*Y.C.* Creating Community Maternal Health Workers with Post-Operative Fistula Patients
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Due to an extreme lack of human resources to serve the health needs of rural communities in developing nations, millions of women give birth to children with no trained support or medical assistance. While the human resource problem is massive and complex to tackle, I have an idea to help ameliorate the situation.
Obstetric fistula is a tragic result of unassisted childbirth, as the increased pressure of prolonged or obstructed labor renders numberless women incontinent across the developing world. Surgery can repair most fisutlas, and surgical units and hospitals have expanded considerably in recent years. Having worked in such a facility in Niger, I have seen first hand the excellence of care given to women as their fistula is repaired and they face a new life of dignity.
Post-operative care in these hospitals is usually accompanied by brief instructional meetings, informing women how to prevent fistula in the future. Often women are even trained as nurses to stay and help at the fistula treatment centers. What I propose is to expand this educational element of post-op fistula care, and provide any willing woman with a more comprehensive training on how to prevent fistula and ensure safe pregnancy and labor not only for her, but for her entire community. The program should not be compulsory, but should be open to any woman who wants to be a TBA, nurse, or midwife in their communities. The facilities I worked at Niger, ONG Dimol and l'Hopital National, had Peace Corps volunteers and nurses who were already engaged in helping teach women the basics of healthcare. If there are women who have had some previous education and are willing to go further with health education, it would be incredibly impactful both for them and their communities to receive more comprehensive training as a community health worker.
About You
Section 1: About You
First Name
Julianne
Last Name
Parker
Website
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Country
Germany
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Yes
Section 2: About Your Organization
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Your idea
Name Your Project
*Y.C.* Creating Community Maternal Health Workers with Post-Operative Fistula Patients
Country your work focuses on
Niger
Describe Your Idea
Due to an extreme lack of human resources to serve the health needs of rural communities in developing nations, millions of women give birth to children with no trained support or medical assistance. While the human resource problem is massive and complex to tackle, I have an idea to help ameliorate the situation.
Obstetric fistula is a tragic result of unassisted childbirth, as the increased pressure of prolonged or obstructed labor renders numberless women incontinent across the developing world. Surgery can repair most fisutlas, and surgical units and hospitals have expanded considerably in recent years. Having worked in such a facility in Niger, I have seen first hand the excellence of care given to women as their fistula is repaired and they face a new life of dignity.
Post-operative care in these hospitals is usually accompanied by brief instructional meetings, informing women how to prevent fistula in the future. Often women are even trained as nurses to stay and help at the fistula treatment centers. What I propose is to expand this educational element of post-op fistula care, and provide any willing woman with a more comprehensive training on how to prevent fistula and ensure safe pregnancy and labor not only for her, but for her entire community. The program should not be compulsory, but should be open to any woman who wants to be a TBA, nurse, or midwife in their communities. The facilities I worked at Niger, ONG Dimol and l'Hopital National, had Peace Corps volunteers and nurses who were already engaged in helping teach women the basics of healthcare. If there are women who have had some previous education and are willing to go further with health education, it would be incredibly impactful both for them and their communities to receive more comprehensive training as a community health worker.
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Innovation
What makes your idea unique?
While similar, more small-scale projects are already in place, the potential for training and educating post-operative fistula patients has not been realized. Training and education resources exist, but are not yet fully utilized. My idea would help provide thousands of community health workers quickly, without a significant increase in resources already available.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
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Problem
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Actions
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Results
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What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Year 1: A significant scale-up of current educational facilities and mechanisms in obstetric fistula units. Possible introduction of additional educators/trainers in hospital and repair centers.
Year 2-3: Follow-up with trainees to ensure that knowledge has been assimilated into action and their communities are now being served.
Since this project would be ongoing with each new wave of fistula patients in the hospital/repair centre, these steps would have to be repeated in a cyclical basis.
What would prevent your project from being a success?
Lack of interest or motivation on the part of health workers, nurses, and educators in fistula-treatment facilities and/or fistula patients.
How many people will your project serve annually?
101‐1000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Idea phase
Is your organization a
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Is your initiative connected to an established organization?
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How long has this organization been operating?
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Does your organization have a Board of Directors or an Advisory Board?
