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Myanmar – maternal and child health, educational and WASH activities in Irrawaddy Delta

Years of political isolation have left a permanent mark on Myanmar, one of the poorest countries of Southeast Asia, in many ways less developed than other states of the region. Due to the unfavourable geographic conditions for the development of infrastructure and the stifling poverty – especially outside urban centres – the people have limited access to much of what we take for granted. The telephone network is very poorly developed and there are interruptions in the power supply.

In the Irrawaddy Delta Region many villages can be reached only by boat. In the rainy season, when the river, the only transport route, floods, many human settlements are cut off from the world. The region is also struggling with the limitations of the health care system, also characteristic for all of Myanmar – a country with one of the lowest ratios of skilled medical personnel in the world, at a level of 1.3 per 1,000 inhabitants.

In such difficult conditions it is a great challenge to provide proper medical care for the communities of the Irrawaddy Delta, particularly expectant mothers and children. Of the 341 women of Wakema Township examined in 2016 by the Polish Medical Mission, 88% stayed in their homes during childbirth. Among these, 15% had complications during birth. Some had caesarean sections, but the remaining women lost their children due to complications. During pregnancy, 23% of the respondents suffered ailments that could threaten the life and health of the unborn child, such as hypertension or genital tract infections. Among the pregnant women, 14% had not been tested for hepatitis B. The test was not administered either for 43% of the women admitted to the maternity ward of the hospital in Wakema. None of the polled women were vaccinated against hepatitis, creating a great hazard for their offspring. If a child of a woman with hepatitis B does not receive the vaccination and immunoglobulin in the first weeks of its life, it will be infected with the mother’s virus.

The prevention of hepatitis among older children also leaves a lot to be desired. The survey showed that only 35% of people between the age of 8 and 15 years were vaccinated against hepatitis B. The majority of the children brought for medical consultation also suffered from bacterial infections resulting in diarrhoea, or had skin problems from poor hygiene.

Another significant problem was the lack of access for some of the rural community of the Wakema District to basic medical care in rural health centres. The residents of some villages had to travel considerable distances to obtain help. The situation created a threat to the life and health of mothers and their children particularly. Conditions in the hospital in Wakema were also deplorable. The biggest clinic in the district, with room for 50 persons at one time, usually had more than 100 patients during the rainy season. The overcrowding and lack of suitable triage of patients were conducive to the spread of infections. The intensively used operating theatre lacked modern medical equipment. New anaesthesia equipment was urgently needed.

Myanmar – maternal and child health, educational and WASH activities in Irrawaddy Delta

The general aim of the project was to improve the state of women’s health in the perinatal stage, in addition to infants and older children, and increasing overall access to health care and providing quality medical services in Wakema. Measures were also planned to shape health awareness among women, develop health education for children and patients of the medical centres and improve access to clean drinking water.

In Module 1, implemented in 2017, obstetric and assistance personnel members from nine rural health centres took part in training which followed up on a course carried out a year earlier by the Polish Medical Mission. The training dealt with care for pregnant women, focusing especially on the identification of such threats as diabetes, hypertension, infections and preeclampsia. Important elements included instruction on how to prevent hepatitis B, hepatitis C and HIV infections. There was also information about contraception methods. The midwives were shown how to convey information to patients in a comprehensible way. Separate training was also carried out to inform them about the principles of WASH (Water, Sanitation, Hygiene).

There were also courses for pregnant women who learned about the threats to a pregnancy, a healthy lifestyle, the proper preparations for childbirth, how to care for a newborn child as well as about prevention of hepatitis B, hepatitis C and HIV. Great emphasis was placed on the observance of hygiene.

The project also included the construction and furnishing of a rural health centre in an area where residents had been forced to travel to neighbouring settlements to obtain help. The new building contains: a waiting room for the patients, a doctor’s office, a nurse’s room, a storage facility and a delivery room.

An important element of the project were consultations (including house calls) for expectant mothers and children. There were also hepatitis vaccinations for children aged 8-15 years and medical examinations for pregnant women who sought consultations. Women with a diagnosed virus were offered a meeting with a representative of the clinic who treats liver diseases.

The actions planned for 2018 within Module 2 were to be a follow-up and expansion of the initiatives begun in 2017. Plans included the installation of water treatment systems or securing access to groundwater in areas with particularly difficult sanitary conditions where people drew water directly from the river.

Myanmar – maternal and child health, educational and WASH activities in Irrawaddy Delta

The actions carried out in 2017 included training for 90 female members of medical and assistance personnel from nine rural health centres. This resulted in improved knowledge and skills of midwives in the field of obstetric care, and the prevention of disease and increased sanitation standards. The course designed for pregnant women, attended by 90 women, raised the awareness of expectant mothers with regard to perinatal health, preparation for childbirth and prevention of disease among children.

In the course of Module 1, 1,026 patients were examined (417 women and 609 children). Among these, 15 were diagnosed with hepatitis B. The child of each of these women was provided with a vaccine and immunoglobin. The first and second dose of the hepatitis vaccine were administered to 280 children aged 8-15 years.

Invaluable support for the local community was provided by the newly established rural health care centre. The institution now has a midwife and an assistant and can receive up to 1600 patients a month.