By Hannah Stapleton
For Sara David, training health workers and volunteers to support pregnant women in developing countries has been a passion 25 years in the making. Her desire to work in this field began when she was a graduate midwife in 1999, backpacking through the mountains of Nepal with her husband. She recalls coming across dozens of female community health workers, desperate for information to be able to support pregnant women.
“I had a sort of premonition. I remember just sitting there and looking out at these massive snow-capped mountains that were 8000 metres high. I just thought – I want to be doing this one day. I want to be teaching community health workers in developing countries.”
Hearing a Call from Papua New Guinea
Thirteen years later, with a successful career in hospital midwifery under her belt, Mrs. David experienced a significant disruption in her personal life and took a sabbatical. During her break from work, community and church commitments, she found herself trying to work out whether she wanted to continue working as a midwife, or whether that season of her life had finished.
One day, whilst waiting to pick up her young children from school, another parent, Pastor Michael Bullard, sidled up to her. He had strong relationships with community and church leaders in some remote villages in the Greater Sepik region of Papua New Guinea, knew Mrs. David was a midwife and had a proposition for her. He had asked the leaders on his last visit, “What are your needs?” Their reply: “A midwife, to give training to our volunteer Village Birth Attendants. Our mothers are dying in childbirth.”
Village Birth Attendants (VBAs) are what Papua New Guineans call “Traditional Birth Attendants.” TBAs exist in developing countries throughout the world, and share the common goal of keeping mothers and babies in their communities alive in childbirth. In some remote areas of Papua New Guinea, there are no formal health and education services, and transport and telecommunications options are very limited. The maternal and newborn mortality rates are among the highest in the world. VBAs step up to provide care for mothers and babies, attend births, and save lives when complications arise. Their knowledge comes from experience – through giving birth themselves, and attending births of others as an ‘apprentice.’ Many VBAs cannot read or write, and have never attended school.
Answering the Call
In 2012, Mrs. David embarked on her first visit to Papua New Guinea at the invitation of community leaders to provide training to the VBAs. She recalls how confronting it was to realise there were no experts or hospitals she could refer sick babies to. “A woman brought a baby who was only six weeks old, and he was very underweight. He was struggling to breathe. His poor little tummy was just sucking the air in, and you could see where his ribs and lungs were working so hard to try and get oxygen in. I remember immediately just thinking, ‘Oh my gosh, there’s no red button to press,’ because normally in hospitals here in Australia, you would go, ‘I need help,’ and press the button so that other staff could come in and help you.”
“Amazingly, every year, every time I’ve gone back to the village, they’ve brought me this baby to see. He’s definitely got some heart or lung problems, but he’s running around and he’s doing ok. He’s got quite a barrel chest and I think he’s probably got a hole in his heart. But that kind of surgery is not available in East Sepik Province.”
She also vividly remembers the sense of overwhelm from standing in front of a group of VBAs for the first time. “I remember just looking out and there were all these faces. I felt very inadequate really in that moment. Fortunately, the night before, Mike [who had passed on the invitation from community leaders for a midwife] had had a chat with us and suggested we share personal stories,” Mrs. David recalls. She and her friend, Lyn Scott, a trained nurse, shared their own birth stories with the group, and then invited them to share their own stories.
“When we asked them to share their stories, I was just making a note of what some of the problems were. Most of the mothers who were dying, were dying from postpartum haemorrhage [bleeding to death after birth]. A lot of them were having trouble delivering the placenta. Traditionally, VBAs would pull on the cord and it would snap, causing retained placenta.”
The VBAs expressed that their primary concern was family planning, so Mrs. David and Mrs. Scott set about teaching the women how their bodies worked. “You could actually see the lightbulb going on in their heads – ‘oh my goodness, there’s all these things happening to my body on the inside that I can’t even see.'” They also taught the VBAs how to use clean birth kits – a small package of some essential items that allow women to have a clean, hygienic birth. They also provided training on essential newborn care, because, previously, the VBAs would leave the baby on the ground once it had been born to see if it showed signs of life. “We taught them that, as soon as the baby has been born, that you dry and stimulate the baby with a clean cloth. We taught them how to clear the airway, because often with newborn babies, there’s some mucus that clogs up their airway.”
The Birth of Living Child
When she returned to Australia, Mrs. David could not stop thinking about the VBAs and the stories they had shared with her. In 2013, with the support of friends and family, she founded a registered charity, “Living Child Inc.” Her vision was that women in the communities in Papua New Guinea that Living Child worked in, would be able to choose when and how many children they had, that they would be able to give birth safely and their children would have every opportunity to grow and thrive.
Over the past 12 years, Living Child have become a trusted partner of the local health authorities in the realm of sexual, reproductive, maternal, newborn, child and adolescent health care. Mrs. David has completed a Masters of Midwifery by research, been made a Member of the Order of Australia, and created a framework for the training of Village Birth Attendants, which can be used all over the world.
“In around 2015, the VBAs had become a lot more knowledgeable and were more confident, and they would say ‘We need a training manual.’ I just thought, ‘yes, I need to do that.’ I knew that it needed to be well-researched and it needed to be peer reviewed, because I knew that what we did for this community was also needed elsewhere because of my experience in Nepal.”
Living Child currently facilitate a variety of projects in Papua New Guinea, including: running VBA training based on Mrs. David’s framework, facilitating a maternal and neonatal upskilling course for qualified nurses, midwives and community health workers, distributing clean birth kits and menstrual hygiene kits, providing essential midwifery equipment to health facilities, hospitals and aid posts, educating remote communities on handwashing, nutrition and breastfeeding through the Care Groups model of health education, and recording a health promotion radio show called “Helti Femeli.”
Facing Disasters in Papua New Guinea
In recent months, the communities that Living Child work in have been deeply affected by prolonged flooding and an earthquake. Homes, crops/food gardens, water tanks and dry toilets have been washed away. When the earthquake struck, Living Child worked quickly under Mrs. David’s leadership to mobilise a disaster liaison midwife volunteer – Christian Wright – to work in partnership with the Provincial Health Authority. Mr. Wright has been supporting local health leaders, distributing aid to remote villages, coordinating mobile health clinics and surveying the communities on their needs.
“Early on, I heard of a quote by Mother Teresa, which was that if you look at the masses, you won’t do anything, but if you look at the one, then you’ll make a start. I think that sort of encapsulates what we’ve tried to do, especially in these formative years, because many, many times we’ve just felt completely overwhelmed by the needs. But when I look back, and I just see how things have progressed, its like Living Child has had this life of its own. It hasn’t depended on me, its had a life of its own, and the momentum has been caused by the people on the ground.”
Mrs. David’s unwavering dedication serves as an inspiration to all who strive to make a difference in the lives of others, reminding us that with empathy, innovation, and determination, we can create a world where every mother and newborn receives the care they deserve.
About the Author
Hannah Stapleton is the head of Administration and Communication at Living Child Inc., Bull Creek, West Australia. She can be reached through her LinkedIn page or at hannah@livingchildinc.org.au.