We've had quite a busy month trying to pull everything together. The house itself just has a few tiny touches left (painting the exterior compound wall, fixing the tiling, painting the ceiling and mounting the water tank outside).
Ebrima and I met with the community health nurse who lives in a neighbouring village and is responsible for village health outreach in Penyem and twelve other villages in his area. His name is Babucaar Jallow and he is the main link between Penyem's village health worker (VHW) and the regional health team (RHT) which coordinates health programming.
Babucaar has trained traditional birth attendants (TBAs) and has lots of experience and good ideas. One idea we are helping with is creating printed birth and death registers for each of the 13 villages Babucaar is responsible for. It's an important step in determining village birth rates, recording causes of maternal and neonatal mortality (when known), etc. Penyem has a birth register but not all of the surrounding villages do, and they don't all capture the same information. We are printing registers for his catchment area that record standard information for births and deaths in the village. It's quite an important step in capturing the right data, and Babucaar will do a training session with all of the village health workers with the new registers once we've handed them over. They are at the printers right now and will be ready to pick up on Tuesday! Here is what they capture:
Inside pages, death register
We also met with the regional health team to get their feedback on the project, and to discuss training for a second TBA from Penyem. It's very important to us that the birthing house be integrated into the existing health system as much as possible. Babucaar has offered to come and do some training on clean management practices for the women who will be responsible for the house, and we are hoping representatives from the regional health team will be able to attend the opening as well.
Last weekend Ebrima and I visited Penyem on Saturday. We met with the women to discuss the program for the opening, and their thoughts on training a second TBA for the village. The current TBA is quite experienced, but also getting older and from a sustainability point of view we would like to support the training of a second younger TBA who can then be mentored by the current TBA. The discussion went really well. The grandmothers are all really looking forward to the opening - as are we! - and discussed the need to engage the men in the village as well in supporting the birthing house and the women who will manage it.
We are on the hunt for hospital beds for the house. We are hoping a donation will come through from a hospital here. We've also asked a local contractor to be on standby to make metal-framed beds for us if the donation doesn't come through. I was an unsuccessful bidder at the American Embassy auction this weekend; I bid on some filing cabinets to store the delivery supplies in the house, but was outbid by the guy standing next to me!
We did lots more errands this weekend, including buying solar lights for the house from d.light (http://www.dlightdesign.com/home_global.php). Here's Ebou with our new lights:
Buying solar lamps for the birthing house!
We still need to pick up our stock of clean delivery supplies from the local pharmacy, which includes antiseptic soap and disinfectant, razors, cord ligatures and gloves. The TBA has a small kit with her own supplies that will be kept in the house, and we are buying a stove and gas tank to boil water for her metal delivery supplies.
Clean delivery practices go a long way in reducing infections acquired during delivery. I've had the chance to learn a fair bit about clean delivery through this project. The World Health Organisation's six principles for clean delivery are:
- clean hands
- clean perineum
- nothing unclean introduced to the vagina
- clean delivery surface
- clean cord-cutting instrument
- clean cord care (including cord ties and cutting surface)
PATH (http://www.path.org/) has great resources on clean delivery kits, including this guide which we have referred to along with Babucaar and the TBA's guidance to ensure the house is properly equipped for clean delivery: http://www.path.org/files/MCHN_BDKG.pdf. Considering that almost 70% of Gambian women still deliver at home, these clean delivery practices can reduce the chances of infection that are responsible for 15% of maternal deaths worldwide every year (120 000 of the 600 000 who die in childbirth every year, according to the WHO).
We still have a few more errands to do, including buying the pear tree we are going to plant during the opening, and coordinating the beds (either donated or made). I need to find a nice big red ribbon for the launch, and we are also having a sign made for the outside of the house when the official opening date is set.
We have been planning for next weekend (December 18th, 2010), but there has recently been a death in the village, and the villagers are also concerned about having enough time to harvest their rice crops. So they are currently discussing whether we should go ahead with the opening next weekend, or wait for a little while. Either way, everyone is looking forward to the launch!! We have recruited the MRC's public relations officer as well to help us publicize the event with the local media! And I know that CBC is interested in doing a follow up interview when we are ready to open.
Stay tuned for another update!!
