In remote areas of Mali, the lack of qualified personnel makes it difficult to attend births in good conditions. Maternal and newborn mortality therefore remain high. Thanks to an innovative approach, Terre des hommes teaches health personnel how to save lives in case of complications at birth.
The community health centre of Kalakè in the Ségou region is very busy on this hot afternoon. A dozen people in the waiting room. In the maternity ward with turquoise walls, the atmosphere is animated. "The child was not in the right position. It made my delivery difficult, but the midwife used the techniques she had learned to help me give birth and to reanimate my child who wasn't breathing at birth," says Djeneba, a mother of three with her baby in her arms.
Aissata Gano, midwife and head of the maternity ward, assisted Djeneba’s delivery. She took part in the SIMESON (Simulation of Essential Obstetric and Neonatal Care) training course, developed and implemented by Tdh, to address the lack of qualified personnel in rural areas of Mali. In the event of difficulties at birth, many health workers have to call on more qualified care providers, as they are not trained in emergency care. Unfortunately, for too many babies and their mothers, this help comes too late.
In order to meet this challenge, Tdh trains all health personnel in the main actions that save the lives of newborn babies and their mothers. This training takes place on the workplace. Dr. Hawa Traoré, our project manager, explains: "We have innovated by carrying out the training on the spot, in rural areas, where more complications and deaths related to perinatal health occur. In this way, health workers do not leave their usual workplace. We adapt the training to the level of qualification of each health worker". Tdh uses didactic material to train health workers, for example by carrying out simulations on mannequins. The training courses are short but frequent, and focus on specific gestures that everyone needs to know in order to be able to save lives in the first minute after birth.
Why is the first minute crucial?
"Let's do an exercise. Can you hold your breath for a minute?" Nana Cissé, midwife and trainer, is giving a course on reanimation. She laughs, but her tone becomes serious again: "If even we adults can't do it, imagine what it's like for a child who knows nothing about life, who is trying to adapt to the outside world”. Midwives, birth attendants and health centre managers are carefully monitored during their training.
"We learned reanimation techniques and were provided with equipment that makes our work easier," explains Aissata, a midwife. "Since my training, I have been able to reanimate four babies. My goal is for women to experience the joy of giving life, because a child is the most beautiful gift". Djeneba's daughter is now five months old. She is healthy and smiling. Djeneba looks at her and radiates happiness. A happiness that the little one would not have been able to give her if she had not been properly cared for at birth.
"My mother was a birth attendant. I learned to love this job through her dedication to her patients."
Increasing attendance at health centres
Mali is one of the most risky places to give birth. The country has only three trained health workers per 10,000 inhabitants. Neonatal and maternal mortality rates are among the highest in the world. In some remote areas, the majority of births are not assisted by trained personnel. The low quality of care can create a distrust of the population towards community health centres. In some cases, pregnant women do not go to community health centres and rely on traditional birth attendants at home instead, unaware of the risks involved.
Sadio Djenepo, our Community Mobilisation Officer says: "When I was young, there were a lot of maternal deaths. It was a difficult subject to talk about in public. I said to myself: I am going to fight against this in my community. A woman should not lose her life by giving life!". She raises awareness among women in her community on the importance of going to the health centre. In her region, she has seen progress: "Thanks to Tdh's training, traditional birth attendants know how to identify signs of danger and refer high-risk pregnancies to health centres.”
Tdh encourages the various representatives of the community to discuss the difficulties linked to the health system and to find solutions themselves. A monitoring committee has been set up by the community to control the quality of care at the health centre. In the Macina health district, where SIMESON started as a pilot project in 2016, the figures speak for themselves: in 2019, maternal deaths in health facilities were reduced by a factor of three and infant deaths at birth fell from 127 to 33.
"Perinatal health was a taboo subject. But when people talked about it, they realised that everyone, including fathers, had to be involved," Sadio says. The involvement of the father in following the pregnancy is, for example, another key topic discussed in the community. Alhassane is the father of twins who were born prematurely. He supported his wife with the kangaroo care technique which consists of placing the premature babies skin to skin on their parents to keep them warm and preserve contact with the human body. He says: "As men, we are not used to following our wives’ pregnancies". Sadio adds: "The women had difficulty paying for the consultations. Many of them were alone on the day of delivery. Now this is no longer the case. Perinatal health is addressed within families!". Alhassane agrees and adds: "Without my involvement, my wife would not have been able to look after the two babies on her own. I would like to thank the health staff and I appeal to the heads of families for their involvement with their wives at all stages of pregnancy, during and after childbirth".
Photo credits: ©Tdh/Kany Sissoko