By Tin Aung, Health and Nutrition Specialist, Mawlamyine UNICEF Field Office
In August, I accompanied a midwife on her mission to an out-of-reach area, and observed the routine immunization, vitamin A supplementation and deworming activities as part of the National Nutrition Promotion Month. These activities took place in Mel Ta Le village in Kya Inn Seik Gyi Township, Kayin State. This village, which is 10 kilometre away from the nearest rural health sub-centre, can only be reachable during the rainy season by ““trolley jeep””, as it is known in Myanmar.
The midwife Naw Pwe Awng comes here every two month for routine immunization activities. In addition, in August, as it is the National Nutrition Promotion Month, the 40 year old woman visits the village not only for routine immunization but also for vitamin A supplementation and deworming activities.
Early in the morning, Naw Pwe Awng and a maternal and child health (MCH) worker, who was trained by the Swiss Development Committee (SDC) and the Karen Department of Health and Welfare (KDHW), took a “trolley jeep” from Kwe Khle rural heath sub centre to the village. The midwife carried her vaccine carrier and a registration book where children’s vaccinations are recorded.
She has been doing this for the last two years: every two months she travels to Mel Ta Le village by “trolley jeep” in the rainy season and by motorbike in the dry season. Her husband has been always her driver for both means of transportation. He smiles and confirms her words. The “road” to the village is very rough. First, we had to cross a one meter depth river. Then we crossed three creeks along the road. The travel lasted about 30 minutes.
Naw Pwe Awng mentioned she would only dress her midwife’s uniform after arriving in the village. On the way there, I understood the reason: for several times she had to help pushing the “trolley jeep” whenever it stuck in the mud.
As soon as Naw Pwe Awng arrived to the village, she informed the mothers she saw along the road to come to the village leader’s house for immunization. After changing her clothes, she started the work. Pregnant women and mothers with under five years old children gradually arrived.
The midwife vaccinated the children with the help of the MCH worker. Since the mothers were worried about the number of vaccination shots, the midwife gave advice on symptoms and treatment after immunisation. She also asked to be informed as soon as possible in case such situations occur.
The majority of the mothers speak local Karen language, also spoken by Naw Pwe Awng, who is from a Karen ethnic group. “Since I speak their language, we can communicate better, which is useful to build their trust and the relationship with the local authorities”, the midwife said. In fact, before she joined the government services, Naw Pwe Awng worked as a midwife for two years in the Karen National Union (KNU) area. I noticed that many children and mothers were quite familiar with Naw Pwe Awng.
After vaccinating every child, she recorded it in the chart and in the registration book. During that day, a total of 8 children came to the vaccinaton session. In adition, she also administered vitamin A supplementation to 20 children between 6 months and 5 years old. Plus, she administered deworming tablets to nearly 20 children between 2 to 5 years.
With the support of the MCH worker, this mission also included ante-natal care and tetanus vaccines for pregnant women. They examined six pregnant mothers and recorded the data in their MCH booklets.
“Every time the midwife arrives, we come here with our children”, said some of the mothers. “We don’t know exactly what vaccines are given and which diseases are prevented but we always come. We believe vaccination can prevent diseases and make our children healthier”.
Although it is notorious that community knowledge on immunization needs to be improved, the work performed by this midwife in a remote area is remarkable. She maintains the cold chain, uses the correct doses and mode of administration, as well as keeps all records up to date. UNICEF will continue to support the work of these health professionals, namely by reinforcing community education and awareness.