start - I saw an obvious need to support this group and Mali Midwives provided a vehicle to do that. In addition to my efforts with Mali Midwives, I have continued to engage in research with the midwives. Don't worry - if you gave money to Mali Midwives you did not pay for my research. All the contributions to Mali Midwives went directly to training costs! But, what I did do is use the Mali Midwives event as an opportunity to gather more informaiton about these women. They are so critical to maternal health in Mali yet no one can really describe who they are, how, where, and when they were trained, etc. So, part of my objective for this most recent trip was to conduct some surveys with the midwives in an effort to describe this critical group of providers. I had research clearance from both my university and the National Institute for Public Health Research in Mali to do this work. With more information about the midwives, we can help tell their story and seek additional funding and support. We can better understand how to support, train, and retain them. I am still working through the surveys we just collected. I'll be sharing their demographic, work environment, and other details on this site and in other venues. Stay tuned if this interest you and please feel free to contact me if you have questions. I've got some good photos coming...but they are in a DHL package somewhere between here and Baltimore! Stay tuned. For now, I'll just throw up a photo of me with our fabulous Malian research assistant, Djeneba Sanogo. http://www.malimidwives.org/blog.php?post_ID=28 http://www.malimidwives.org/blog.php?post_ID=28 Thu, 02 Sep 2010 23:05:38 -0400 Here is Bea's perspective on the event. Bea is the Peace Corps volunteer who assisted us with the training: Mali Midwives Training a Success!! We finished the fourth and final 'Active Management of the Third Stage of Labor (AMTSL)' training sessions in Koutiala, Mali this past Saturday. Although everyone was exhausted by the end after having worked for two weeks straight, I'm happy to report that the trainings were a success!! The staff of the hospital in Koutiala was essential in making this project a success. The training was run by two OB-GYN doctors, Dr. Coulibaly and Dr. Magassa and a nurse midwife, Madame Traore. They had all just come from a training-of-trainers workshop in nearby Sikasso, so they were raring and ready to teach their colleagues all they needed to know about preventing post-partum hemorrhaging. The training consisted of two parts: theory and practice. The doctors spent two days prepping the women using PowerPoint presentations on the ins-and-outs of AMTSL before switching to the most exciting part: the hands on practice. The women were split into two groups, each group with its own dummy. Each woman was in turn asked to formally go through the steps of a birth, and was critiqued afterwards using a checklist created by a consortium of international NGO's. Not only did this list include the essential medical protocol, but it emphasized the importance of bedside manner, something that is often completely overlooked in Mali. Along with the AMTSL training, Nicole Warren, the head of Mali Midwives, used these two weeks as an opportunity to do research about the living and working conditions of the rural midwives. Nicole is also a professor at the Johns Hopkins University of Nursing, and was able to get approval to formally interview the women in an attempt to fully understand their situations in order to bring them trainings tailored to their specific needs. We found out that some of the women have been working essentially by themselves in their villages for years without support or continuing education. I learned that one woman was obliged to buy all the supplies for her clinic by herself because her village couldn't find the money to help her. Another older midwife has been working in her village for 22 years without support or classes to bring her up to date on the latest birthing techniques. Can you imagine if the first person you had to go to for the birth of your child was a woman who was trained years ago and lacked the basic supplies necessary to do her job? And yet these women persist, some working for free as their villages refuse to pay them for their vital and often life-saving services. I heard woman after woman plead for Mali Midwives to come back with more trainings for them because they were desperate to learn as much as possible. They want to do their jobs well, but nobody but Mali Midwives is offering the training or support to help make this dream a reality. On the part of the midwives in Koutiala, Mali, I thank you for your continuing support. Stay updated on the latest Mali Midwives activities at www.malimidwives.org as we move into the next and most critical stage of the AMTSL training: on-site follow-up and evaluation. http://www.malimidwives.org/blog.php?post_ID=27 http://www.malimidwives.org/blog.php?post_ID=27 Thu, 02 Sep 2010 23:02:05 -0400 Apologies for delay in posting this update. The trip to Mali coincided with a personal move and things are just getting back to normal. But - WOW - what a story to tell. The training was held from August 16th - August 28th. The final paper work is still coming in but it looks like we reached our goal of 80 midwives! CONGRATULATIONS to everyone who was involved and THANKS! Special thanks to Beatrice Scheuermann - she is the Peace Corps volunteer who helped on the ground. Her language