Second Community Dialogue

Today we finished our very last day of programming with the second community dialogue.  Twenty additional TTMs joined our class for the afternoon.  The discussion was similar in content to last week, and one TTM expressed her desire to "open a new book" of relations between the health workers and the TTMs.  This weekend the final report and preparations will be completed as we look forward to the July training.  Our time in Ganta has flown by, and we are sad to leave so many new friends.  The acting administrator from Ganta United Methodist Hospital, Patrick, came to close out the ceremony with some wise words.  He quoted Theodore Roosevelt, saying that compassionate care can be summed up as, "Nobody cares how much you know, until they know how much you care."  He also reiterated the hospital's commitment to continuing this program, something we are very excited about seeing though.  Thanks to everyone who worked hard to make the past few weeks a reality and all the support of our family and friends back home. See you all soon!

Week 2- Part 2

Today we finished up the training of trainers portion for our second group of participants!  Tomorrow we will be meeting with a second group of TTMs to complete the programming.  Again, the pre and post test materials showed a successful week in terms of content, and the evaluations were very positive.  After heading back to Monrovia, we will take all of the feedback and print trainee manuals to be used in July.  We have received the go ahead for the next training to take place under the direction of Anni and Liz, the Curamericas interns.  After that, the program will be completely under the direction of the hospital administration.  This experience has allowed us a chance to learn while working in an area that we both feel very passionately about, and for that and so many other aspects, we are grateful.

Week 2

The second week of the training of trainers portion of our programming is underway!  We have a new group of health professionals and together we are putting the finishing touches on the materials that will be left for more training. The feedback has been overwhelmingly positive, and pre and post test evaluations show that the material was well understood.

As one participant, a certified midwife, told us last Friday: "I feel this has woken something inside me, I want to practice what I have learned to help all laboring women."

We couldn't be happier with the results.  We will be leaving to Monrovia this weekend, and there we will be printing revised trainee manuals for future use in Ganta.  We are looking at organizing a training during July that the wonderful Curamerica's interns, Anni and Liz, would be able to evaluate.  This has been an exciting and informative experience and we can't wait to see what this week has to offer!

Community Dialogue

Our Friday session included a visit from Trained Traditional Midwives from twenty of the communities surrounding Ganta United Methodist Hospital.  The goals of this meeting, developed by our participants, were to inform the TTMs and thereby their communities about the compassionate labor program, build relationships, and to define the role the TTM would play in the health center setting.  The session was guided by a series of questions developed over the week that addressed stereotypes and reinforced that the health workers and the TTMs both had the welfare of their patients in mind and good intentions.  The discourse was friendly and polite, and the TTMs expressed that many felt honored to be included in this important discussion and to have their voices heard.  The health workers expressed that small misunderstandings often contributed to the conflicts between these two groups, and were hoping their "mothers" would be understanding that an effort to improve the environment for everyone was underway.  The health workers also showed off some of the comfort techniques that we practiced this week, and several enthusiastic TTMs jumped up to try them out, and even taught us a few techniques of their own.  There was a lot of laughing and even singing.  We wrapped up by discussing some administrative issues--that TTMs should remember their ID cards to be admitted to help their patient labor, and should also expect to step out of the room in an emergency situation.  Hopefully these experiences can be the framework for a productive partnership that can make the health center a safer place for all women- as the health workers and the TTMs work together to provide a safe, supportive environment for new life to enter the world.

Day 4 Training of Trainers

We had a busy final day of the Training of Trainer's program here in Nimba County, Liberia.  We started the afternoon off by reviewing everything we had learned this week by role playing a complete birth.  The participants broke up into teams of three and took turns playing one of three roles- mother, healthcare worker, or family member.  We then worked through scenarios giving the mother a role to play and having her partners support her.  In between each scene, we heard from our "moms" about what their caregivers did that they found effective, then everyone switched roles.  It was a fun way to bring the week together.  After the "baby was born," we moved on to discuss afterbirth comfort measures and the newborn.  We also covered ways that one can process the birth experience by looking at the event as a story and focusing on the changes, significant moments, and the ending.  This measure can help reinforce positive impressions of the birth experience and address negative impressions by giving information and validating the women's experience.  The final unit covered training others, and we talked about the basics of adult education, learning tasks, and took down names of those who would be interested in doing the first training for their peers in (hopefully) July.  We then did a post-test and an evaluation of the program overall.  This information will help us make next weeks program even stronger.  Finally, the participants set goals for 3 weeks, 3 months, and 3 years.  We're excited about meeting some of the Trained Traditional Midwives tomorrow and hope that both groups will be able to learn from one another, and we from them.

Day 3 Training of Trainers

Today in our third day of training, we tackled "challenging childbirths," which can include long labors, poor coping, complications, cesarean births, stillbirths/expected loss, or working with survivors of physical/sexual assault.  Our conversations were serious and focused, with everyone showing a real commitment to learning how to best support these patients. Women in these situations can benefit greatly from the support measures we have been practicing all week.  We then discussed how to best support family members or friends to make them "part of the labor team."  A helpful family member can make the health workers job much easier by making women feel more comfortable, and even assisting with physical comfort measures at the health worker's suggestion.  The final item on our agenda was was to discuss Trained Traditional Midwives (TTM), women who care for laboring patients in the rural communities.  One of the goals of this program is to foster positive relationships with these women and to clearly define the roles that they may play should they choose to accompany their patients to the health facility.  Together we have started developing an agenda for our meeting with 20 TTMs on Friday, and we hope that they will carry news of this program back to their communities, therefore helping mitigate the perception that the health center can be an unsupportive environment.

