As a certified nurse-midwife serving in Indonesia, I am passionate about providing good health care and helping Indonesian women have safe pregnancies and births. This blog will share just a few thoughts and tales from that passion.
I spent last week in Florida attending a Health, Agriculture, Culture, and Community Workshop hosted by ECHO and MedSend. This workshop was a requirement as part of my grant from MedSend (more on that soon on my other blog). I will be honest I had no idea what to expect of this workshop but I have to say I learned a lot and met a lot of great people.
The workshop brought together nurses, physician-assistants, physicians, nurse-practitioners, a midwife, and a veterinarian who have all dedicated to serve in an area of need around the world and in the United States. We came from a variety of backgrounds and are serving with several different organizations, so it was great to compare notes and learn from each other. It was amazing to hear their stories and about the ministries God has planned for them.
The workshop was led for the most part by Dr. Dan Fountain. He served as a doctor in the Congo for several decades. We covered a lot of topics in the five days we were together. Much of it was practical information and ideas that we can adapt and apply to our own work. We heard lots and lots of stories from Dr. Fountain about his years of service. One of the important things I have been learning is the importance of not just importing my culture and worldview but instead using a Biblical worldview. We also spent several hours each day hearing from the experts at ECHO. They taught us about plants, animals, and appropriate technologies we can use in our respective areas of service to improve the health and nutrition of the people we are serving. I really consider myself pretty much lacking a green thumb, but they provided numerous simple resources and ideas for us. Here are a few pictures from the week...
Learning in the Classroom
Learning on the Farm
Learning about appropriate technologies we can use to improve community health
Hands-on learning about practical techniques to use in community health
Many of you reading this post are women who have given birth. What do you remember about that experience? Most women remember it for the rest of their lives. Just ask any mom out there about her births and she can pretty much recount them moment-by-moment. That is one of reasons it is so special to be part of that time in a women's life, because they remember you and your care forever.
Throughout the world today however many women are not experiencing the care you would want for yourself during those special moments. This happens in poor countries as well as rich. A number of organizations, including White Ribbon Alliance have recently started a campaign to highlight the need for respectful maternity care around the world.
I have experienced situations both here in the US and in Indonesia where women were not respected during those very vulnerable moments. One moment sticks in my memory from Indonesia. I was present at a birth (not at Bethesda) where the midwife slapped and yelled at the women giving birth about not getting prenatal care or coming to the hospital when her labor started. The situation was made all the worse by the fact that the women was delivering her baby who had already died at the time.
Here in the US jaded by those we see as "unfit mothers" (including those frequently abusing alcohol or drugs during their pregnancy) we don't treat every woman with the respect she deserves. I cannot tell you how many times I have gotten report and been told "she is one of those patients" or we picked you to be her nurse because "she and/or her family needs lots of patience." I know I have said some of the same things before during a long 12-hour shift. In reality though, that is no excuse and I have to admit reading through the charter and watching this film was convicting for me.
The 7 Universal Rights of the Childbearing Women
1. Every woman has the right to be free from harm and ill treatment.
No one can physically abuse you.
2. Every woman has the right to information, informed consent and refusal, and respect for her choices and preferences, including companionship during maternity care.
No one can force you to do or do things to you without your knowledge and consent.
3. Every woman has the right to privacy and confidentiality.
No one can expose your or your personal information.
4. Every woman has the right to be treated with dignity and respect.
No one can humiliate or verbally abuse you.
5. Every woman has the right to equality, freedom from discrimination, and equitable care.
No one can discriminate because of something they don't like about you.
6. Every woman has the right to healthcare and the highest attainable level of health.
No one can prevent you from getting the maternity care you need.
7. Every woman has the right to liberty, autonomy, self-determination, and freedom from coercion. No one can detain your or your baby without legal authority.
Today, March 8th, is International Women's Day. This is the 100th year the world has celebrated International Women's Day. It has grown to become a global day of recognition and celebration across developed and developing countries alike. There are thousands of events scheduled around the world, some big and some small including everything from photos to petitions.
One of the events that caught my eye will be held in England during the Women of the World Festival. It is a series of photographs from around the world highlighting women with the theme Dreams for My Daughter. This theme was chosen after Hadhya Yahya Mohamed Al‐Zawm from Yemen said the following at an event highlighting the issue of early marriage...
“Every mother in the world dreams that her daughter will have a better life than she has. My mother was married at age 9 and had her first child at age 13. She wants more for me”
This video includes many of the photographs that will be displayed as well as quotes from mothers around the world about the dreams they have for their daughters.
Maybe it is because I am one of four girls, but it made me start to think about how moms have so many dreams for their daughters... dreams for a better life, an easier life, more than what she had. This is especially true in the developing world where so often girls face a life with little education, early marriage and a higher risk of maternal mortality. There are things we can do to change this though. Simple things like helping girls stay in school, getting them good health care, and helping them support themselves. Each small change effects the next generation, with each generation building on the progress of the previous generation. Check out this video about "The Girl Effect" for more information.
(for those of you reading this in an RSS reader or your email you may have to click on "read more" to make the videos visible and play them)
... an Indonesian woman dies giving birth. That is from the latest statistics published in the State of World's Midwifery report late last year. That means about 10,000 Indonesian women will die this year alone, many from complications that could have been prevented or treated.
There is good news though too... in the last twenty years Indonesia has significantly reduced their maternal mortality from 620 maternal deaths per 100,000 women giving birth to 240. The goal is to reduce that number even lower to 155 maternal deaths per 100,000 women by 2015. Compare that to 24 women in the US.
