By: Neena Irshad, UNV Midwife-Nurse Clinical Training Advisor for UNFPA Lao PDR
In my visits to different communities as a volunteer Midwife in Lao PDR, I have found that many pregnant women are living without proper health care and timely health education, supervision, medical treatment and availability of Skilled Birth Attendance. In addition, along with their pregnancy, and the risk this brings, they also suffer from many adverse health-related situations and miseries, such as limited nutritious foods, increasing cases of malaria and many other endemic diseases, plus long distances to health facilities and sometimes lack of transport, all of which can prove fatal for them and their babies.

Luckily, in 2009, the Lao Ministry of Health with support from UNFPA and other development partners introduced a Community Midwifery (CMW) Programme, which is reaching the unreached families in remote villages of Laos.

In a recent supervision mission to Manji, a remote UNFPA-supported village located about 250 kilometres away from Savannakhet capital city in southern Laos; we had the chance to visit the health center. At the time of arrival, we were welcomed by Ms Bovon, a committed and hard-working Community Midwife trained under the CMW Programme, doing her daily work. She was providing family planning counselling to a mother whom she helped deliver recently.

This facility covers a population of about 5400 people Some of the problems confronted in Manji and surrounding villages are that many of the population are from different ethnic groups, many do not speak Lao language and many adults have limited education. Women work very rigorously in the fields and also at home, even when they are pregnant or immediately after birth, furthermore there are strong cultural beliefs and taboos many of which create further problems to health and wellbeing in pregnancy.

The Community Midwives are professional health workers who are trained to work with these communities. During one year of intensive training, midwifery students go to practice in remote villages for 2 months after their clinical practice in the Provincial hospital. During the training programme they gain theoretical knowledge in the classroom and begin to develop skills during demonstrations and practice in the labs. Like her colleagues, Midwife Bovon is trained in all the basic competencies required for a Skilled Birth Attendant including critical thinking, how to deal with emergencies, and working with families and communities to strengthen the referral system so women and babies can be transferred to the nearest Emergency Obstetric Care facility also in time to save the life of the mother and the baby.One of the very important sessions in the CMW curriculum is called "The Role of the Midwife in the Community", where they learn how to work with the help of community leaders, District Hospitals and others. After finishing the training, they go back to these remote villages and support the women and their babies with the help of the village leaders. During selection of the CMW students it is always kept in mind that they are chosen from the health center they later will go to work with.

The programme is part of the Skilled Birth Attendance Plan and the idea behind it is to prepare well qualified skilled Midwives who can work with local people who know them, to gain the people's trust, to inform them about the facilities they can avail and hopefully to address and ameliorate some of the harmful taboos and beliefs they follow. The most important thing says Midwife Bovon, is people trust her, "if they don't trust the Health Worker they will not avail services" she adds.

But hers is not an easy job. Ms Bovon told us that she faces many problems to help local communities to understand that mothers need nutritious food during pregnancy and after birth, and that breast milk especially colostrum -the first 3-days breast milk- is very useful for the baby and provides not just good nutrition but also protection especially against infectious diseases. She is also working hard with the community to promote that pregnant women deliver safely with the help of a skilled birth attendant at home or at the Health Centre and also learn to take care of the newborn.

Although now Lao PDR has many, many dedicated midwives like Ms Bovon who are working hard every day to save mothers and babies in their communities, still many more midwifes are needed.