skills, cultural knowledge, and ability to work between cultures made the event a success. Thanks, Bea! The new medical director, Dr. Mahamadou Magassa, was enormously helpful. He put three of his staff - Drs. Coulibaly and Maghassa as well as a highly trained midwife, Madame Traore - in charge of the training. Luckily, not only are all three of them very clinically skilled, but 2 of 3 had just returned from a "train the trainers" conference for AMTSL so they were more than ready to go! The trainers worked for 12 out of 13 days to make this happen. The midwives attended in 4 groups of about 20 midwives each over the 13 day period. Each group had its own dynamic - there were some midwives who work in health centers in rural areas with a nurse and another midwife. Other midwives work more or less alone - this the group that seems the most in need of training and most vulnerable to job strain and stress. The trainers out did themselves again this year in terms of using adult education techniques. There were a lot of laughs, opportunitities for everyone to practice, and of course - some core theoretical content to help contextualize the techniques. My favorite part - like last year - were the impromptu discussions among the midwives and between the midwives and the trainers. Keep in mind that these midwives rarely get access to such highly trained colleagues. During this training there was ample time for questions about their practice in general, not just AMTSL. This training really provides a rare opportunity for midwives to increase their skill set and talk with colleagues - it is vital to their professional development. Any trip to Mali is guaranteed to include some surprises and this was no exception. Based on information I had from the past few years, I understoood there were about 85 of the midwives we target in Koutiala. It turns out there are now about 140! This huge discrepancy reflects a couple things: more matrones are being trained by the MOH and the systems in place to keep track of an account for this personnel are improving over time. Still, it was a surprise to realize that we wouldn't be able to reach all the midwives in Koutiala. We had only allowed enough money and time to train about 80. Despite the fact that we did not get all the Koutiala midwives trained, the good news is that there are some funds left over to cover the training for the other matrones. We will have to work to ensure that the follow-up takes place - we are all convinced this is critical to ensuring that the matrones retain and can actually use content they learned at the original training. Right now, we are planning how and when to both train the rest of the midwives and arrange follow-up for the entire group in the upcoming months. It's an enormous job but we are privileged to be working with some very dedicated and competent Malian partners who can make it happen. This time around we didn't have Bob Akers, our fabulous photographer from 2009, but the photos we do have to share are just as inspiring. I'll post my own as soon as I can but for now, here is the link to Beatrice's album - http://picasaweb.google.com/lh/sredir?uname=bea384 and target=ALBUM and id=5509442155813061585 and authkey=Gv1sRgCPHk4PX8zMHzFg and feat=email. I hate to sound like a broken record but every time I am in the company of these women I am awed by the work they do. If you contributed to Mali Midwives, in any way shape, or form, you should be proud. There are some midwives out there, doing some very difficult work, who feel a bit less alone. Who are more prepared to help save women. Who have a renewed energy to do their work. Onward! http://www.malimidwives.org/blog.php?post_ID=26 http://www.malimidwives.org/blog.php?post_ID=26 Thu, 02 Sep 2010 22:15:26 -0400 We are about to get on the plane to Casablanca, en route to Bamako. We'll spend just two nights there and then we will go to Koutiala for the training. The first group arrive on August 16th. I am working with our Malian collaborators from last year, Dr. Coulibaly and Maghassa. The folks in Koutiala anticipate 80+ participants in the training...stay tuned. http://www.malimidwives.org/blog.php?post_ID=25 http://www.malimidwives.org/blog.php?post_ID=25 Mon, 09 Aug 2010 17:44:33 -0400 These are the postcards we are sending out as a reminder to folks to give what they can! http://www.malimidwives.org/blog.php?post_ID=22 http://www.malimidwives.org/blog.php?post_ID=22 Wed, 30 Jun 2010 22:35:28 -0400 Wow. Busy couple of weeks. Right now, we are in a very solid place. Thanks to a phenomenal showing from folks in Pittsburgh, we've got more than $15,000 in total contributions. Just to explain, the Pittsburgh showing is thanks to Beatrice Scheuermann's family and friends. Beatrice is a current Peace Corps volunteer who participated in last years event. She'll be working with us this year as well. Beatrice's mom, Michalina Pendzich, spearheaded some fundraising and wow - what a response. With enough funds to pull this off, logistics are now falling into place. I believe we can pull off at least a portion of the follow up sessions even though we did not reach the $25,000 goal (its' not too late!). Some is certainly better than none. Right now, the medical director in Koutiala has provided a budget for both the training and the follow up. We are still planning to start the event around August 9th. the great news is that Dr. Coulibably, the phenomenal trainer from last year will be involved again. A total