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Ratna with her son Ralvin at the local health centre
in Galesong
©UNICEF
Indonesia/2014/Ramadana |
Ibu Basse
has been helping women in Galesong give birth for 33 years and is a respected
member of the community. She lives about a five minute walk from Ratna, so she
hurried over to help the expectant mother.
Reassured by
the older woman’s presence, Ratna agreed with her suggestion that it was time
to seek help at the local health centre. Ratna had a seven year old daughter,
but her second pregnancy had ended in a still birth so she was anxious that
this time round, everything should go smoothly. Ibu Basse found a motorised
rickshaw to take them to the clinic, and soon the women were on their way.
At the
health centre they were greeted by Syarhruni, a young midwife who was on duty
that night. Ratna’s baby was in the breech position – with its legs instead of
its head pointing down. After two hours of contractions, one of the baby’s feet
had appeared but Syarhruni could see that Ratna was making little further
progress in her labour, so she decided she should be transferred to a hospital.
With red
lights blazing, Ratna was rushed by ambulance to Takalar hospital, a half hour
drive away. Ibu Basse stayed by her side, massaging her swollen belly and
reassuring her that everything would be alright.
“I believe
her presence brought me good luck and she helped to take away some of my pain,”
says Ratna about Ibu Basse.
Trusted Presence
A few years
ago, women in Galesong relied entirely on TBAs to help them through labour. The
TBAs provided moral support and their birth rituals, like massaging the
mother’s belly, were thought to ensure a smooth delivery.
Older and
more familiar than the young, new midwives who came to the village, the TBAs
were trusted by mothers. But they didn’t know how to spot the signs of a
complication in delivery, like eclampsia or a breech birth. Nor would they
routinely seek assistance from others, particularly health care providers.
The Ministry
of Health, supported by development partners like UNICEF has been working to
change this. In 2007, they initiated a programme that brought together midwives
and TBAs from five health centres in two sub-districts of Takalar for a joint
training programme to get them working together for improved women’s health.
The TBAs were shown how to recognise danger signs in pregnancy and labour, and
were trained in the importance of persuading pregnant women to see a midwife.
The midwives
were taught that the TBAs could help them to reach more women and make sure
they attended deliveries.
The TBAs and
midwives in Galesong now work together and complement each other’s skills to
help pregnant mothers – the midwives bring their up-to-date technical skills
and the TBAs bring their long-established links and credibility in the
community.
Around 12
women used to die every year in Takalar district due to complications in
pregnancy and childbirth. Since the training programme began in 2007, that
number has dropped to zero.
The
programme has also been expanded at national level
as it is a first step to improve the uptake of maternal and newborn health care
service in the puskesmas (health centres). It has been included as a
minimum service standard in puskesmas for the maternal health programme.
Emergency
The referral
system in Takalar is still not perfect. After half an hour in the ambulance,
Ratna and Ibu Basse reached Takalar hospital but they were greeted by bad news.
The obstetrics specialist was away and there was no-one there with enough
expertise to help.
By this
point, both the baby’s legs were visible but its body seemed stuck. The women
got back in the ambulance and headed back through Galesong and onwards to the
city of Makassar.
An hour
later, they reached the hospital there, and with the help of expert care and
oxygen, Ratna was able to deliver her baby boy naturally. Ralvin was born at
2.30am.
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Baby Ralvin with (from left to right) his father,
mother and TBA Ibu Basse
©UNICEF
Indonesia/2014/Ramadana |
There may
still be glitches in the referral system but thanks to the collective efforts
of Ibu Basse and Syarhruni, Ratna received medical care in time.
Two months
later, Ratna and Ralvin are doing well. “I think Ibu Basse helped to bless my
delivery,” says Ratna. “I couldn’t have done it without her.”
