Thursday, April 30, 2009

Here, you throw your trash out the window

Yesterday morning, a little after eight, I climbed into the micro bus with Fatama and Aysha. Fatama and Aysha both work in the CHX-OR part of the Projahnmo project. CHX-OR (which stands for introduction of Chlorhexidine Operations Research) is running a trial of cleaning infant umbilical cords with a 4% Chlorhexidine solution in an effort to keep them from becoming infected. The trial is now in its second phase, where Projahnmo has introduced a squirt bottle to use in application rather than an open mouthed one that requires the use of a cotton ball and more physical contact.

I had been invited to join them at a training for Traditional Birth Attendants (TBAs), which was taking place in a GoB Union Health and Family Wellfare Center about an hour and a half outside of the city. This clinic was considerably cleaner than the last I had visited, but much emptier.
When we arrived, the room was already mostly full of older women, all wearing head coverings. I think there were probably 20 to 25 women present for the training, and when they went around introducing themselves, they were asked to also say how many births they had attended in the last two months. Almost everyone said between 2 and 4. The Field Research Officer who sat next to me said, if each of them is delivering between 2 and 4 babies in two months in this one Union, that is a lot of babies.
The training was not unlike others I've been to, even ones in the States. Fatama and Aysha talked about how to use a Delivery Packet (which includes a large plastic sheet to lay under the mother, three sterile threads to tie off the umbilical cord, one sterile razor blade to cut it, two sterile gauze pads, and a bar of soap) and, using the best newborn baby doll ever, showed how to clean the cord with the CHX and how to wrap up the baby (first drying/wiping it off with one clean cloth, and then wrapping it with another-avoiding a bath).
The difference in this training was that none of the TBAs could read. The handouts all were in pictures, there was heavy emphasis on visual props, and a lot of discussion. This was great for me (not knowing the language) and seemed to be pretty effective. However, after two role plays disintigrated into heated discussion, Fatama translated for me that they had all decided that they would share the information their way. I had been wondering about that. It seems that it would be very easy to use just parts of the training without the others.
After tea, the session turned to how to distribute and sell CHX to families. TBAs and Village Doctors can sell the solution, but if the family can't or doesn't want to buy it (it is only 45 taka, super super cheap) they can come to a government facility and recieve it for free. The hitch here is that the TBAs are unable to provide written documentation of who they sold it to, when, or for how much. Interestingly, they were all handed out notebooks and pens, and Aysha explained to me that the hope is that maybe some of their clients or maybe their family members can help them with recording.
As the training wrapped up, Fatama arranged for me to talk to two TBAs on our own, providing herself as an interpreter. Though she struggles with English, she did a great job considering the complexities of the questions I was asking (what do you do when you are not attending a delivery?) and the answers we were recieving (sometimes I gather wood, like this, and cut it, like this, and sell it to families who need it to make their cooking fires. Mostly, my children are hungry.) Both of the women are widows (so though they have nose piercings, they will never wear an ornament again) and they each had more than five children, of which only one- the youngest son -was in school. They do not attend deliveries for payment, believing that God knows this is good work and they will be rewarded with heaven. Sometimes though, a family will pay them 50 to 100 taka. Fatama translated at the end, "they share their stories and hardships with many people, but this does not solve their problems. Maybe it will help you solve yours."
After our interview, the women were really friendly and warm. They took my hands and touched their heads and hearts. When we took a photo together (shown above), they were both holding my hands.
Fatama and Aysha were excellent traveling companions, on the way home they pointed out lots of things and asked me lots of questions. Fatama got very excited about a song on the radio, and after singing along with every word, translated it for me. It was about a young man who couldn't get married to the one he loved because he did not have a job. Then, he got a job and called her on a payphone to tell her, but he kept getting the wrong number. She explained that this was a favorite song among university students because many of them are in love with people who are poorer than they but their fiances are very wealthy.
Today, Friday, is the only day of the weekend here, though Kahala and many other people work on this day too. Next week, Dr. Salahuddin has been so kind as to arrange many interviews and visits for me, about which I am super excited.
The heavy clouds that seemed to hang low right over the tree tops have finally begun to pour down their cool rain, which is much appreciated after three days of dense hot humidity. Little boys are running screaming through the big puddles outside my window.

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