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Plastic bags and bamboo knives: birth in rural PNG

Almost three decades ago, traditional birth attendant Jullian delivered her first baby.

In her village in Central Province, the closest health centre is a two-hour walk so, with the woman already experiencing severe labour pains, Jullian had been summoned to help the expectant mother give birth at home.

More than 24 hours later, the baby was born healthy, the mother had survived an agonising ordeal, and Jullian could breathe a sigh of relief. It was an intense and emotionally overwhelming introduction to her new role as a traditional birth attendant, one which she began with no formal training.

In those early days, Jullian’s arsenal of midwifery equipment was rudimentary at best. “There were no hand gloves, so I would put on plastic bags on my hands. To cut the cord I would use a type of bamboo as a knife. I used whatever I could find.”

Nor was her working environment any better. “It’s a long walk to the clinic, and sometimes women can’t wait, especially in times of emergency. Women worry that they might give birth on the road, so they decide to stay at home instead.

“I would spread old clothes or 50kg produce bags underneath the women during their labour. The string from the bags could also be used to tie the umbilical cord.”

For the approximately 3,000 women who live in the villages of Kivori, the delivery options are extremely limited, if non existent. A basic clinic can only be reached by a long journey on foot, and the district health centre is over an hour’s drive on a poorly maintained road.

Public motor vehicles – the only form of transport available and equivalent to travelling on a large and overcrowded produce truck – do not travel this road on a daily basis. The cost of using this service is also prohibitive.

There are no doctors available in Central province, so to reach a hospital for more specialist care means a five-hour journey to Port Moresby.

For these reasons, women like Jullian perform a vital and sometimes life-saving service. For the majority of pregnant women, they are the only childbirth support available.

During the early years of her work, Jullian was fortunate to learn some additional midwifery skills by shadowing the Community Health Worker – the equivalent of a basic nurse in Australia in terms of qualifications.

 

Jullian became a Village Health Volunteer in 2015 after taking part in ChildFund’s intensive healthcare training program.

Jullian would assist him by setting up the delivery room and handing him any medical equipment during the delivery process. Julian is illiterate, but through observation she learnt many basic procedures.

In 2015, ChildFund Papua New Guinea (ChildFund PNG) gave Jullian the opportunity to take part in a new intensive training program for Village Health Volunteers (VHVs). This six-week course covered a broad range of healthcare issues, while also giving Jullian more in-depth knowledge in safe motherhood and early childhood care and development.

“The training was in simple terms and easy to understand. I learnt many new things on maternal health and general health, but more importantly the proper steps to take before, during and after delivery in those cases when a mother cannot get to the clinic.”

And she has already had to put this training into practice.

Jullian says: “When my first-born daughter gave birth to her fourth baby, the umbilical cord broke in the womb. The baby was not breathing when she was born but I was able to resuscitate the baby, and she’s six months old now.

“I went through all that training, and now I can save the life of a baby.”

Team Leader for ChildFund PNG’s Health Program, Olive Oa, says ChildFund strongly encourages women to deliver at the nearest health facility where possible.

But she adds: “Due to issues of inaccessibility, and the hardships of reaching a clinic in many villages, women will continue to rely on traditional birth attendants.

“So it’s extremely important that we make sure they have up-to-date skills, and some basic equipment. We also provide VHVs with birthing and newborn kits to ensure better safety and hygiene for women and their newborns.”

Olive adds: “Being able to recognise signs of danger is also vital for a VHV. Knowing when to refer a women to more specialist care can mean the difference between life and death.”

Today, Jullian estimates that she has delivered around 180 babies. She encourages women to give birth at the clinic, but is always there to help when she is needed.

“Many times, I have walked long distances and in the night to reach women. Even when it rains, I find my way to them. It is tiring but I love what I do.

“I believe God gave me a gift to save lives so I will continue to help women until the day when my legs can no longer carry me.”

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