Does your organization have a non-monetary partnerships with NGOs?
Does your organization have a non-monetary partnerships with businesses?
Does your organization have a non-monetary partnerships with government?
Please tell us more about how these partnerships are critical to the success of your innovation.
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What are the three most important actions needed to grow your initiative or organization?
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The Story
What was the defining moment that you led to this innovation?
I have been interested in maternal health, fistula particularly, ever since I read about the Hamlin Hospital in Ethiopia when I was 18. Since then I have made it a goal to gather as much knowledge and information as I could to eventually help change policies in favor of women at risk of injury or death as a result of childbirth.
While completing my Masters in African Studies at Oxford, I concentrated my studies on public health, and conducted an intensive research project in Niger on women suffering from obstetric fistula. While there, simple truths began to emerge and I realized while on the ground that 1. fistula affects all women, not just young girls as is so often popularized in advocacy campaigns, and 2. these women are brave, intelligent, and only lack proper health care and infrastructure. These women were not ignorant, but instead have great knowledge and an in depth understanding of their communities and the problems that impede health.
It was when among those women that I realized they are being underutilized, treated more as ignorant young girls whom Western medicine needs to repair. They are not weak, but rather have an amazing capacity to change their own lievs and those of their communities for the better.
Tell us about the social innovator behind this idea.
I am a 25 year old passionate feminist, born and raised in Los Angeles, I have now lived all over the world, getting a Masters degree at Oxford with field experience in the Middle East and Southern and West Africa. I currently live in Germany, completing a year-long policy consultancy with UNICEF.
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Comments
How do you plan to significantly scale-up educational facilities and mechanisms in obstetric fistula units. And what exactly do you mean by scaling them up?
Many thanks for your comment, and sorry for the delay in my response. I've been travelling and internet connection is touch and go!
When I speak of "scaling up" I mean building on existing education programmes. To that end, I would recommend facilities continue to utilize the same educators in use before. I am speaking from my experience at the Hopital National de Niamey, Niger, where multiple educators are in place and could easily adapt the programmes to a more "rigorous" community health worker course. By no means would I expect the women to come out fully trained in obstetric care - however, I do believe basic reproductive health issues could be conveyed through simple courses presented for the duration of a fistula patient's recovery. One or two educators is all who would be necessary, as I know not every woman would be willing or capable of undergoing such an educational programme. A possible schedule would be 2-3 days a week, 1-2 hours instruction, covering basics of family planning, pregnancy (particularly detecting signs of a traumatic pregnancy), labor/delivery, and breastfeeding.
The main point would be to educate the women on how to recognize when a pregnancy and labor/delivery are going awry. Transmitting this basic knowledge to women in smaller communities could help them prepare to travel to medical facilities in capital cities, most of which provide free c-sections and maternal healthcare (speaking of Niger, but this may change with the junta!).
Hope this helps to clarify. Thanks again!
I like your idea but I was wondering how you would train them especially taking into account possible educational differences and education levels. Also who would take over the jobs in the hospital for those people that would train in the community?
Thank you again for your entry!
Hi!
Thanks so much for your comment! In terms of education levels, I understand completely that these differ vastly among fistula suffers - some are literate, others are not, but even those who are literate will likely have a very limited knowledge of reproductive health (most women in the world, including developing countries know very little about pregnancy and how their bodies work, even if they have a college degree!). So I would structure the curriculum at the most basic level, with visual diagrams/images that could allow literate and non-literate women the same environment of learning. I would assume that only a few women at any time would want to engage in the learning process, so I would hope that the instructor would then have plenty of time to coach those who struggle more due to a lack of previous educational background.
As to your second question, I don't anticipate any direct training in the communities: all education would take place at the hospital facilities. And again, I am not asking for an intensive nursing course: I think a very basic expansion of existing educational services, i.e. teaching the women basic tools to detect high risk pregnancies and early signs of stressful labour so they can help other women with such symptoms get to an appropriate health facility (usually in an urban environment) ASAP, rather than waiting for the labor to become more complicated and the risk of fistula, eclampsia, or death becoming greater. So no additional staff should be required at hospitals which already have existing educational programmes.
Hope this helps and answers your inquiries!!
all the best,
Julianne.