Go to the People;
Learn from them;
Start from where they are;
Build on what they have.
This excerpt from a famous quotation which Larry Mellon had above his desk at his office in Deschapelles is brought to life every day by the workers in HAS’ Services Communautaires Intégrés, as they support the needs of the people in the Artibonite Valley. We were privileged to see an excellent example of this earlier this week when we went to a church where traditional birth attendants (matrones) were receiving training in birthing skills.
The course instructor, Jeanne Bright, is an energetic nurse who has worked in labor and delivery suites and also with community-based maternity services. All of the traditional rules of education were broken in her class; the chairs were set in a circle, so the participants could see and talk with each other. Jeanne conducted the program not with lectures, but with questions; all of the participants had been delivering babies in the home for several years, and most are also “Dokte Fey” (herbalists) and were well-recognized for their interest and skills in medical care. As Jeanne asked questions, she could assess the participants’ current level of knowledge and compliment them on their answers. The students responded enthusiastically, giving examples from their work experience. At opportune moments, Jeanne taught a song which reinforced the current message in the class, and the church rang with their joyous singing.
More than 85% of all childbirths occur in the home here, attended by a matrone. HAS traditionally has offered continuing education to these specialists, and provided them with sterile birthing kits. The training of matrones was a key step in the eradication of neonatal tetanus in the hospital’s early years. This current instruction is intended to re-identify the recognized matrones in the region and strengthen their capabilities as well as to welcome new women into this women-dominated field.
Jeanne Bright may or may not have been influenced by Go To The People, but she intuitively knew that the principles of that quotation would guide her planning for the course. Before she developed her curriculum (adapted from the Ministry of Health manual), she went to each of the four HAS dispensaries and met with several practicing matrones. She inquired about their experiences, and asked them if there were something they wanted to learn. Each group offered ideas, and questions were asked about the impact of cholera on pregnancy (severe cholera can have a major impact on birth outcomes). When she returned, she designed a curriculum which drew from their questions. She also developed teaching materials which are almost all graphics, since most of the matrones are illiterate. In this way, the curriculum becomes their curriculum, not the Ministry’s, and addresses their needs and interests.
Maternal mortality (women who die during childbirth) is very high in Haiti, but the reported rates in the HAS region are very low. It is possible that some deaths in childbirth are not reported, but the numbers of women who are referred to the hospital’s high-risk obstetrics unit would indicate that the signs of maternal distress are recognized by the matrones and that they take appropriate action to refer women at risk.
Concerned about the high rates of maternal mortality, the Ministry of Health established a policy which calls for all births to be supported in an institutional setting (hospital or health center). Recognizing that this policy would be promulgated, when the HAS dispensaries were renovated and expanded in 2009, rooms were included to provide for in-patient birthing services. However, due to budgetary constraints and other clinical demands during 2010, it was not possible to set these services up. Nevertheless, we were fortunate to have a series of HOPE volunteer nurse-midwives who trained the nurses and auxiliaries in emergency childbirth, in the event that a woman might come to the dispensary in active labor.
HAS is dedicated to seeing these services in place and Jeanne will continue to train the matrones and search for new candidates for the future. More than 250 matrones have participated in this first class in a planned series of four classes. Attendance will undoubtedly increase as the word spreads that a lunch is offered, and that we welcome candidates for future roles in the system.
What will ultimately bring the participants back is the enthusiasm and respect shown by Jeanne Bright, and her willingness to adapt a formal curriculum to feature issues of interest and concern of the participants, and to create a comfortable learning environment for people who have never been in a school.
The full text of the quotation which is above Larry’s desk is:
Go to the People;
Live among them;
Love them;
Learn from them;
Start from where they are;
Work with them;
Build on what they have.
Written on a folded piece of wrapping paper, the faded writing has been renewed periodically and returned to its frame, but now it is succumbing to the assaults of small bugs who find nourishment in the words….