of approximately 80 matrones will cycle through during the month in groups of 20. Very exciting stuff. Stay tuned for more... http://www.malimidwives.org/blog.php?post_ID=21 http://www.malimidwives.org/blog.php?post_ID=21 Wed, 30 Jun 2010 20:51:03 -0400 I think I mentioned that we have gotten approval from Peace Corps Mali to work with one of their volunteers, Beatrice Scheuermann, in August. Her support will be vital. Beatrice's family contacted their family and friends and let them know about Mali Midwives' upcoming event and the response has been tremendous. We've received more than 15 contributions from her people - nearly all of whom are in Pittsburgh. Their support put us over our halfway mark!! So I think I'm becoming a Steelers fan. Thanks so much to them for their faith in Beatrice and what Mali Midwives is trying to accomplish. http://www.malimidwives.org/blog.php?post_ID=20 http://www.malimidwives.org/blog.php?post_ID=20 Wed, 16 Jun 2010 22:34:43 -0400 On June 13th we set up a booth in the exhibit hall at the annual meeting for the American College of Nurse Midwives. There was a solid stream of midwives near the table and our effort generated a lot of interest. In total, we raised just over $1,000.00! Interestingly, I actually SOLD the blankets I had brought as decoration for the booth (graciously the buyer agreed to wait until the end of the day to collect her goods). So, I am getting new ideas about how to market our message. I guess that means I'll buy a lot more blankets when I go back to Mali. Regardless, many many thanks to the continued support of the US midwifery community. They have been behind us since the beginning and it is a fantastic feeling. Thanks to everyone who contributed. http://www.malimidwives.org/blog.php?post_ID=19 http://www.malimidwives.org/blog.php?post_ID=19 Wed, 16 Jun 2010 22:30:46 -0400 On June 13th Mali Midwives will have a booth - near the food vendors, no less! - at the American College of Nurse Midwives (ACNM) national meeting in Washington DC. We'll have new postcards and lots of copies of Monique and the Mango Rains for sale. Keep your fingers crossed this is a successful fundraising venture. My experience at ACNM in 2008 was very positive so I am hopeful. If you have other venues you think might be a good fit Mali Midwives, let us know at malimidwives@gmail.com. thanks, Nicole http://www.malimidwives.org/blog.php?post_ID=18 http://www.malimidwives.org/blog.php?post_ID=18 Sat, 05 Jun 2010 21:00:43 -0400 We've had phenomenal couple of weeks. Right now this is the picture: we had approx 5,000 left over from 2009 events. Adding to that we've raised an additional $7720 - THIS IS UNBELIEVABLE. That puts us HALF WAY THERE! Enormous thanks to everyone who gave. Special recognition to the Helen and William Mazer Foundation, family and friends of Beatrice Scheuermann's family and friends in Pittsburgh, and the Women and Children's Hope Foundation. I am inspired, humbled, and completely energized to continue with the planning for August's event! http://www.malimidwives.org/blog.php?post_ID=17 http://www.malimidwives.org/blog.php?post_ID=17 Sat, 05 Jun 2010 20:52:22 -0400 If you don't know about this book already - check it out: www.moniquemangorains.com This is a story written by Kris Holloway who was a Peace Corps Volunteer in Mali. Her host family mother, colleague, and friend was Monique. Monique is EXACTLY the kind of auxiliary midwife, or matrone, that Mali Midwives is dedicated to helping. It's a great read. If you can appreciate Monique's story, you'll understand why it is so important to help Mali Midwives continue its work. Cheers. http://www.malimidwives.org/blog.php?post_ID=15 http://www.malimidwives.org/blog.php?post_ID=15 Mon, 24 May 2010 19:36:08 -0400 MALI MIDWIVES ________________________________________ There is no question AMTSL saves lives. The question is: How long will it take before midwives worldwide can access the training? A Malian proverb says that a woman in labor has one foot on earth, and one foot in the grave. The proverb is all too true: a woman in Mali, West Africa has a 1 in 15 lifetime chance of dying from childbearing complications . Almost all of these deaths could be avoided with skilled care. Unfortunately, there are few trained providers in the rural areas where most Malian lives. For most Malian women, auxiliary midwives are first and only health care provider they will ever see. Mali Midwives facilitates continuing education opportunities for auxiliary midwives in Mali. Our goal is to raise $25,000 to sponsor our 2nd education event. We plan to train midwives to use the Active Management of the Third Stage of Labor (AMTSL) prevent postpartum hemorrhage, the major cause of maternal mortality worldwide. Background Auxiliary midwives, or matrones, attend 60% of all births that involve a formally trained health worker in Mali . Although these women work in a context of high maternal and neonatal mortality, they are at the bottom of the national medical hierarchy, facing enormous responsibility with few resources. I first worked with matrones in the rural city of Koutiala, Mali as a Peace Corps volunteer (1994-1996), and later as a midwife and researcher (2003-2004). I created Mali Midwives to connect this committed group of women with others who care about maternal health in Mali and other developing settings. In 2009, we held Mali Midwives' first continuing education event. Working closely with local health officials, local