Midwife training resumes after 20 years

The first group of 140 students to undergo specialized midwifery training in Laos in 22 years is expected to graduate by the end of December.



Nationwide, 405 women died for every 100,000 live births in 2005; 72 percent of those deaths were preventable, according to the UN Population Fund (UNFPA).



A big part of the problem is that nine out of 10 deliveries take place in the home, with untrained people delivering eight of those babies, according to government data.



In a midwife training programme in the capital, Vientiane, community nurse BounLouan Seng Phachanh spoke of how wrong things can go during a delivery based on her work at a clinic in the central province of Bolikhamsai.



"A mother in her ninth pregnancy came in for delivery and we were forced to do it in the dark when the electricity went off. Her uterus was not contracting after the delivery; there was no refrigeration and no ice to treat her haemorrhaging."



Phachanh was the only one on duty and at a loss.



"I did not know what to do and just stuffed gauze up her vagina and massaged her stomach."



When asked how she might handle the case differently after her year-long training financed by UNFPA and the government, she replied that she was now qualified to administer oxytocin, a drug that can be used to treat such bleeding.



There are 100 midwives nationwide who trained 20 years ago and are still working. Even if the government can continue annual training programmes, reaching an additional 160 health workers every year, it would take another decade to staff each of the country's 825 health centres and 122 district hospitals with at least one trained midwife, said the deputy general director of health personnel at the Health Ministry, Phouthone Vangkonevilay.



And training is just part of the equation he added. "Our biggest challenges are how to equip centres with enough medical supplies and how to motivate these new workers with incentives to stay in and improve performance in remote areas."



In the southern province of Attapeu a competition is being piloted among health centres to see which one can get the most pregnant women in for at least three pre-natal examinations.



Vangkonevilay said the Health Ministry had submitted a health reform development plan, which proposes an increased health worker training and incentive budget, to the prime minister.



"We keep asking. And they keep denying [us]."



pt/mw