In urban areas they have also done well at educating and providing resources to their maternity care providers including doctors, midwives, and nurses. Unfortunately, there is still a large gap in care for those who live in urban versus rural locations. Many who leave their villages and communities to attend school to become nurses and midwives do not return to those home areas, which are in desperate need of skilled birth providers. Life in the city is different with easy access to many amenities and level of living not available in the villages. There is also the allure of financial gain by practicing in the city.
Babies in Indonesia also struggle with 19 of every 1000 babies born dying in the first month. Compare that to 4 in the United States. In addition, 15 of every 1000 babies born are stillborn. It is thought that many of those born still or that die in the first month could be saved by a simple form of neonatal resuscitation by a skilled birth attendant. Finally, 41 of every 1000 babies born die before they reach their 5th birthday. In the US that number is around 8. Many of these children are dying from disease preventable by immunizations, clean water, and treating dehydration.
Finally the last statistic that caught my eye was that Indonesia needs 3,560 additional nurses, midwives and doctors trained as skilled birth providers so that 95% of all of births in Indonesia can be attended by a skilled birth attendant.
As a trained nurse-midwife hopefully I can help meet some of those needs in my small area of Indonesia, but more importantly I hope I can train and teach others as I work at the nursing school near the hospital. Many of these young people return to their villages and communities and some have committed to serve in other areas of need.
This video from the World Health Organization has some of the latest statistics from around the world as well as information on preventing and treating many of the problems associated with maternal, infant, and child mortality.
Her name is Robin Lim or Ibu (Mother) Robin to the community she serves in Bali, Indonesia. She is an American midwife who has given her life to serving families, women, and babies in need through her Bumi Sehat clinics.
In Indonesia, the average family earns the equivalent of $8 a day,
according to the International Monetary Fund. But a baby delivery costs
about $70 at a hospital, and a Cesarean section can cost as much as
$700. Lim believes Indonesia's high maternal and infant mortality rates are
caused in part by these costs, which many women cannot meet.
She made this impassioned plea during her acceptance speech, "Today on our Earth, 981 mothers in the prime of their life will die --
and tomorrow again and yesterday," she said. "And I'm asking you to help
change that. We don't even know how many babies are lost, but all of us
can help change that." She also said that, "health care is the right of all people."
You can read more about her and watch several videos of her work on the CNN web page here.
The following was recently written by Jennifer Williams, a certified nurse-midwife, on the American College of Nurse Midwives blog. You can read it here. I liked it so much I thought I would also share it on my blog
When I was a little girl, I always thought there was a problem
with our Nativity set. I could never figure out why the baby was barely dressed
and separated from his mama, laying in a bucket of hay. He looked pretty cold
and lonely to me. When I was in middle school, I looked at the Nativity set and
thought, “Wow, Mary looks pretty good for just having given birth in a stable.”
As you can see, my fascination with birth greatly preceded my plans for
midwifery school.
Even now, one of my favorite parts of the Christmas season
is seeing all of the images of Mary and her baby son, Jesus. Throughout
history, artists have been compelled to illustrate the Madonna and her newborn.
Christmas as a celebration of birth captures my imagination. I love the
Christmas card aisle at the store and, even though I am a notorious slacker at sending Christmas cards, some years I am
tempted enough to purchase a pack just because I love the images. I love the
cultural interpretations of the Nativity that are prevalent in my state, New
Mexico. A Pueblo Nativity is a work of art and love and draws my mind through
cultures and time. Pregnancy and birth is a universal experience for mothers,
often joyous, sometimes tragic, occasionally both.
There is a joke about what would have happened if three wise
women had shown up at Jesus’ birth instead of three wise men. It goes, “Three
wise women would
have asked directions, arrived on time, helped deliver the baby, cleaned the
stable, made a casserole, and brought practical gifts.” I wonder
if perhaps a wise woman did attend that
young mother in the stable. I always hoped that Mary had someone around who
could support her, dry off her baby, help her get started breastfeeding, keep
an eye on her bleeding—these are the same things I wish for all women, but unfortunately
many lack this very basic care.
As midwives, we come from a rich variety of cultures and
beliefs. However, if the image of a birth in a stable captures your imagination
the way it captures mine, I would invite you to reflect upon the conditions and
circumstances surrounding birth around the world today. Whatever your personal
beliefs, I know that we all wish for safe births attended by loving and
supportive hands. I know we wish for all children to be educated, valued, and
fed. I know we all wish for peace on earth and goodwill for humankind.
When a woman who has just given birth cannot afford to pay medical fees,
there is a risk in Indonesia that her baby will be taken hostage.
This was a recent story on the BBC web page that told the too common story of newborns separated from their families by hospitals, clinics, and private midwives when they are unable to pay the bill for care during their birth. The story highlighted one such family in Bali (pictured above) in which a women who had given birth to twins but only had enough to pay for one birth. She was separated from her son for four months as every day the debt increased, as the clinic charged for the baby's upkeep. In the end her son was returned to her thanks to the intervention of an American midwife living and working in Bali.
According to the story 36 such cases were reported to the government in 2010 but they acknowledge that many more cases probably occurred as most people probably didn't report it. Care for poor women who are pregnant has been paid for by the government for several years now, but correctly identifying those women, budget shortfalls, and bureaucracy have prevented this funding from reaching those in need. In the coming year a new plan will hopefully be put in place providing universal health care for pregnant women throughout Indonesia but funding problems are expected. Hopefully at least these steps will help reduce this problem. In addition, hopefully it will encourage those who avoid coming to clinics and hospitals because of the cost to seek care.