experts provided continuing education to a group of 82 midwives in 'Essential Newborn Care'. The midwives chose this topic because in addition to caring for women, they also care for newborns. The event gave midwives a rare chance to discuss practice issues with peers and supervisors. You can see photos of the training at http://www.malimidwives.org/slides.php . This event's total cost was just over $8,000.00, or less than 100.00 per participant. What's Next? The 2009 event was so successful plans are underway for a second project. This time the focus will be on the Active Management of the Third Stage of Labor (AMTSL). AMSTL is a technique to prevent postpartum hemorrhage, the major cause of maternal mortality in the world . The evidence is clear: AMTSL can reduce the incidence of postpartum hemorrhage by up to 60% . Preventing hemorrhage is particularly important in a place like Mali because effectively treating a hemorrhage after it starts requires personnel and facilities that are simply out of reach for most women. Mali Midwives is partnering with the Malian Ministry of Health for this event. In 2009, the Malian Ministry of Health decided to permit auxiliary midwives to use AMSTL. It is now a national priority to train all auxiliary midwives in this skill. Unfortunately, because the health system is overwhelmed, the Ministry cannot train them all. This leaves most women at high risk for hemorrhage and death. I have spoken with Madame Binta Keita, the Director of the Reproductive Health in the Ministry of Health, as well as the local health director in the district where our pilot project was held: both are eager for Mali Midwives to help them reach their goal of training every auxiliary midwife to use AMSTL. Dr. Keita stated that she sees Mali Midwives as a partner in Mali's strategy to reduce maternal mortality. The training for AMSTL requires matrones to work in small groups with a facilitator and demonstrate skills until they are proficient. Other areas of Mali have conducted AMTSL training and we will build on their experience. We anticipate it will take 4 weeks to train all 82 auxiliary midwives in one district. The estimated cost of this training is $25,000.00. This covers travel, lodging, food, and a set of resource materials for trainers and participants. This cost will also cover site visits by an expert trainer to small groups of midwives in rural sites. Site visits are crucial because they will provide midwives the opportunity to ask questions and clarify techniques in the field. Evaluation A simple pre and post test will be administered before and after the training to gage whether matrons have become proficient in using this life-saving technique. A six month follow up evaluation will also be implemented. This information will inform subsequent continuing education efforts for our organization and the Ministry of Health. Contributions By contributing to Mali Midwives, you will help cover the expenses to train 82 auxiliary midwives in Koutiala, Mali. These women will return to their villages with life-saving skills that will help prevent unnecessary deaths related to childbirth in their community. Mali Midwives is grateful to The Village Project, Inc. for serving as our fiscal sponsor. The Village Project, Inc. is a 501c3 with experience in organizing educational activities abroad. Contributions to Mali Midwives via The Village Project, Inc. are tax-deductible. Contributions can be made on line with PayPal at http://www.malimidwives.org/donate.php Checks payable to The Village Project, Inc. with Mali Midwives written in the memo section can be sent to Mali Midwives c/o Nicole Warren, 4509 Schenley Road, Baltimore Maryland, 21210. To learn more about Mali Midwives contact us at malimidwives@gmail.com. To read more about postpartum hemorrhage and AMTSL, visit http://www.pphprevention.org/amtsl.php. Sincerely, Nicole Warren, PhD, MPH, CNM President, Mali Midwives http://www.malimidwives.org/blog.php?post_ID=14 http://www.malimidwives.org/blog.php?post_ID=14 Wed, 12 May 2010 21:44:54 -0400 This came out today. Sadly, it places Mali as the 7th worst place to be a mother. http://www.savethechildren.org/publications/state-of-the-worlds-mothers-report/2010-interactive/index-1.html http://www.malimidwives.org/blog.php?post_ID=13 http://www.malimidwives.org/blog.php?post_ID=13 Tue, 11 May 2010 18:21:34 -0400 check out our new photo book Click here to view this photo book larger http://www.malimidwives.org/blog.php?post_ID=12 http://www.malimidwives.org/blog.php?post_ID=12 Mon, 10 May 2010 22:15:27 -0400 The Helen and William Mazer Foundation made a generous donation toward our 2010 event today. Many thanks! http://www.malimidwives.org/blog.php?post_ID=11 http://www.malimidwives.org/blog.php?post_ID=11 Thu, 03 Dec 2009 21:16:44 -0500 On November 20th I had the chance to attend the wrap-up meetings for the Prevention of Post Partum Hemmorhage Initiative (POPPHI) project in Washington DC. ( http://www.pphprevention.org/overview.php ). This event included researchers, clinicians, and policy makers from all over the world to gather and discuss their efforts during the project's 5 years. POPPHI efforts have focused on the Active Management of the Third Stage of Labor (AMTSL), a technique to prevent postpartum hemorrhage . The results of their efforts to integrate AMTSL into every birth attendant's repertoire of skills are amazing. POPPHI's efforts have changed policy and practice around the world. The