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Sunday, August 31, 2014

Reproductive Health Services and Education in Africa (interview)

photo courtesy Heidi Ricks
Heidi Ricks is a Licensed Midwife and the director of HeartSpace Midwifery in Troy, NY.  Ms. Ricks has also volunteered in Zimbabwe, Tanzania, and Morocco:  She initiated a feminine pad project, developed women’s empowerment initiatives, and worked with traditional birth attendants to teach basic life-saving skills.

How is the education of African girls affected by the lack of reproductive health services?  What are some ways we can help? 

Many women and girls suffer because they have no access to menstrual care products and have to stay at home during their cycles.  I knew of a pad project that had run in India and volunteered to lead a similar project in the villages I visited in Zimbabwe and Tanzania.

During a return trip to one of the villages, my 7-year-old son was wandering around with one of the local children.  He came running back to me insisting that I come with him to a room at the back of the school. 

There I found several young girls sitting together in a pile of fabric sewing the cloth menstrual pads that I had introduced the year before!  They had piles of pads that were available for girls to take when they needed them.  I was told that the absentee rate for girls had plummeted and they were expecting the graduation rate to go up as a result of this simple project.  My heart soared!

Why did you decide to volunteer in Africa?

I’ve felt called to Africa since I was a child.  I don’t know why or when it started but I can remember reading my dad’s National Geographics and thinking, “I need to be there.”  My first trip was at a time in my life when most people would have said it was insane to go: three children, one of them only a few years old. 

I was in a place of needing something in my life to shift and had just said a “prayer”/request/intention to God/the universe/higher power that I really wanted to travel but wanted to do good work while I was traveling. 

Within a week I found an article about a local group that was planning a trip.  The photo of a volunteer holding a child from the village captured me.  Shortly after, a friend handed me a sticky note with the name of a woman saying that she needed CPR classes for a group that was going to Zimbabwe.  It was the same group that I had read the article about. 

I signed my husband up to teach the class for them and told him I was going too.  The poor guy never saw it coming, but there was never a question in my mind.

What is the role of Traditional Birth Attendants, and what type of training do they normally receive?  

Traditional Birth Attendants (TBAs) traditionally learn their skills from elder TBAs and from experiential on-the-job learning, but unfortunately much of this knowledge seems to have been lost.  I tried to ascertain if there were traditional herbal remedies in use and could find no one who knew of any.  (Of course, it’s possible that I wasn’t there long enough to gain the trust of these wisdom keepers.)

I did learn about some benign cultural traditions passed down through the years, like treating postpartum hemorrhage by drinking water in which a donkey’s umbilical cord has soaked.  And I heard about some dangerous practices, like cutting umbilical cords with old razor blades or bits of glass.

Many governments in Africa don’t value the roles of TBAs and actively try to eradicate them by leading women to believe that the old practices have no value.  They instead want women to go to hospital to give birth with government-trained providers.  Unfortunately, this policy is unfeasible and even downright unsafe in many rural situations. 
  • There is sometimes no infrastructure (like roads), and there is no transportation other than foot, bicycle or donkey cart. 
  • The women are expected to pay for hospital services, and for families already living at subsistence levels this is completely impossible. 
  • The hospital staff is often not paid well or at all so it is usually inadequately staffed. 
  • Hospitals are functioning sometimes without the benefit of clean water or electricity and almost always with inadequate or substandard equipment.

After witnessing a birth at a rural hospital I am convinced that women with healthy pregnancies and low risk factors would be better served birthing at home with TBAs who at least know and maybe even respect them. 

In my experience, TBAs want to learn and want to provide the best care possible but they are shut out of the government programs and are not supported in any way, yet they are the ones attending the majority of rural births. 

I wholeheartedly believe that cutting TBAs out of the system and withholding basic training from them will only serve to keep the infant and maternal mortality rates at the same unacceptably high level. 

What was it like teaching in such a different cultural situation?  How were you received?

Before my first trip, it was a challenge to know what to prepare as I could find no other midwives who had worked in this area.  I gathered supplies from midwifery organizations in the U.S., and I researched various educational tools and methods to bring along.  Some of this turned out to be useful, but some of it was culturally inappropriate or required resources that weren’t available locally. 

I discovered that bringing in western supplies and attitudes isn’t helpful if the people we are supposedly serving can’t maintain the project after we leave.  Even with the pad project I mentioned earlier, we brought the fabric, needles, scissors, etc. I think this type of project could be much more sustainable by researching local plant fibers that could be used.  (Here are two articles about this type of research:  the JaniPad in Western Kenya, and Sustainable Health Enterprises in Rwanda.)
Another challenge on my first trip was that the government of Zimbabwe (under Mugabe) decided to co-opt my time with the TBAs by sending a government- sanctioned midwife to train them.  This was a blessing in disguise because the women were able to receive culturally-appropriate training in their own language.  This would normally have been impossible as they would have been required to travel long distances and to pay for this training.  The women were grateful to have the training come to them and I was able to witness what skills they learned and how they learned them.  This proved very helpful in planning future trips. 

My most successful training happened on an independent trip to Tanzania.  When I got to the village I was originally told that all of the TBAs were far away at a funeral, but I suspect they were actually waiting for clearance from someone in the community.  Since I hadn’t been able to get in touch with them beforehand to let them know I was coming, they must have wondered about the crazy white woman who had traveled there alone toting her young son.

I let them know who I was and why I was there.  I started by asking if there were ever babies that were born and didn’t breathe on their own and then what they did in that situation.  They assured me that it happened fairly often and that they had a few tricks they knew to help.  One was to stick tobacco up the baby’s nostrils.  Another was to submerge the baby in cold water. 

I then let them know that I had another tool that might be helpful.  I had been given infant mannequins by a friend who teaches neonatal resuscitation here in the US.  Using some teaching tools I had learned from the midwifery training in Zimbabwe, I was able to teach about basic anatomy and physiology and the mouth-to-mouth resuscitation technique. 

The TBAs expressed dismay that they didn’t know something so simple that could help.  They said (through the translator) that they would definitely try this new way of getting babies to breathe if they needed to help them. 

What does “mindful teaching” mean to you?

Mindful teaching is the capacity to meet someone non-judgmentally in their world and then to create a safe place for the unfolding of thinking, feelings and actions.  After that has been established, new ways of seeing or thinking can be introduced.

Teaching consciously includes a willingness to learn from the students as much or more than you are teaching.  Mindful teaching has to include self-knowledge and an ability to say you don’t know--a lot! 

Tapping into the interests and needs of the individual or group in crucial.  Mindful teaching requires an ability to set preconceived goals aside in favor of being in the flow of the moment and having the flexibility to change course based on current needs. 

Do you have a personal mindfulness practice, and if so, how does it help you in your work?

I use knitting, gardening and biking as meditation.  I also have an on-again off-again sitting meditation practice.  I'm in an on-again phase right now, and find that it’s helping greatly with the daily stresses of trying to balance family, work and self.  I don’t claim to be at all proficient in meditation but have aspirations of getting better. 

I incorporate the concept of seva into my life.  The idea of using my life’s work as an offering to the betterment of the world has always been important to me.

related posts:

Work of the Heart, for the Heart, and for the People of Haiti (interview) 

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