Choosing to save lives

Story and pictures by PAULA KARI
VILLAGE birth attendants, or VBAs, are mainly older women, who themselves have had children. A village birth assistant helps pregnant mothers during the delivery of their babies.
About 200km towards the northern coast of Madang is the Bogia district, there, in a village called Temnung, you will find a 32 year old mother of four named Dominica. She is also a VBA and since taking up the role not too long ago, she has delivered 20 babies and takes great pride in her role.
While home birth is a risky choice, it is sometimes the only option available to women in her village due to long distances of travel, unaffordability, inconsistent transportation, restricting cultural norms and beliefs and lack of health staff and/or drugs and facilities at community health centers.
From Temnung village, a pregnant mother has to walk for five hours (sometimes in great distress) to the nearest health centre at Bunapas to get help. By boat along the Ramu River, it takes three hours.
Dominica, herself, has walked the distance twice for the births of two of her children and knows the great difficulties full-term pregnant women face.
In Temnung, and other villages that either hug the banks of the mighty Ramu or spill out on to plains, pregnant mothers do not give birth in their homes. They are culturally required to move to a special birthing hut or a makeshift space in the bushes. Dominica is required to step in as a midwife in these instances and she loves her role.
“I like helping women. Mothers are calm and grateful, knowing that I am there to help them. There are five other women like me in our village of about 720 people,” she said with a quiet smile.
Dominica says that she has noticed a change in her remote village since the introduction of VBAs.
“Babies are healthier and women are no longer dying from birth complications due to increased health information reaching them,” said she.
Bunapas Health Centre sits right on the bank of the 640 km-long Ramu River- the biggest and longest river in Madang- which runs from the Kratke Range in the Eastern Highlands down to Usino-Bundi District of Madang and continues down to the Bismark Sea in Bogia District.
The health centre serves a catchment of around 20,000 people. The figures are according to the 2011 census and by their projection, this would have increased by 24 births for every 1,000 people by a year ago (estimate for PNG overall).  Andrew Ska is the centre’s health extension officer. He is also the officer in charge. Around 20 patients visit the health centre daily. Andrew says medical drugs supply is very limited and even treating patients for simple illnesses is often a challenge at this out-of-the-way facility. When medicine dries out, patients are asked to make purchases from pharmacies in Madang. Patients have to fork out K80 for a return PMV trip. Alternatively, they ask their relatives in town to make the purchase and send it back home.
According to UNICEF data, just over half of the births in PNG (53%) are attended to by skilled health staff. It is approximated that in PNG, only 60% of aid posts, designed to serve rural populations, are functioning. In the case of this catchment area, only 20% of existing aid posts (2/10) are functioning, but with limited to non-existing capacities. Apart from Andrew, there are two aid post orderlies (APOs) at Bunapas Health Centre. This is less than the required eight health workers needed to staff the centre.
Without a female member of the staff, many women prefer to give birth at home. The neighbouring Bogia health centre is about an hour by PMV and some women visit there for antenatal clinics and for delivery as well. WHO estimates that more than 60% of childbirths in PNG occur outside of health facilities.
The health centre at Bunapas is starting to show signs of physical improvement, thanks to World Vision’s intervention with funding support from the New Zealand Ministry of Foreign Affairs & Trade (MFAT)’s Sustainable Development Fund (now the NZ Partnerships for International Development Fund or Partnerships Fund) and World Vision New Zealand. It’s small 1.5×2 delivery room is now extended to an even bigger space of 2.4×3 metres, a gesture, much appreciated by Dominica and others.
The outpatient, ward and ‘wait haus’ has been improved with project staff living in the community and working with local volunteers on the refurbishment. Much-needed water was also reconnected to the health centre.
Mary Dare, of Regene village, wants to do more for other women. Fifteen years ago she gave birth to one of her three children under the cocoa trees, assisted only by her sister-in-law.
“Most times women give birth either further away from the village or for those luckier, within a stone throw away. A large number of women deliver their babies on their own. They ask me to help them when they are in labour but I am not a trained birth attendant…I would like to attend village birth attendant training that World Vision is running to able to assist more mothers,” said Mary.
Father of five Fabian Semi of Regene village spoke of how Mary assisted his wife Janet, safely deliver their last child. The baby boy could not wait much longer and Mary had to help deliver him just 5 minutes short of a health centre. Baby Willie is now reaching his second birthday.  Fabian expressed his gratitude, adding that the current refurbishment work being done by World Vision at the health centre will serve local women and children well. The project has also worked and upgraded a total of six health facilities or maternity sections of health facilities in the district, including training of health workers.
According to the Global Burden of Diseases Study 2013, Mortality and Causes of Death, Collaborators (17 December 2014), post-partum hemorrhage or PPH results in 44,000 to 86,000 deaths per year globally, making it the leading cause of death during pregnancy.  While standards of antenatal care have risen in many parts of the world in the past decade, according to the WHO, only 46% of women in low-income countries benefit from skilled care during childbirth. Maternal health and access to reproductive health services have deteriorated and at the same time population has increased over the last two decades. While preventable through well-known safe motherhood interventions such as quality antenatal care and supervised childbirth, PPH is one of the most common causes of maternal mortality in PNG.
Mary is among 71 certified VBA’s trained through the project. The project has also trained 179 Community Health Resource Persons (CHRPs) from 10 target communities in the Yawar and Almami Local Level Government (LLG) in Bogia. Out of these, 29 are certified as Village Health Volunteers (VHVs) under the VHV curriculum. CHRPs include VBAs, village health committees and community peer educators. While VBAs complete one module ‘Safe Motherhood Training’ under the VHV program, VHVs complete the full five modules to be certified as VHV. All are volunteer members of the community who advocate and create outreach for improved health of families, including mothers and children.
MNCH Project Manager Manu Peter said it was announced at a review meeting early this month that two female health staff will join the Bunapas Health Centre team – great news and result for the 4-year project, which winds down this month.
World Vision is working with like-minded partners and vulnerable communities in PNG to invest in rural health service delivery in line with the government’s policy and strategic priorities. At the same time development of such alliances should be pursued and existing ones strengthened. Communities are empowered to pursue opportunities for mobilising resources from existing avenues for improved health and well-being of children and families. Where possible, more partnerships should be leveraged to take the pressure of public expenditure on health, and to foster innovative service delivery.

• Paula Kari is senior communications officer at World Vision PNG.