*Y.C.* Combining Tradition with Innovation

*Y.C.* Combining Tradition with Innovation

Tanzania
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
< $1,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Have you ever noticed how ingenious public health ideas often flop when implemented? Mosquito bed nets used as fishing nets, and powerful pieces of technology that collect dust in the corner of village health clinics are just a couple of examples that demonstrate the need to carefully understand a community's culture and needs in order to make meaningful health improvements. In Ukerewe, Tanzania, women are still dying in childbirth or incurring crippling morbidities such as obstetric fistulas. Theoretically, women there do have access to obstetric services in town, however, many still opt to birth at home with traditional birth attendants (TBA's) whom they have known and trusted for generations. Instead of side-stepping this tradition, we should link it to a culturally acceptable intervention: a maternal waiting home (MWH) where women could be near emergency obstetric equipment and medical intervention if needed. Inviting TBA's to provide services and receive additional training at an MWH adjacent to a hospital and advertising via radio announcements could be a key innovation to effectively reduce maternal morbidity and mortality. The community does not need to adopt a strictly western model of maternal health care. Instead, we should work with the community to find an innovation that works for them.

About Project

Problem: What problem is this project trying to address?

The primary problem is the need for safe childbirth. There are three areas that contribute to this problem: 1. Transportation between the islands and to the mainland to access health care services, 2. Lack of relationship between the hospitals and the traditional birth attendants, and 3. Health worker capacity for the population. Accessing emergency obstetric equipment is not possible for many families throughout the archipelago. The barriers for women begin with obtaining the funds for transportation in an emergency. The cost and availability of fast vehicles such as boats and automobiles to travel from one island to the main the hospital is inhibitory. Women often have to obtain permission/funds from their husbands who may not recognize the need to give birth at the hospital. This could be especially true because of the tradition to birth at home with an experienced woman from the community. There is no collaboration between TBA's and the main hospital in the city. Therefore, it may be too late when a TBA tells a woman to go to the hospital for help. In addition, the hospital is severely understaffed and may have difficulty accommodating all women who arrive.
About You
Organization:
Medical School for International Health
Section 1: About You
First Name

Rachel

Last Name

Pope

Website
Organization

Medical School for International Health

Country
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?

Yes

Section 2: About Your Organization
Organization Name

Medical School for International Health

Organization Phone
Organization Address
Organization Country

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Your idea
Country your work focuses on

, MW

Website URL
Innovation
What makes your idea unique?

There are several innovations that would help to improve maternal health in places with high maternal morbidity and mortality. What is more complex, however, is determining what would work best for the community in Ukerewe, a set of islands with its own transport obstacles, specific traditional beliefs, and birth practices. The idea of witchcraft is held strongly, the use of traditional birth attendants (TBA's) is commonplace, and hospital workers are overloaded. Therefore, the changes needed for women to access care would require a change in the local culture of birth as well as a strengthening of the health care capacity. A blend of traditional and new birth practices could be in a maternal waiting home (MWH) that strongly involves TBA's. Studies have shown that MWH’s require a high degree of community involvement to be successful. If TBA’s were not only permitted—but also encouraged to accompany a woman in labor and establish roles among the midwives, this could alleviate the workload of the hospital and enhance the overall care for each woman. They could bring women to the birth center throughout the pregnancy for antenatal care and to become acquainted with the center. Information could be conveyed through radio announcements, a common way to share news on the islands. If TBA’s could be supported to receive training and even become skilled midwives, they could add to the workforce that is much needed in Ukerewe. Otherwise, they could be offered other positions, such as doulas or other types of care takers. This is a low-cost and potentially high-yield intervention that could be delicately woven into current practice.

Do you have a patent for this idea?

Impact
What impact have you had?

Thus far this project has only involved on of the results the lack of maternal health services. We have spent time in the community working on the issue of obstetric fistulas. Most recently, we had a community meeting discussing the problems with maternal mortality and discussed the possibility of a birthing center. We have also discussed this with the local community council, all of whom are enthusiastic about such a center.

Actions

By providing a self-sustaining maternal waiting home, women can plan in advance to come towards the end of their last trimester of pregnancy. The advantage of time will allow families to save funds and work out their transportation in a non-emergent manner. The first cohort of women who choose to come to the center can have their transportation costs provided for in order to kick-start the MWH. This group can return to the community and encourage others to use the center.
The center will provide a friendly environment for traditional birth attendants (TBA's) and hospital personnel to work together. If TBA's feel comfortable, they can learn more midwifery skills and eventually contribute to the workforce of the maternal health services. Using midwifery courses brought in from the mainland, and provided by the ministry of health, TBA's could learn more advanced techniques, improving their skill. In order to encourage them to work at the center, they will be compensated by the ministry of health only if they work at the MWH. This would lighten the burden of the staff at the hospital and hopefully improve the quality of care for all women who come to birth at the center.

