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UNICEF and Papuan midwives tackle maternal malaria

© UNICEF/2008
Erna, 25, waits at the village puskesmas in Waiya, Papua, to have her one-year-old daughter tested for malaria.

WAIYA, Papua, 23 September, 2008 - Malaria is one of the leading causes of complications in pregnancy for Indonesian women today. Pregnant mothers who contract the disease are in danger of premature delivery, anemia and bleeding, and women in rural areas are particularly at risk. 

But in Depapre sub-district, an hour outside of Papua’s capital, UNICEF is working to stamp out maternal malaria by making screening and treatment a routine part of basic ante-natal care.

Care for mothers and their babies
It is early Monday morning, but already a queue has formed outside the puskesmas or health clinic in Waiya, a little village high in Depapre’s jungle-covered hills. Young mothers hush their crying babies, while older men sit patiently in the shade, fanning themselves with palm leaves.

At the end of the queue, 25-year-old Erna tries to keep hold of her squirming daughter while filling in the clinic’s paperwork. She has come to Waiya by boat from the village of Kendate to have little Jennifer tested for malaria. The one-year-old has been running a high fever for over a week now.
 
“At first I thought it was influenza so I gave her paracetamol, but that didn’t make her better,” Erna says, “I took her to see the midwife in my village and she tested her for malaria. That test was inconclusive, so she told me to bring Jennifer here straight away to get a full blood test done.

“I’m scared for her as she is only very small and I don’t want her to be sick.”

The test carried out by Erna’s village midwife is one of the tools being supplied by UNICEF to help combat malaria. Called a Rapid Diagnostic Test (RDT), it works in the same way as a pregnancy test; only instead of urine it needs a small drop of blood.

The tests are an important tool for village midwives, as they allow them to quickly tell whether a mother has malaria or not, and start treatment straight away if this is needed. The alternative is a trip to the nearest puskesmas to have a full blood test done, something which can take days for people in very remote communities.

 

© UNICEF/2008
Lea is Waiya’s only midwife, providing care for dozens of mothers as well as basic medical services to all the residents of her village.

Midwives on the front line
Of course, the tests are not much good without people who know how to use them, which is why UNICEF also works with government health officials to train village midwives in malaria assessment, treatment and prevention. Erna’s midwife, Lea, received this training in 2007, which is why she was quick to refer little Jennifer for further tests.

“When women come to me in the first trimester of pregnancy, or when any little baby is brought here with a fever, the first thing I do is test them for malaria using an RDT,” Lea says.

If the RDT shows that a mother has malaria, Lea begins treatment. The guidelines are clearly laid out on large UNICEF posters which hang around the walls of her clinic and show which medicines to give depending on the stage of the mother’s pregnancy and the type of malaria.

“It is very helpful for me to have these guidelines because I know that I am definitely giving the right treatment now,” Lea says.

“In the past I was often scared to give medication to pregnant mothers because I was worried about hurting the baby. Sometimes I would give no treatment at all rather than give the wrong one.”

If the test is negative, Lea’s focus shifts to malaria prevention, ensuring the mother does not contract the disease during her pregnancy. In this program, each pregnant women is given a  free insecticide-treated bednet as well as information and advice about how to correctly use and care for the net.

“The free bednets are good because sleeping under them is one of the best ways to protect women from malaria. They are also good because when women hear that we are giving them away, they come to my clinic to get them and I am able to give them ante-natal check ups at the same time,” Lea said.

Reaching out to communities

As one of only 7 midwives working in Depapre sub-district, Lea’s knowledge and skills in battling malaria are vital. Depapre has a population of more than 5000 people spread across 11 remote villages, and for some, her services are the only kind of medical care they will access. By training village midwives like Lea to diagnose, treat and prevent malaria, UNICEF is helping to reduce the prevalence of this disease in areas where other medical services just don’t reach.       

Back at the puskesmas, Jennifer has had a blood sample taken and Erna must now wait anxiously for the results. But if the test proves positive for malaria, at least she can be sure that her daughter will receive good quality treatment and care, right within her own village.       

 

 

 
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