July 04, 2006

June 19th

The trainers have organized a refresher training on Low Risk Maternity on topics ranging from generalities on the health system in the R.D.Congo, to Behavior Change Communication techniques, to prevention of and care of people living with HIV and AIDS.

The topic that commands to most attention from slumbering participants is the one on family planning. Proper male and female condoms techniques are illustrated, IUD are activated, and a cycle bead necklace is passed around.

She is a true feminist, extolling the virtues of contraception not just for reducing numbers of children but for allowing a woman to reach her full potential at work. She beseeches men to take an active role in their wives’ family planning and suggests—rather scandalously!—that the men acquaint themselves with their partners’ fertility cycle as well. The talks elicit “uh huh” and “that’s right!” from the midwives, and female nurses and gentle chuckling from the male doctors and nurses.

(The trainer is showing how to work an IUD, how to follow one's menstrual cycle using Cycle Beads and how to insert a female condom)

The trainers bring news of Kinshasa to the participants that are so isolated from the capital—the little news that some of them get is from the static-filled radio stations. The trainers talk of system-wide “greve” in Kinshasa to force the government to reconsider their salary. Presently, their salaries are a meager $10 a month…that’s if they get them every month (consider this: a very small apartment with one bedroom cost $35 a month).

As the training continues, there is a lot of discussion and laughter causes by the norms set by the Ministry of Health/WHO and the realities of the field:
1. The benefits of breastfeeding are apparent but policies are different if a mother is HIV positive. But let’s be honest, the majority of the hospitals don’t have counseling and testing centers. So, mothers are released and are rarely given proper recommendations on breastfeeding
2. According to WHO, there is an increased incidence of maternal deaths when assisted by a mid-wife. As a result, WHO has officially asked that mid-wives not be part of a health team. In a lot of instances however, a mother can give birth far from the health center or the nurse may be overwhelmed by work. By banning mid-wives, you’re taking away a person who has seen and assisted a lot of births. And you’re asking mothers to give birth alone or unassisted in a health center.

In the evening, I eat quickly, regal in a dessert (desserts are not often served in these parts) which is made from mashed Coeur de Boeuf (Bread fruit) and Maracuja.


Beaver said...

Wow. WHO is AGAINST midwives ? That's interesting.... and disturbing.

Great updates, agent 007 ! You've done well. I love your description of the food. Hmmm food.

Flies that grow in your buttocks. Wow. You've done it all, girl!

*condoms? really? me surprised...*

Much love as usual, oh Great Lady of the Congo !


Carl said...

I like the stories from the field.

Kingston Girl said...

Excellent writing!

I love watching young guys at training sessions where they teach about the female condom - at first they are all 'i'm not touching that' but a really good trainer can have them getting into it in no time!

Congogirl said...

I went to a lecture here by a prof in MCH, whose research indicates that HIV+ moms SHOULD breastfeed for the following reasons:

1. litte access to ARVs, so effects of ARVs on infants irrelevant
2. even with comm. health worker training, mixing of formula in wrong proportions, so not healthier
3. likelihood of bad water used for formula, and that women can't collect enough firewood to boil enough to keep babies fed with formula
4. exclusive bf: with complementary feeding too early, cornmeal etc. can damage infant digestive tract, which aids transmission of the virus
5. under-5 mortality increased among non-bf kids, which is riskier than chances that child will contract HIV.

007 in Africa said...

Thanks Vick, Carl and Kingston Girl for the compliments **blush**.
Congo Girl--I actually learned the same things about breastfeeding in my Public Health classes. It's always shocking to find out however that highly trained doctors are so isolated in the field that they don't get this crucial information...