Results

In time, positive experiences would encourage more women and TBA's to participate in the center. Eventually families in the community will also see the benefit of personalized care at the center. When the need for emergency backup arises, the hospital and staff will be readily available and both maternal mortality and morbidity will decrease. Having women near the hospital and in a comfortable and yet safe environment will reduce both maternal and infant mortality and morbidity in Ukerewe.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Year one:
-Research the birthing culture and patterns of women in Ukerewe, asking women specifically what elements of a birth center would appeal to them or convince them to make use of it.
-Research also the work of TBA's and discuss their willingness to utilize the center and receive increased training in recognizing and handling obstructed labor.
-Collect baseline data on birth rates, mortality, and morbidity for accurate evaluation of the MWH.
-Arrange to purchase the land and building equipment for the center.
-Establish partnership with the Ministry of Health and other local NGO's.
-Launch a public awareness campaign primarily through the radio highlighting reasons the center could improve birth outcomes and reasons families should make arrangements to come.
-Arrange with the Ministry of Health to post an additional nurse midwife at the center or recruit TBA's already in Ukerewe to receive midwifery training.

Year two:
-Build the center and set up the facility.
-Continue public campaign to raise awareness in community of the MWH.
-Invite guest midwives to work with local midwives to share experiences from similar birth centers.
-Invite women to begin coming to the center .
-Maintain meticulous records on women who come, birth experiences and outcomes.
-Begin training programs for TBA's.

Year three:
-Continue running the center and keeping records.
-Continue training programs for TBA's.
-Evaluate overall outcomes.
-Continue advertising to the community and share outcomes.

What would prevent your project from being a success?

All the issues that would prevent the project from being a success are socio-cultural in nature. For example, if the women do not choose to use the center or do not perceive a benefit in its use, the project will not work.
We could hold community meetings (a common way to disseminate information in Ukerewe) and explain to the community how the center would work and how it could provide a safe place to deliver. We could ask some of the women we know there who have experienced childbirth injuries to share their experiences with the women if they agree with us that a birth center would be helpful.

Additionally, if the TBA's do not feel comfortable and welcome at the center or discourage women from going there, the project will have limited success.
We will have to meet with them individually to learn what we could offer specifically that would interest them enough to travel to the center.

The relationship between the TBA's and nurse-midwives will also be important in the smooth functioning of the center. All of these examples are why it is critical to begin the project by assessing the interest and willingness of as many women, families, and TBA's.

A firm commitment from the Ministry of Health is also critical in the success of the project. This is why I would like to work quickly to follow the enthusiasm of the Member of Parliament who has expressed interest in this project. She could rally the support of the government and establish a partnership that would be needed to support the staff of the center and to keep it running smoothly.

How many people will your project serve annually?

1001‐10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Idea phase

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Women's Dignity

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have a non-monetary partnerships with NGOs?

Yes

Does your organization have a non-monetary partnerships with businesses?

Does your organization have a non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

I am not employed by any particular NGO at this time. However, because of my previous work with Women's Dignity, I am hoping to lead this project with their support. It will be critical to facilitate the collaboration between two or three key NGO's who are already invested in Ukerewe and the Ministry of Health of Tanzania. Because of Women's Dignity's experience in doing this sort of collaboration, they are an optimal organization with whom to continue working.

What are the three most important actions needed to grow your initiative or organization?

-Research and baseline information surrounding the community's interest and willingness to use the birth center, including what elements will contribute to its success.
-Funding to build the center, to recruit another midwife, and to provide ongoing training.
-Commitment from NGO's and the Ministry of Health to sustain the center.

The Story
What was the defining moment that you led to this innovation?

While studying anthropology as an undergraduate, I volunteered for a professor's research study. She was doing some basic physiological tests on me while telling me about an idea for my senior thesis. She told me about the problem of obstetric fistulas, and about the Fistula hospital she had come across while working in Ethiopia. She told me that we had to stop talking about it for that moment, because my heart rate had spiked and I was skewing her data.
After educating myself about the problem of obstetric fistulas and the areas that needed more research, I found partnership in the Tanzania-based organization, Women's Dignity. I worked with them to conduct my field research on the social reintegration process of women with fistulas and met dozens of women whose lives have been severely affected by the lack of obstetric care. Fortunately, many have accessed surgical repair and are doing well.
After completing the research, I began medical school at a unique school to train physicians to work in developing countries. Since the school is in Israel, I've been able to stay connected to the work on fistulas in Africa. I spent part of my summer after first year with surgeons at the Hamlin Fistula Hospital in Ethiopia and then returned to Tanzania to follow up on the research we had conducted there and disseminate the findings to the community. During a community meeting, I was urged by a community leader to continue working on the issue of maternal health and to "not forget the people of Ukerewe."
I also had the chance to meet with the Member of Parliament representing Ukerewe who confirmed her desire to work on a major project to prevent fistulas on the island and to reduce maternal mortality and morbidity.
This past year, although very busy with school, I have had the privilege of attending two international conferences that addressed the issue of obstetric fistulas. I presented our research at the conference for International Society of Fistula Surgeons and learned even more about the medical and social issues of women with fistulas in communities around the world. I met many experts who convinced me that what I most needed to direct my energy on was actually preventing the fistulas from happening in the first place. It is clear that with improved maternal health care and access to that care, the problem of obstetric fistulas will also disappear.

Tell us about the social innovator behind this idea.

I am a young medical student with an MPH, who believes strongly in thinking creatively to solve social problems. There are many low-cost, community-based projects that can improve the quality of life for women and I am excited by the prospect to work on such a project. I believe in the importance of cultural influences on health and though I have not had much applied experience to date, I am hoping that this competition will help me with that.

How did you first hear about Changemakers?

Through another organization or company

If through another, please provide the name of the organization or company

American Medical Student Association

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