This is a country of extremes – heat and cold, desert and mountains, generous hospitality and extreme poverty. It is not a country that would ever be called pretty, but it is so often beautiful.
And it is a country with some of the highest rates of infant and maternal mortality in the world – 460 out of 100,000 women here die of pregnancy-related conditions (compare that to 11 out of 100,000 in New Zealand), and approximately one in five children die by the age of five years (one in 200 in New Zealand).
I have worked in this Central Asian nation for more than ten years, in various clinical roles in clinics and hospitals, caring for mothers and children, modelling good practice, and mentoring local nurses, but it has always felt like such a tiny little drop in a huge ocean of need. During this time I had heard people talking about a community-based programme that offered lessons in the basic foundational issues around good health for pregnant women and new-born babies. It seemed like a great concept. But community education has never been my strong suit, so when I was offered a position on the programme I turned it down – twice.
In 2014 I had to leave the organisation I had been working for, and went on home leave. I left reluctantly, with my feet dragging, and I begged God to find a way for me to return. As my six-month home leave turned into a year, and then more, I found myself pushing on doors that refused to open. Then last year this door, this unexpected – almost unwanted – door just flew open, and in November I became the National Director of that twice-refused mother-and-baby health education programme, providing oversight and support to a very able group of mostly national facilitators as they implement the programme in three regions of this country. And, unexpectedly, it has proven to be a beautiful fit for me. It has been a very real blessing to join this team and be working at the grassroots level to help reduce what is one of the greatest health crises in the country.
The programme teaches men and women who are often illiterate and have little choice in life, how women can have safe and healthy pregnancies and healthy new-born babies. After a long process of selection, groups of about 20 people – men in one group and women in another – attend lessons one hour a week for 17 weeks. They don’t get any food or money for coming – the only real incentive is that what they learn in the course could save their own life or the life of a member of their family. Although it is always women who attend a birth and advise on pre-natal and post-natal care, the men are the decision makers in the family; if they understand what is needed to achieve a healthy outcome for a mother and new-born baby, then they will be better able to make good decisions when the time comes.
We hear so many good stories about the impact the programme is having. An older woman, Ara*, who was participating in the course, tells of being asked to go quickly to the home of a woman who had just given birth. When Ara arrived she found the baby was safely delivered and looked well, but the mother was still bleeding heavily. Ara encouraged the mother to breastfeed (which helps the uterus contract), but things did not improve. There was a local birth attendant present, so Ara asked her if she had checked the placenta to make sure it was whole. The birth attendant had never heard of such a thing, but agreed to do it. When they found there was a small piece of the placenta missing, Ara quickly arranged for a vehicle to take the mother to the hospital, where a doctor removed the retained part of the placenta. He congratulated Ara on acting so quickly. The mother recovered well, and the community now refer to Ara as ‘Doctor’, and respect her knowledge, a fact she is very proud of.
I also recently heard of an older man in one of the groups where they had just had the lesson on how to help new-born babies breathe. At the end of the lesson he was in tears, as he realised that maybe his first three babies could have survived if he had known this. Later on he was nearby when one of his grandchildren was born. After the baby had arrived, all the man could hear was wailing and crying, so he put his head in through the window and asked what was wrong. He was told that the baby was born not breathing, and had died. He said, “No, give the baby to me”, so they passed the baby out through the window, where he began rubbing the baby’s body, flicking its feet, and breathing gently through the nose and mouth. And the baby began to breathe!
Stories like this reinforce to me just how transforming this simple knowledge can be for families and communities. I am also encouraged to see how women, in particular, grow in confidence during the course. Many have never had any opportunity for formal education – if they were able to attend school at all, they most likely had to leave at a very young age. The opportunity for them to learn and grow in a new area is life-changing. As the participants gain knowledge through the course, they are better able to advocate for their own needs.
Although there are times when I miss the clinical nursing which has always been such a part of my life, I find myself thriving in this new position. My role is primarily one of facilitation – keeping an eye on budgets and donors, writing proposals and reports, taking advice from my colleagues about changes needed in the lessons, helping my local colleagues as they interact with the Government body that oversees our work, and generally making sure my colleagues are free to get on with the work in the field that is so important. Sometimes I feel as if I am at both the top and the bottom of the food chain! But I love being a part of a programme that has so much potential to change the outcomes for mothers and babies, that builds capacity, knowledge and strength in communities, and that is driven largely by the needs and desires of local people. And, although much of our ‘transformational’ work is on the physical level, our hope is that the messages of hope and healing that the programme brings will somehow also impact the spirits of those who participate. ♦
Please continue to pray for Kelly as she serves in this very important ministry.
* Name has been changed
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