best part of the event was meeting Madame Binta Keita, the Director of the Reproductive Health Division of Mali's Ministry of Health. She told me that she is deeply committed to seeing all matrones trained to use AMTSL. This is HUGE because matrones were not previously allowed to use the drug that is needed to perform AMTSL. Now they are. Of course, funding is needed from partners to get all thee matrones trained. She encouraged me to continue to work through the Medical Director in Koutiala to continue to partner with the matrones there. See confirmed that YES they want Mali Midwives to keep working in Koutiala and that YES she is thrilled we can help to get EVERY matrone trained in AMTSL. So I was pleased to have that confirmation, from the very top of the national policy hierarchy, that Mali Midwives' efforts are not only needed and appropriate, but they are directly contributing to the MOH's policies. Bottom line(s): AMTSL save lives. The more matrones know how to use it - the fewer women die. And there is no other way I know of to help to matrones and the women they serve more directly or more efficiently than through Mali Midwives. http://www.malimidwives.org/blog.php?post_ID=8 http://www.malimidwives.org/blog.php?post_ID=8 Sun, 29 Nov 2009 21:24:58 -0500 Last night the mango rains came. It started in the evening with lightening striking every once in a while as I walked back home from the internet cafe. At night, no one can see that I am a tubabo (white) and I can get really close before they realize this and the little kids begin yelling it after me. During the night it began to pour, louder that I have ever heard before, rain unlike any I have experienced before. If I had to guess what a monsoon feels like, this would be it. The sound was soothing, and yet astonishing. I got up and looked out the window at the yellow sky and the huge drops hitting the ground. It was very intense. This morning, everything is muddy and it's a bit cooler. Day one of the second stage has begun. Madame Berte has returned to Sikasso, a fact that I think will greatly influence the environment of this second group's experience. Yesterday, when talking about breast feeding, she made some of the mothers sit on a chair at the front of the room and 'demonstrate'. The little girl I had played with the previous day (and spent the afternoon with her strapped to my back-I will be doing this with my own children in the FAR future---it felt so natural and freed my hands to do whatever, while she was cool as a cucumber and happy to play my hair and smile) was turned this way and that as her mother and Madame berte tried to make her stay still in the correct position...it was a jovial room, everyone was laughing and asking questions-the best kind of active learning. Dr. Coulibali is incredibly dynamic and a great facilitator- he gives great positive reinforcement and makes the women feel comfortable and keeps them engaged. It's hilarious to me that all the photos in the slideshow presentations show white babies feeding on white breasts. I don't think the matrones will be encountering many white bodies en brousse in the near future. The women were asked to come up with topics they are hoping to learn in this stage. One woman said she wants to know what happens because the baby will be washed and fine and then she'll return and it will be dead. This is astounding. This is their reality. I try to imagine such a scenario in the U.S.... the women WANT to know why this is happening, what they can do about it...mind you, this is not their matrone training. They have been practicing and doing their best with little resources, combating these occurrences with little understanding of the sources of these deaths. I say to myself, well I am happy that they get to have a forum to ask questions and learn here, and this must mean so much to them, but on the other hand, I think of the women who returned to their villages today. It seems so unfair to place so much responsibility on someone without fully preparing them. They are the best care most women in Mali can hope to get. We had the women fill out a short questionnaire, and one question was, which part of being a matrone do you like most? A majority put down: I love everything about birth. For these women, it's a calling to be a matrone; this is how they center their identity. In this sense, while overworked, underpaid and under prepared, these women truly love what they do, believe in its importance and continue to do it lovingly despite the conditions. For me, who finds pregnancy and birth fascinating, miraculous and so powerful, these narratives fill me with pleasure. My next idea, get a VW van and put up a matrone-education traveling show. Hey, as one of the only white people around I am already a circus show, why not go all out? http://www.malimidwives.org/blog.php?post_ID=6 http://www.malimidwives.org/blog.php?post_ID=6 Fri, 29 May 2009 21:50:46 -0400 Here are some comments from Ariela. She is the undergrad student from Mich. that came along . She's been unbelievably helpful and a fantastic travel companion. So I'll cut and paste her comments below. I'm sitting in a long room swollen with Matrones to twice is capacity; two ceiling fans are feebly trying to dissipate the intense heat and humidity of the hot season in southern Mali. Around me are 38 matrones, each dressed in beautiful pagnes of intense colors and patterns, beautiful embroidery and matching head scarves- it is obvious that