Dr. Rebecca Jones preface:
It has been ten years since a wave of maternal mortalities among families associated with the Nomad Foundation inspired the initiation of our traditional birth attendant training program. The goal all along has been to provide basic education and supplies that could reduce the number of young women losing their lives in childbirth. On the whole, our mission appears to have been successful! However, we have been interested in having an independent expert review our training program and assess our new and old trainees. Assessment is one of the most important and most difficult portions of our program.
On our 2019 mission, we had taken steps to prepare local women to carry out further training sessions which, thanks to the generous support of John Massey, they were able to do. Our most recent mission was perfectly timed to evaluate the program overall and in particular, to look at the skills of our newest trainees – those trained by the nomadic trainers. This required expertise in global health and childbirth education as well as excellent communication, both of which we were fortunate to be able to expand dramatically. Thanks to the participation of Jen Stevens and our two new interpreters, Jamilla Alhousseini and Ilias Ahmed we were able to begin to undertake that important task. We look forward to Jen’s assessment. I predict that on at least one critical parameter our trainees will rate high and that is in compassionate, kind care. Research has shown that respectful care enhances trust and confidence in care providers and that this directly improves outcomes. This is a topic of particular interest for Dr Stevens and one in which she has significant expertise.
Nomad Foundation’s matron training program is unique for many different reasons. Not only did the program begin at the request of the Tuareg, but it was built on a foundation strong personal relationships and commitment to the people. The plan to turn the matron training over to the local matrons, while providing technical support and mentoring allows for sustainability. Covid presented an ideal situation to evaluate how the plan was progressing.
In 2019 “master matron” trainers were identified and encouraged to continue training other matrons. Because of Covid, no missions occurred in 2020 and 2021, while the master matrons continued the work. This allowed us to evaluate the matrons trained exclusively by the master matrons compared to the matrons trained by international trainers. A research design was developed that asked the question, what is the relationship between the retention of emergency birth skills with matrons trained by national staff compared to those trained by international staff? Essentially, how effective are the master matrons as teachers?
To effectively evaluate the matrons and remain sensitive to them being illiterate, we assessed their knowledge, skills and retention through storytelling and demonstration of skills in simulations.
Interviews with the 3 master matron trainers, 7 matrons trained by international staff, and 5 matrons trained by the master matrons were conducted in English and translated to Tamasheq by our amazing translators. The interviews involved the matrons sharing stories of women who had birth complications and how they responded. Responses were translated back to English in live time to allow for clarification. All interviews were recorded and transcribed. The transcriptions will be evaluated for mention of safe skills or behaviors, and identification of any unsafe skills or behaviors. Transcription and assistance in analysis is being done at Georgia State University (GSU).
Additionally matron skills were observed in simulated birth scenarios. Three “Mamabirthies” were donated by Laerdal to assist in training. These birth mannequins allowed for an interactive simulation to assess the skills of all matrons. The matrons were observed for skills in managing simulations of; normal birth, newborn resuscitation, post-partum hemorrhage and obtaining a BP.
Overall our first impressions are that all the matrons– those trained by the master matrons and by the international staff were doing great! All of the information gathered, along with the analysed interviews will provide the final assessment.
(1) Stevens JR, Sabin LL, Onyango MA, Sarker M, Declercq E (2022) Midwifery centers as enabled environments for midwifery: A quasi experimental design assessing women’s birth experiences in three models of care in Bangladesh, before and during covid. PLoS ONE 17(12): e0278336. https://doi.org/10.1371/journal. pone.0278336