Laos: Saving the Lives of Mothers and Children

The infant mortality rate in Phongsaly Province, a poverty-stricken province located in a mountainous region in the northern part of Laos, is at 120 deaths per 1,000 live births (of children under one year of age). The death of one in eight infants is caused by premature birth and infectious diseases. The infant mortality rate in Phongsaly is the highest in Laos. Although the data is less accurate, we found that an extremely high number of maternal deaths occur from postpartum bleeding and other related complications.

One in Four Expecting Mothers Receive Prenatal Examinations… Some Give Birth on Their Own 

There are many reasons as to why mothers do not receive appropriate examinations or do not deliver at health centers. These include: lack of, or frequent, malfunction of medical equipment; lack of, or misplacement, of medical tools such as scissors and forceps; shortage of disinfectants; and poor sanitation conditions. Furthermore, pregnant mothers do not make the time to visit hospitals for examinations because they are pre-occupied with farming, or they do not have appropriate education on pregnancy and are thus unaware of the importance of prenatal examinations. In fact, only one in four expecting mothers receive prenatal examinations and only one in five pregnant mothers choose to give birth in medical facilities. A survey of a village, whose health center is only 1 kilometer away from the residential area, found that all pregnant mothers chose to give birth at home; and of those pregnant mothers, 10% of them gave birth on their own and without the assistance of others. Since last fall AAR Japan has been actively involved in providing education on pregnancy, labor and child health in the Phongsaly Province so that women may be able to have a safer childbirth.
Local hospital employee learns how to listen to the heartbeat of an unborn child utilizing a Doppler ultrasound equipment provided by AAR Japan. Ando Noriko, AAR Japan representative (third from the left) (All pictures below are taken in the Phongsaly Province, March 15th, 2016)

Provision, Reorganization and Maintenance of Medical Equipment

AAR Japan has equipped certain hospitals and health centers with sonograms and infant incubators that are required to assist with child birth and conduct pre and post labor examinations. AAR Japan also provided training on the proper use and maintenance of this medical equipment (picture to the right) as well as procedures to clean and sanitize hospital rooms and examination rooms and the importance of continuous monitoring and documentation of pregnant women and children.
With the cooperation of an expecting mother, we provided training on the proper use of the sonogram to employees at a hospital in Phongsaly Province (February 23rd, 2016)

“This is The First Time We Learnt about Maternal and Child Health”

AAR Japan provides assistance to health center employees who visit villages to provide vaccination and other maternal and child health services. Specifically, AAR Japan provides:
-    Training on maternal and child health topics such as regulation of physical health conditions of expectant and nursing mothers, emergency care, importance of physical examinations, care for newborns after birth, and nutrition for children
-    Physical examination of expectant and nursing mothers and children
-    Education on Planned Parenthood and supplies of contraceptive medicines.
Moreover, AAR Japan further promotes these activities by providing spaces where health center employees can offer services and vaccinations and provide training to health center employees on various procedures. Our training sessions on maternal and child health target expecting mothers as well as fathers and grandparents. In order to accommodate women from small villages who do not speak Laotian as their native tongue, we prepare pictorial educational materials and provide other educational materials that allow participants to experience what pregnancy actually feels like. These women from the Yao Hwan village participating in the training sessions said, “This is the first time we learnt about maternal and child health. It was very educational and we will recommend this to other people in our villages.”
Women from the small Ho village are intrigued and ask questions at the training session on maternal and child health held at the Yao Hwan village (June 8th, 2016)

“We are Glad We Came to the Health Center”

The results of our initiatives to promote maternal and child health are slowly beginning to alter the lives of many people. The health centers are now equipped with sonograms that enable health center employees to conduct examinations that were previously only available at hospitals in neighboring countries or in China. With the aid of infant incubators, neonatal infants born weighing less than 1,500 grams can now grow healthy and be dispatched from hospital. Additionally, the number of women that chose to give birth at health centers instead of their homes has increased. Ms. Sutti is 25 years old and lives in Tah Sen Bonh village. She has previously given birth to two children at her home. Similar to her previous births, when her contractions started Ms. Sutti initially called a health center employee who periodically visits her village to assist with the labor at her home. However, since her home was not even equipped with tools to cut the umbilical cord, Ms. Sutti was transferred to a health center. Ms. Sutti’s contractions were not becoming more frequent and there was concern of a long and difficult labor. However, with the appropriate assistance offered by the health center employees, Ms. Sutti gave birth to a healthy baby girl weighing 3,100 grams with little blood loss (Picture to the right). Perhaps because the health center was furnished with the proper equipment, Ms. Sutti and her husband expressed that they were “glad to have come to the health center” and that they will recommend the health center as a place for child birth to their fellow villagers.
Ms. Onshii, a health center employee (age 21), carries a baby girl in her arms. “I hope all women come to the health center for a safe child birth.” (June 7th, 2016)

The health center in the Hatto Sa village, which had rarely delivered babies in the past, hosted four child births in May. Ms. Buarappah (26 years old) who recently gave birth to her child at the health center said, “From now on, I will visit the health center to receive medical examinations during pregnancy.”
Ms. Buarappah came to the health center when her contractions started in the middle of the night. This is her second child. (May 19th, 2016)

“The Number of People Showing Interest in Maternal and Child Healthcare have Increased” 

Small populations that speak a number of different languages inhabit the Phongsaly Province. Many women do not understand Laotian, making it difficult to deliver accurate knowledge on child birth. Moreover, each population has traditional dietary restrictions for mothers after giving birth, which can jeopardize the mothers’ health pre and post child birth. Our AAR Japan local staff, Pasto Kuang Somuan (26 years old) takes an active role in the Phongsaly Province. Pasto, from the small Punoi village of Phongsaly Province, joined our organization because he “wanted to give back to his community.” Pasto makes use of his ability to speak his native language to encourage people to attend training sessions. Pasto says “I am aware of the current situation in the villages. I am hopeful that, through AAR Japan’s activities, we can improve the conditions surrounding pregnancy and childbirth. Despite the difficulties, it is rewarding to see that the number of people interested in maternal and child health has increased through our training sessions.”

Although there remains a significant number of challenges to overcome, including supplying medical facilities with proper medical tools to assist with deliveries involving dystocia, AAR Japan is committed to promoting safe labor, as well as maternal and child health.
Pasto (second from the right) explains healthy foods for pregnant women during one of our training sessions. (April 24th, 2016)
【Reporter】 Noriko ANDO, AAR Japan Japan Xieng Khuang Office
After working as a university hospital as a nurse for 10 years, ANDO joined Japan Overseas Cooperation Volunteers (JOCV) to work in Laos for two years. After coming back to Japan, ANDO continued to work as a nurse for a while before joining AAR Japan Japan in February 2012. Working at Tokyo Headquarters, ANDO assisted activities in Xieng Khuang from October 2012 to June 2014. She is originally from Gifu Prefecture.

Japanese-English translation by Ms. Mami Usui
English editing by Mr Scutella Joseph

This article has been translated by volunteers as part of the AAR Japan's Volunteer Programme. Their generous contributions allow us to spread our activities and ideas globally, through an ever-growing selection of our reports from the field.