From Midwifery to National Healthcare, Step by Step

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 Auxiliary midwives in training attend anatomy classes.Credit: Rebecca Wolsak

By Rebecca Wolsak

I pulled up a pink plastic chair and sat amongst the young women. Each from a different Karen village outside the town of Pa-An in Burma where we now sat, all looked to be about twenty and too shy to speak. I was a bit disappointed at their timidity, but their nervous giggles were understandable; they were only in their second week of training.

The women were studying to be auxiliary midwives in their communities. Instead of taking the low-quality government training, which doesn’t equip students to deliver babies or provide basic treatment, these women were being trained by our counterpart, the Back Pack Health Worker Team. Founded in 1998, the team provides primary healthcare and trainings in conflict-affected ethnic communities where there is little or no government care.

After a recent ceasefire made it easier and safer for them to travel in Karen State, the team initiated a joint auxiliary midwife training project with one of Pa-An's larger NGOs and the local State government. It has not been simple: the ceasefire has not always been respected, the area is highly militarized, and the national peace process has barely begun. Healthcare is so centralized that even decisions on hiring and firing of hospital staff are made in Burma’s capital.

After four months of studying theory, the trainees spend three months gaining practical experience with another Inter Pares counterpart, Mae Tao Clinic.  With an average of eight babies born every day, the clinic provides the trainees with unparalleled experience.

The Back Pack team and Mae Tao Clinic are members of a coalition that is working towards national decentralized healthcare with a holistic, public healthcare approach. They see this midwife training as one step in the process towards effective coordination of services.

By chance, several months after our laughter-filled chat in Pa-An, I saw many of these women interning in Mae Tao Clinic. Again we were unable to have a fulsome conversation. But this time, it was because they were ducking between maternity ward beds with an air of confidence and compassion, checking in on the rows of new and expecting mothers. It was a beautiful sight.

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