Pulling a 50 pound suitcase through pea gravel in a tent city with curious eyes watching, asking “What’s in there?”
TMSL Clean Birth Kit
Finally, we get to deliver Train Midwives Save Lives clean birth kits to midwives. The kits, as I’ve written before, are so simple. A black garbage bag, which provides a clean surface on which the laboring mama can birth. A little bar of soap, for hand washing. Three non-sterile gloves, two for the birth attendant to wear during birth and the immediate postpartum and one as a backup. Three clean strings, one to tie the umbilical cord a few inches up from the baby’s belly, one to tie the cord a few more inches up, and a spare. A clean razor blade to cut the cord. And, finally, pictorial instructions for use of the contents of the kit.
Because TMSL is a small little project at this point, the kits were assembled at my house, with my kids serving as workers in the process. It was tedious work, cleaning each razor blade individually, fitting all of the contents into a 3 x 5 baggie, cutting strings to length, and folding those pesky garbage bags to size. In the end, they turned out great! 16 clean birth kits fit into a 1 gallon Ziploc and weigh 2 pounds, which is great for packing purposes, since airlines are very strict regarding weight limitations these days.
We are back in Simone Pele today. The midwives have returned … and it is clear that they have been contemplating our talks since we left yesterday. Once everyone in assembled, the midwives have something to say to us … well, actually, they have a lot to say!
“We want an association of midwives for knowledge sharing, peer review [my words, not theirs!], and to help each other.” I am not sure, in Haiti, if there is anything like this. We will find out. I am aware of the Caribbean alliance of midwives, which is a new organization that I suspect is targeted toward “Skilled” Birth Attendants, but perhaps we can build off of this organization to provide an avenue for the Haitian midwives to communicate with each other and learn from each other.
“We want to learn more!” The midwives are ready to talk about a training process! We talk with them about language issues, as in, French, Creole, or none? A good percentage of these midwives are illiterate, so we will stick with Train Midwives Save Lives initial plan to provide primarily pictorial training tools. The challenge is on! When there is material that needs to be presented “in language,” then we will provide it in Creole. This will be a challenge, for sure, because translating into Creole is no easy task. A loose plan is made regarding delivery of some materials in November, with a return trip to follow up in January.
“We want something other than razors to cut the cord!” On the surface, this seems like a reasonable request. And, really, it is more appealing for midwives to be using scissors instead of razors. But, there are just a few issues with that … It is easy to deliver clean, single-packed razors, for single-use. Scissors, on the other hand, need to be sterilized between uses. It may be possible to do a small study on the use of scissors with chlorhexidine as a sterilizing agent with these midwives, but that will be in the future. As we’ve talked with them these two days, we’ve learned that they cut the umbilical cord and then wrap it in gauze and drench the whole thing in alcohol. They are very open to using chlorhexidine on the cords instead of alcohol. Train Midwives Save Lives will get chlorhexidine into the hands of these midwives for this purpose. We will be looking at a way to include it in the birth kits, but in the liquid form that is tricky.
“We want to take the training out into the villages!” WOW! Such forward thinking from this group. One young man in particular, who is new to midwifery and who has impressed us with his technology acumen and self-study skills, is very vocal about wanting to learn and then go out into the villages to teach.
There are many other “wants” that come out in the lively discussion that ensues. Those above are what TMSL will concentrate on for the time-being.
— oh – and we MUST get some size Large gloves for this group! I never anticipated that there would be so many men midwives (or, well, any men!) who could benefit from larger gloves! –
At the end of the day, we give each midwife a certificate stating that they have attended this two day training session. Lisa and I sign each one. As we are doing this, all I can think about is that I have learned so much from them! I feel like I should be receiving a certificate from these midwives because they have taught me so much about their culture, their needs, their wants, their work. Spur of the moment, I pull out two more certificates and write my name and Lisa’s name on them and then ask the midwives to sign our certificates. Great idea on the surface … except that not everyone knows how to write! In the end, each and every midwife signs their name or has someone else sign for them, although I notice that even the oldest of the granny midwives insists on signing her own name and tediously prints out her first name. It is lovely and I am honored to receive this certificate from these midwives.
This group of midwives is so diverse and engaged and interested in learning – we have been blessed with a wonderful focus group!