I recently spent two weeks travelling in Grand Gedeh and Sinoe Counties, in the deepest reaches of Liberia’s south-east. It was an amazingly beautiful drive from the capital Monrovia, which took me through some of West Africa’s densest forests, through small villages, and along the dusty roads that connect Liberia’s interior counties. But I had no time to look around. I was travelling with a Ministry of Health and UNICEF team that was conducting trainings for physician assistants, nurses and midwives on life-saving skills to improve the survival of newborns during the crucial first hours of life.
We conducted the trainings in the southeast of Liberia, where some of the lowest health indicators are reported, ranging from a lack of facilities, personnel, and access. Some of health facilities are very remote, and sometimes people have to walk 9 hours to reach a health facility.
To help train the healthcare workers, we used a mannequin of a newborn with an attached umbilical cord, bag and mask, oxygen tube and reservoir, and stethoscope. Being a medical doctor myself, I had used these in my own training in Indonesia from where I come.
We trained them on initial breastfeeding techniques, continued skin-to-skin care, and monitoring of breathing, eyes, and umbilical cord care.
I watched as each trainee then conducted repeated simulated deliveries and initial care techniques. It brought back memories of my own training. I recall how I felt some hesitation and nervousness in times when I had to do this same procedure during my medical training and later in real life situations as a physician. I know how tough it can be, and also how rewarding it can feel to help save lives and make sure the mother and child are in good health.
The training is essential to help reduce newborn deaths. It combines two elements – Helping Babies Breathe – which focuses on resuscitation just after delivery if required; and Essential Care for Every Baby, the provision of essential care in the first 90 minutes and beyond.
I was impressed by the dedication of all of the trainees, especially because they come from many remote areas across the counties.
For almost all of my journey back to the capital, I kept remembering this act of dedication by the health workers. It signified for me how important these trainings are for improving the skills of health workers at remote health facilities, and the need to provide essential life-saving treatment in rural, isolated communities.
If we do not do these training, I kept thinking of how difficult it would otherwise be for a pregnant woman to walk all that way just to access health care.
Given that there are so few doctors across Liberia and qualified physicians are only available in hospitals, it is essential that we ensure healthcare workers at primary health care facilities in isolated corners of Liberia have the required skills to deliver safe births and the survival of both babies and their mothers.
During this visit, we trained 68 health personnel from primary health care facilities and two District Hospitals.
The Ebola outbreak in the past 18 months added to the complications, devastating the already fragile health system, and reversing many of the hard-won gains of the past decade. Between August and December 2014, antenatal care and deliveries assisted by skilled attendants in a health facility declined by 43% and 38% respectively (MoH Report 2014) compared to the same period in 2013.
The outbreak exposed cracks in Liberia’s health system, including the inadequate number of skilled health professionals and the lack of essential equipment required for appropriate and timely medical response.
Increased health risks for both mother and baby occur around the critical time of birth. For this reason, the first ”golden” minutes after birth are crucial, and adequate knowledge of effective responses in resuscitation are essential to improve child survival in Liberia.
UNICEF is working with the Government of Liberia and other partners to increase access and availability of good quality, cost-effective health care for mothers and babies. UNICEF has supported the Ministry of Health in delivering this training to health professionals in Grand Gedeh and Sinoe counties and will shortly start further trainings in Bomi county. UNICEF is also supplying training materials and resuscitation kits to 55 health facilities. The Ministry of Health is planning to extend the training in other counties with the support from other partners.
Yulia Widiati is a medical doctor, and presently works as a Maternal and Child Health Officer at UNICEF Liberia.