Day 2 of Training of Trainers

Today we picked up where we left off with a review of the emotional and psychological processes of birth before diving into "The Three R's"- Rhythm, Ritual, and Relaxation.  We discussed each of these concepts, and the group through of examples they had seen in their patients.  We watched Penny Simkin's Relaxation, Rhythm, Ritual: The 3 Rs of Childbirth, looking for examples from the film and discussing how we can support spontaneous rituals, or suggest new ones to women struggling to cope with labor.  We then moved on to practicing physical comfort measures.  Each group of two received a card with a position and a description, which they presented their position to the group to practice.  We also learned positions for pushing and discussed when all of these measures are appropriate.  From there we talked about verbal comfort measures including words of encouragement and active listening.  We ended our time together with the "take charge routine," and an overall review.  It was a lot of information, but everyone ended the day with high spirits.

Day 1 of Training of Trainers

We had a wonderful first day of training here in Ganta with our group of 25 hardworking, dedicated health professionals.  The first day included registration, introductions, a pretest, a discussion on the history of birth, a presentation of the obstetric benefits for women as well benefits for the hospital in using labor support, goal-setting, and the physical, emotional, and psychological processes of birth.  The discussions were lively with plenty of stories from the hospital and surrounding communities as well as questions and suggestions. We look forward to working with this dedicated group of women (and two men!) to make this health care facility a more supportive environment for all women, but especially for rural women who may be far from home.  A word that kept coming up today was "empowerment," and we hope to keep that important goal in mind for the rest of the week.


Here's a picture of the space we're using for training and some of our participants. We're hoping to be able to upload more pictures this coming weekend.

T-minus 1 day!

Hey everyone! After a week of adjusting, observing, organizing, and preparing we will be having the first day of our training of trainers this Monday for 25 "students"--a mix of nurses, administrators, and students from the nursing school.  We're very excited to get started!  As this is a pilot of sorts, we will be asking for lots of feedback from our participants as we go along to best adjust the program for long term use.  The UNC Volunteer Doula program has agreed to help support the program on the ground long term with informational support- a partnership we are very excited about!

The next week will look something like this:

-Monday through Thursday one set of medical professionals will be learning about the importance of supportive care during labor, learning and practicing comfort measures, and talking through a series of issues surrounding facility births as they are now.

-Friday will be a dialogue with Trained Traditional Midwives, (TTMs) who work in rural communities, with the goal of establishing a respectful and well defined relationship between the two groups to better serve laboring patients.

After the first week, adjustments will be made to better accommodate the needs of the medical professionals, and the program will be repeated with a new group during week two.  So excited to meet our team!

Preparing and Observing

Hey everyone.  During the past few days we have had the pleasure of exploring the Ganta area by going along with outreach teams as they conduct community visits.  A community visit starts by gathering everyone together and hearing any problems or questions that have come up since the last visit.  Then, the director will do a review of general health topics covered in the past. (Malaria prevention, immunizations, etc.)  Community members take turns answering and clarifying each other's responses.  The outreach team then breaks down into their specialties (HIV, family planning, maternal health, immunizations) to treat patients or do further counseling.  We also had an opportunity to talk to women of reproductive age about their views on health facilities vs. trained traditional midwives.  Needless to say, this observation is important so that we can have a full picture of healthcare for these rural communities.  We also joined the gCHVs again to finish up their Malaria training, and are 90% done getting our materials together for next week.  We are definitely looking forward to starting our Compassionate Labor program next Monday and have enjoyed so much interest and support. More next week!

Settling in.

Greetings again from Ganta!  We've been working hard on our preparations each day, sorting out all kinds of logistics from food for the training to making sure the lights stay on!  This morning, we were able to join the Integrated Management of Childhood Illnesses (IMCI) team as they trained general Community Health Volunteers (gCHVs), in how to assess their target population, children under five, for signs of malaria.  The gCHVs are all from rural communities and are selected for their character and good reputation.  They come to Ganta every few months for a workshop and in turn share this information with their villages.  It was a lively and interactive training that gave us a good idea of what to expect next week.

Tomorrow, our plans include going out on community visits with the Maternal Newborn Health staff, and we hope to have time on site to do a few interviews that we can add to our field data.

General comments- It’s hot and the food is good!

More updates soon!

We made it!

Madiha and Dani here— we have arrived safely in Ganta, Liberia. In the coming weeks, we will be working with the Ganta United Methodist Hospital, the local nursing school, and other local partners to complete a Training of Trainers in Compassionate Labor Care.  The idea for the project game from our experience in the United States as doulas, as well as from a report by Leah McManus that concluded that the main reason cited when a woman chooses not to have a facility birth is the fear that she will not be supported and respected by health facility staff. Funding for this project was provided by a Davis Projects for Peace Grant, and we are grateful for this opportunity.

Today was our second full day on site, and a Sunday.  Sundays are slow, so we spent the day catching up on sleep and putting final touches on our programming.  We had the pleasure of meeting many of the administrators we will be working with Saturday morning, and are looking forward to focus groups with maternal health staff, expectant mothers, doctors, and nurses this week.  We also will be making a few site visits so that we can go into training weeks with a full picture of how healthcare works here in Nimba County.