This is discussion about *Y.C.* Combining Tradition with Innovation.
I like your idea, it can have a great impact in maternal health.
Thanks for your entry! It sounds like a great idea, and we’d really like to hear more from you. While you state in your entry that your initial research may help evaluate overall interest in a maternal waiting home, how are you planning on convincing people to participate if you find that they’re not open to changing their traditional practices? Also, wouldn’t this kind of an initiative, especially building a new facility, be expensive? Rather than building a new center, have you thought about repurposing old buildings instead? We look forward to your response and remember to filter your additional comments back into your entry form so that the team can better evaluate your submission!
- Naveen Shakir, Ashoka’s Changemakers
Hi, Naveen, and thank you for your comment! Regarding convincing people to participate, I think we could hold community meetings (a common way to disseminate information in Ukerewe) and explain to the community how the center would work and how it could provide a safe place to deliver. We could ask some of the women we know there who have experienced childbirth injuries to share their experiences with the women if they agree with us that a birth center would be helpful. What I predict to be more difficult will be convincing the TBA's. We'll have to meet with them individually to learn what we could offer specifically that would interest them enough to travel to the center.
In terms of the building itself, I would definitely consider re-purposing old buildings if there were any. However, there are not any structures large enough to serve as a birth center and close enough to the hospital. In fact, in terms of a town or city, there aren't many buildings there at all. There are some guesthouses and small shops, but nothing that isn't being currently used. There is, however, plenty of land near the hospital. Hopefully we could find a way to build it conservatively and also include environmentally friendly elements such as solar panels to cut down on long-term costs.
I think it is great that you are integrating traditional practices in your innovation. Just a few questions:
What resources will be available to the families of women staying at the waiting home (place to stay, etc.)?
Will there be any type of outreach or provided transportation for women who cannot afford the costs of traveling to the waiting home?
How many women are you anticipating the center could accommodate at any given period of time?
I look forward to hearing more details about your idea!
Hi Sarah and thank you for your thoughtful comments! Here are some answers to your questions.
Resources available for families of women staying at the waiting home: In Ukerewe, women tend to birth among women and not necessarily with the rest of the family. Also, the women whom I met who had received surgery to repair their fistulas seemed to be fine to leave their children in the care of mothers or sisters while they traveled and were hospitalized. I would still like to encourage families to be together for the birth if possible, therefore, I need to learn more about what the women themselves would prefer. If they want their families to accompany them, this must be taken into account as the housing/boarding for several families at a time is much more complicated and space-demanding than for individuals.
To skip to your last question since it's related to this one, I would hope that the center would be able to accommodate approximately 25-30 women at any given time if they come without their families. If each women comes with her entire family, then probably only 5 or 6 families could be hosted at once. Maybe the best way to plan is for 10-15 individual women and 2 or 3 families that way the most people could be accommodated according to their wishes.
Transportation: I have considered including funding or reimbursements for the transport costs for women to come to the center, however, I do not think it helps in terms of sustainability. During a community meeting that our group led about maternal deaths on the islands last year, many community leaders agreed to start a fund for covering the transportation costs of reaching the hospital in case of an obstructed labor of any woman in their community. If such funds could be arranged instead to be used to bring women to the center, I think that this project would have a better chance of succeeding in the long-term and would simultaneously create a sense of value for the entire community.
I hope this clarified my idea a bit. Feel free to ask more questions! :)
Thank you so much for your entry and the great answers to everyone's questions! I was wondering if at the center there would be doctors there or just the TBA's and midwives? I was also wondering how/if you would train the TBA's and if this training could then help them assist with births back in their community instead of having to come to the center?
Hi Bre! Thank you for your comment and I apologize for the delay of my response. I was traveling and did not have great access to the internet.
I think there could be physicians at the center, though they would not be necessary if the midwives can do most of the work. However, if this center is established just adjacent to the main hospital in Nansio, the doctors would be just next door and therefore, available for consultation and emergency intervention.
The TBA's would ideally be trained by midwives so that a partnership is established from the beginning. Formal classes would also be offered based on a standard midwifery training model. After receiving training, I would not be surprised if they would wish to bring their skills back home. I think this would be the eventual goal, however, before creating additional centers that house emergency obstetric equipment (and the ability to have an emergency cesarean section) near their respective homes, I would not feel comfortable encouraging them to practice there. Therefore, in order to give them incentive to use the center, I think we could just arrange that payment is primarily distributed at the center and that the TBA would receive better wages if she worked there.
These are certainly complicated issues, which would need to be worked out based on the community's feedback in initially establishng the center.
Thanks so much for your thoughts. Feel free to continue correspondence.