In 2000, the World Health Organization (WHO) ranked Myanmar second-last out of 191 countries surveyed for overall health system performance. Aside from a few charity hospitals, people still need to pay for healthcare.
Years of military rule have left the healthcare system in a state of disrepair. The country has one of the highest maternal and infant mortality rates in South East Asia, with 200 maternal deaths for every 100,000 live births (The World Bank). Three quarters of all maternal deaths occur during delivery and the immediate postpartum period.
There is a huge unmet need for family planning. Abortion rates are high at 174 for 1000 pregnancies. Levels of unwanted pregnancies are likely to be very high given that abortion is illegal and carried out in dangerous conditions. Abortion-related complications account for around half of maternal deaths.
In this context, skilled midwives save lives.
The role of the midwife
In Myanmar, midwives do much more than deliver babies. They are responsible for primary healthcare at the village level. Midwives have wide-ranging responsibilities, but they are still viewed as the lowest level of healthcare staff.
Alice Castillejo, Country Director for Voluntary Service Overseas’ Myanmar office, explains why VSO is helping to train Myanmar’s midwives: “Where there is no one else, there may be a midwife. As the only front-line health worker around they are likely to be dealing with TB, child nutrition and malaria. On top of this they are delivering babies, with limited technical knowledge and few resources.”
According to UNICEF, 43% of births are not attended by a skilled health worker. There is a shortage of adequately trained midwives and this is due to a combination of factors. There is a shortage of healthcare facilities, which means people often have to travel long distances, which comes at a cost. Then there’s the cost of medical assistance.
“Adolescent girls (15 -19 years old) have the lowest attendance by a skilled health worker,” says Alice. “Low health seeking behaviour is associated with limited education at the community level.”
VSO organises professional volunteer placements throughout Asia and Africa. VSO has worked along the Thai-Myanmar border since 1999 and has had a presence in Myanmar since 2013. Over the past 12 months the organisation has been scoping out areas where it can make the most significant contribution. Healthcare and midwifery in particular, have been identified as key areas.
“The curriculum for midwifery training has just been revised,” says Alice. “The duration of training has now increased from 18 months to 24 months. There are village health workers and traditional birth attendants who both provide some level of unskilled care when women can’t get a midwife.
“We hope that VSO will be working with partners inside the government midwifery training centres, building the skills of the staff to deliver the curriculum and mentoring them in the supervision and assessment of the clinical practice component. Only government trained midwives are accepted into the health service, at both public and private facilities.”
By providing training at midwifery colleges, VSO will be able to reach a large number of midwives.
“The volunteers will improve pre-service teaching capacity,” explains Alice. “By supporting the faculty of the colleges we can improve the teaching that all new midwives receive. In this way we can improve the skills of hundreds of new midwives, so they can save the lives of mothers and children.
“If we only work in the community directly delivering services we reach only the small number of women who reach that specific clinic. The skills we leave behind will remain in the teaching faculty and continue to contribute to the improvement of skills of midwives long after we have gone.
“We hope this is the first step in VSO’s engagement in midwifery in Myanmar, with further work on in-service professional development to follow. This work is part of the overall health programme of VSO Myanmar, which also focuses on access to family planning and new-born survival.”
A call to all midwives
VSO is now recruiting midwives for Myanmar. There’s an urgent need to improve the quality of the teaching at health training institutions. This is your opportunity to help re-build Myanmar’s healthcare system.
Volunteering with VSO is beneficial in terms of personal and professional growth. Volunteering internationally gives health professionals the opportunity to develop new skills, respond to a broad range of challenges, and learn to do more with less. Volunteers will need two to six years relevant professional experience, a professional qualification and some experience of supervising, mentoring or project management.
VSO will support volunteer midwives by providing them with comprehensive training and covering the costs of flights, accommodation and a basic living allowance. VSO is also recruiting for doctors, nurses, midwives and health managers to help in countries across Asia and Africa. To find out more about the wide range of roles in various specialities across 33 developing countries click here.