they put quite a bit of effort into their appearance at this, the second day of the first matrones stage. As I write this, the matrones are discussing the needs of the newborn; both the basics as well as which practices are most beneficial. Each woman is called on in turn to read out loud the French slides, which are then discussed heatedly in Bambara. Some stumble with the French, after all, their first language is usually Minianka, then Bambara and then French. They discuss and debate, growing more confident and willing to ask questions and acknowledge that they are unsure about the specifics of a process: they want to know, it's pretty incredible to see how intent they are, how they yearn for this knowledge. It's also shocking how much they do not know. After these three days, they will return to their small village en brousse, and continue their work, independently (or with the help of a traditional birth attendant) delivering and caring for the pregnant women of the village. It's obvious that these matrones get how important and rare an opportunity this is for them- and things are coming up that remind me of how much work is yet to be done. These women are all here, engaged, and the matrone leader from the department is taking charge of this entire training and seems fully in-step with the importance of these days. However, the slides are speaking of the steps of care these women are supposed to follow, even though the women lack the tools and equipment to perform them. It's incredible to me that this world of matrones opened up to me only four days ago, I could swear it's been at least three weeks. Time moves slowly here in Koutiala. Before the trip I was so nervous and excited, realizing that I really had very little idea of what I was getting into. I am so glad that this was possible, and that now I am here, sweating and listening for the few French words code-switched with Bambara. It does not cease to amaze me how well children are integrated into these women's' lives. Some breastfeed while taking notes and listening to the lecture, babes passed out happily bundled on their mothers backs in a pagne or towel, a small lump of baby. The children of Mali rarely part from their mothers, and this stage is no exception. Some of the matrones are pregnant, most have left older children at home, this stage, these trainings are so vital, for the wellbeing of women and their babies at the highest risk, isolated and working with a lack of equipment. These matrones know how much rests in their hands. http://www.malimidwives.org/blog.php?post_ID=5 http://www.malimidwives.org/blog.php?post_ID=5 Thu, 28 May 2009 02:58:20 -0400 Okay, so here we are already on our way back to Bamako to start heading home. We left Kotuiala yesterday after a whirlwind second session. We took one night to go out to the village of one of the matrones who attended the first session. I'm going to paste some comments I wrote a few days ago. It starts at the beginning more or less and moves through to the end of the 2nd session's first day. I will admit I was worried. This event had been largely based on a fantasy of seeing this group of women together in an environment where they could learn from and exchange ideas with colleagues and supervisors. A few months before we were supposed to have the event, I discovered that a good friend of ours, Sadio Sogoba, was in Koutiala. I thought Sadio was in the capital, Bamako. It was like a gift to find out here was in the city where I was trying desperately to get this event arranged. As soon as he heard what I had been working on he went to see the Medecin Chef, the physician in charge of the Koutiala region's health activities/services. Until then, I was just a strange voice on the phone and I'm not sure the Med Chef had taken me seriously. Who could blame him? Regardless, if he wasn't taking me seriously then he was unlikely to have started any real preparation for the event. After Sadio came to see the Med Chef and began clarifying dates and other details, the med chef became a lot more responsive. I got an agenda and a revised budget via email. I was encouraged. After that, his communication stopped again and I had only Sadio to assure me that the event still seemed on track. Fast forward to just before departure. I became nervous that I had been asking too much of the health center staff - did they have the materials, the time, the interest to put this event together? I had no intention of being the 'trainer' - I tried that in Peace Corps and knew it didn't work. Still, would they - could they - come through? Just before I left for Mali Ariela, an undergrad from U. of Michigan with an interest in Africa and women's health, decided to come with me. I knew her through another colleague and felt confident she'd enjoy the trip. I was impressed she decided to go with so little notice. The trip was a bit stressful b/c of bad weather and I just barely made the flight out of New York. Still, we made it. My bags, of course, did not. Oh well. It was a good reminder that a good bit of this trip was out of my control and I had better get used to it. We arrived in Mali in the wee hours of May 18th. We spent the day changing money and running a few errand. The next day we headed out to Koutiala. We took public transport which means tour-style buses from who knows what era from who knows what country. Our trip was made especially uncomfortable because despite the 100+ temperature, the driver did not