Project Summary: Tibet has one of the highest maternal mortality rates in the world; therefore improving women’s health is critical to improve the health situation in Tibetan society overall. Tibetan Healing Fund along with local medical professionals determined that the most pressing need for Tibetan women in rural villages was to have access to a Community Midwife to provide basic maternal and child health care in rural villages along with providing basic health care education. Tibetan Healing Fund trains rural Tibetan women to function as community midwives, bringing healthcare services and education to rural Tibetan women and their families.

Project Goals: To improve the quality, accessibility, culturally appropriate and timely availability of essential health services, medicines and health education information for priority maternal and child health problems by providing access to community midwives. We will accomplish this goal by:

Increasing the number of village Community Midwives to assist safe delivery and arrange for emergency transport if complications arise;
Increasing the number of rural women receiving pre-natal, post-natal and neonatal care;
Increasing rural women’s knowledge of physiology, women's health, family heath, hygiene, nutrition, infectious disease, such as HIV/AIDS and TB and disease prevention.

Project History: Tibetan Healing Fund conducted a preliminary needs assessment in 2002 leading to the creation of the “Community Midwife” training. Tibetan women and infants are at high risk for birth related deaths. Traditionally, there are few midwives in rural villages and nomadic communities, women typically give birth at home with the assistance of a female relative or neighbor, and many women deliver their babies alone. Conditions are often unsanitary, and if complications arise little hope exists for resolution for mother and/or child. The majority of births take place in cold environments without access to electricity or running water and often at high altitude. And, although theoretically free, the average cost of a normal delivery in hospital is nearly four times the average per capita income with payment for care due upon admission. In addition, vehicles are rarely available, roads often treacherous or impassible, and language and cultural barriers alienating.

The first cohort of five women attended the program in 2002, and the second, of 15, in 2004 after a follow-up assessment was completed in-between. Another qualitative assessment of efficacy was conducted in 2006, which suggested that indeed the majority of the trained village midwives were being used by their communities and summoned for some complications of birth; an additional finding indicated that they were universally interested in continuing education.

Project Activities: Each midwife trainee was selected based on her basic literacy level, desire to help other village women, ability to speak and read Tibetan and/or Chinese, and her age and personal experience. Each received a certificate of completion from the hospital at the end of the 2-month training with female Tibetan Obstetrician and THF partner Dr Tsering Kyi.

As a part of, the community midwife trainees shadow doctors at the Tibetan Natural Birth and Health Training Center observing pre-natal check-ups, assisting with births and follow-up care. The course includes information on women’s physiology, basic hygiene, sanitation practices, disease prevention and nutrition. Recognition of complications including indications for transport to the hospital, and family planning are also part of the curriculum. Community midwives are trained to identify newborns with problems and infants likely to develop serious problems; they provide parents with basic health care information, promote immunizations, monitor growth rates and promote and support breastfeeding.

Long-term Impact: International health literature consistently shows that trained community midwives have the potential to be the cornerstone of a healthy community. They provide pre-natal, delivery and post-delivery care as well as valuable information about women’s health, family nutrition, sanitation, hygiene and disease prevention including sexually transmitted infections and HIV/AIDS.

Community midwife training can save lives of rural Tibetan women and babies and decrease the risk of disability as a result of unsafe and unassisted delivery. These community midwives can become an integral part of their communities and an integral part of the rural health system. Through additional training and regular re-evaluation, the community midwives will develop a high level of skill and knowledge to provide the best possible care for women in their village and surrounding villages.

Timeline:
Community Midwife Training in Trika County in October-November 2002.
Community Midwife Training in Repkong County in October-November 2004.
Continued Education of all community midwives in October-November 2006.