apparently understand he had the heater on full blast. I kept burning my feet on the scalding radiator that ran along the windows. Sadio would later tell me that people burn their feet on this bus line all the time. Mental note to self: take a different bus line next time. Despite the heat, we arrived just in time to suffer the worst of the days' heat wandering around Koutiala figuring out where we were going to stay. Ssdio, as usual, saved us. He had originally thought we could stay in the extra rooms of a quiet NGO. We arrived there and it was a bit far. End of First Session So far, this has been just amazing. The staff here has been amazing. The topic of the 3 day session is 'Essential Newborn Care' '. The first day we covered prenatal factors that affect the newborn. At the end of the session the matrone started asking questions of the facilitators. For example, 'if I hear heart tones at the first prenatal visit but not at the second, what should I do' and 'how many pills of iron should the woman take?', and 'when in pregnancy should she get the malaria medication?'. These discussions put everyone on the edge of their seats - like the were all dying to have these details clarified. It was fantastic to see them exchange ideas and information with each other and their supervisors. Today we finished the first 1/2 of the event. 40 matrones participated in 3 days of 'Essential Newborn CareThe next day, day 2, we focused on immediate newborn care. Participants got a chance to work with mannequins to practice going through the 11 essential steps of newborn care. We discussed newborn resuscitation, how to maintain the newborn's temperature, and signs of danger that would necessitate a transfer. Today, the third and final day of the first session, was all about breastfeeding. Although it is rare for Malians to do any BUT breastfeed, they tend to supplement with water and other fluids too early. So, there was a lot of laughing when we used some of the participants' babies as models so we could demonstrate appropriate latches and positioning. After the session, matrones just started asking questions about various breastfeeding-related problems and it became an informal Q and A. You could really feel that the matrones were taking advantage of having these women here. When the questions were over Madame Berthe gave the mannequin baby to a few matrones and asked them to practice giving women basic breastfeeding instructions. They started softly and hesitantly at first - not because they don't do this all the time but just not typically in front of their bosses and colleagues - and then gained confidence as the facilitator gave her positive feedback, 'that's it!' or 'exactly!'. This led in, somehow to a big discussion about whether or not there was such a thing as 'dirty milk'. - it was established there was no such thing except for HIV+ women who need to discuss this with a doctor and also in some rare cases of maternal medications. Generally, women and breastfeed anywhere anytime! The first day certain rules were agreed upon - one of which was to not sleep. The sanctions for this and other offenses include buying candy for everyone else. As we neared 2 pm in this heat I started to nod off. During the break no less then 5 or 6 matrones came up to me to remind me that I owed them candy! How embarrassing. Madame Berthe is a sage-femme from the health administration in Sikasso. She's one of the three facilitator's here at the first session. She is a talented facilitator and gentle teacher. She has a sweet nature and is fairly quite. When she is leading a session, she comes alive and the participants seem to feel comfortable with her. Yesterday, she had 1/2 of the participants to practice immediate newborn care. She had them in hysterics because they began each participant's 'practice' with a birth including groaning and pushing encouragement from the matrone. They were just having a great time. Madame Diarra is a sage-femme here in Koutiala. She is under the supervision of the med chef in Koutiala and also Madame Berthe. She is a very large woman which is unusal in Mali. She has kept people in line here - getting them going on time, chastising them if there is too much chit chat. But she still has the fantastic ability to answer questions without making the participants feel self-conscious. Dr. Mustaphe Coulibaly. He is 30 years old I think. He is a physician who did specialized training with the Ob/gyn who was here for years. So be is the defacto ob/gyn man now. He's from Koutiala - Minianka even - but he says a lot of people don't know that because his skin is lighter than most people from here. I asked him if her was going to try and find a wife in Bamako. He laughed and said there were plenty of women he could marry here in Koutiala. I found this reassuring - it seems there are so few educated professionals who don't want to go to Bamako. This guy is a fabulous facilitator - he just gets it. He'll probably get snatched up by some ngo in the near future but for now Koutiala is benefiting tremendously from his service. He is bright as hell but still has this little boy character that peeks out now and then. As he sat frustrated with his computer he pushed the power button and spat out 'this thing sucks' (nin miye deh!) like a little kid with broken toy. Day 4 (1st day of Session B) Today is Sunday and they would not normally be working. But because of the stage, the troops are supposed to be here. The feel was different today than the first day. Early this morning was the first real rain I've heard - and it was a good one. One of those mornings for sleeping. A real mango rain. So, by the time I got to the health center nearly all the matrones were here - about 36 in all - but the center was locked and they sat staring at the huge puddles that stood between them and our conference room. After several phone calls and some patience, the players arrived and the room was opened. All the table and chairs had been put away to soon Diarra had everyone working to get the room ready for the day. Like last time everyone found a place at the table or in the chairs just behind. We handed out the coveted folders with notebooks and pens. Agenda followed. Diarra kicked things off by asking all the matrones to introduce themselves. They stood up hesitantly and mumbled their names and the village where they work. Then Coulibaly and Diarra introduced themselves and passed the parole to me. I did my schitk again - it was less emotional than the first session but it still felt great. They smiled back and gave me a little applause. It was, overall, a less festive start than the first session but I liked that is was calmer, more methodical. More orderly. This time I took closer note of the process itself. After the intros Diaraa said, now we're here as a village so we have to have laws. Like last time, we ended up with you can't sleep, can't have you cell phone go off loud enough to bother people, can't leave without permission, no chit chat, and must actively participate. Next order of busniness - select a chief of the village, or dugutigi.. The immediately designated Madame Traore. She's an older matrone that I remember from the Association de Matrones de Koutiala meetings I attended in 2003 and 2004. She has these coke bottle glasses that make her look older and smarter than she already does. After the dugutigi we passed out the pre-teste. Its at this point where the crowd seems anxious - too much French, too much medical language. The play with the test nervously in their hands and whisper to each other as thought they are trying to figure out what to do with it. This time Coulibably translates it for them question by question. The first session, only the post-test was translated which really made a comparison between their pre and post test impossible. We pointed this out and so they've corrected that and are translating them both this time. Madame Berthe went back to Sikasso which is a huge loss - but I think the remaining folks can pull it off. (end of session two day one). http://www.malimidwives.org/blog.php?post_ID=4 http://www.malimidwives.org/blog.php?post_ID=4 Thu, 28 May 2009 02:49:09 -0400 Well, I just wrote quite a bit and accidentally deleted - errr. But suffice it to say that the last three days - our 1/2 mark - have been phenomenal! The matrones are just soaking this up! The trainers are fantastic - one doctor and two highly trained midwives or "sage-femmes". All three truly apply adult learning principles to this event which has been amazing to watch. The pictures attached to this post are from the first day which was an overview of neonatal mortality and what the next two days would review in detail. It was so wonderful to approach the health center that first morning and find all of these women waiting and eager to go! Really, the session have been phenomenal. The best part is when they start asking questions and discussion gets going - there was a lot of debate about when/why to bathe a newborn, how many iron pills to give, how to treat and prevent malaria in pregnant women...it went on and on. You could tell the matrones were going to take advantage of being around their peers and supervisors. I'll post more details about day 2 and 3 tomorrow. For now - enjoy these photos from Day 1. More to come on website. And, by the way, it's mango seasons so despite the heat its been fabulous!Coulibaly does a gloving demo http://www.malimidwives.org/blog.php?post_ID=3 http://www.malimidwives.org/blog.php?post_ID=3 Sat, 23 May 2009 16:16:32 -0400 This is a test of our Mali Midwives blog. If you are reading this because you contributed to Mali Midwives, you can give yourself a big pat on the back. I'm here in Koutiala enjoying one of the best days of my life. I feel like everything I have been struggling to put together just CAME together. I am so grateful to the staff at the health center for taking this opportunity wiht such efficiency, such professionalism. I am grateful to all the donors who made this possible. The staff here in Koutiala did exactly what I had hoped - they took complete ownership of the event. Today we began with the first group - 40 matrones in all. We were crammed in a sweltering room but the snacks and lunch were good, the trainers were fabulous, and there was an amazing energy. Even after this long day the matrone stayed to ask questions of their direct supervisor and her boss. It is a rare opportunity for them to be among colleagues and supervisors - they asked so many questions and you could tell that they were all listening, engaged, leaning forward, nodding, taking in. It was gorgeous to watch. I am so proud of this event I cannot find the words to express it. I am truly grateful for how this has worked out. I took a million pictures and will post as soon as I figure out how. http://www.malimidwives.org/blog.php?post_ID=1 http://www.malimidwives.org/blog.php?post_ID=1 Thu, 21 May 2009 10:43:06 -0400