Special delivery: women give birth safely

Isabelle wants to deliver her fifth child at a health centre
© UNICEF Timor-Leste/2012/Andy Brown

Isabelle de Santos, 29, lives in Suku (village) Hatólia in Ermera district, Timor-Leste. Her husband is a coffee farmer. She already has four children aged six to 12-years old, and is four months pregnant with her fifth. “I’m hoping it will be a boy so he can help his father in the fields,” she says, laughing.

Suku Hatólia is part of a new initiative that encourages women to give birth at their nearest health centre. After a meeting with her local community, Isabelle signed up. “I don’t want to suffer or die giving birth,” she says. “Now, when I go into labour we can call the health centre and they will send the ambulance to collect me. I’m very happy to know they will come.”

The programme is run by local NGO Alola Foundation with support from UNICEF. There have already been some early successes. In the previous quarter, only nine women gave birth in the local health centre. This is now up to 20 and rising.

Early start

Part of the view from the mountainside above Suku Hatólia
© UNICEF Timor-Leste/2012/Andy Brown

I visited Suku Hatólia with my UNICEF colleagues Mi-Ann, Tony and Indra on the second day of our visit to Ermera district (see part one of this blog). As before, we spent several hours negotiating bumpy mountain roads, but this time the views were spectacular. We started in the early morning, driving along forested mountainsides where tall acacia trees rose out of the early morning mist, their pale trunks glowing orange in the low-angled light of the rising sun. We passed an old man leading a donkey along the road with sacks of coffee on its back, then crossed a river where a woman was washing clothes and laying them out to dry on the rocks.

Above Suku Hatólia, the view suddenly opened up and we stopped for a minute. Standing on the shoulder of the mountain, we could see a wide, deep valley ending in interlocking fingers of land with the expanse of sea beyond. The sky was clear and blue, except for a few clouds piling up behind the peak of the tallest mountain opposite. Along the valley floor, dried-out river beds like dusty scars on the landscape traced the route that the waters would later take to spill into the sea during the rainy season.

I was driving with UNICEF health specialist Aderito Docarmo, so I asked him about the programme. “The percentage of assisted births in this area is just 22 per cent,” he said. “We wanted to find a way to increase this.”

UNICEF started with advocacy, from the Ministry of Health down to village chief level. Once everyone was on board, Aderito and colleagues started meeting with local communities including pregnant women. “We asked them to list the reasons that they don’t go to the health centre to deliver,” he said. “Their reasons included lack of money, difficulties in transportation and lack of family support. Then we helped them to develop solutions to those problems. For example, if all the mothers in the village save $1 a month, they can use that money to help pregnant women when they need to go to the clinic.”

The team also helped the villagers determine which women needed extra help. “We get three coloured baskets and write all the pregnant women’s names on pieces of paper,” Aderito continued. “If the community agrees that ‘Maria’ can get to the clinic by herself, her name goes in the green basket. If they think ‘Johanna’ will need help, she goes in the red basket. Anyone that they’re not sure of goes in the yellow basket, and we follow up with them later.”


Midwife Ofelia (left) and head of the health centre and with their ambulance
© UNICEF Timor-Leste/2012/Andy Brown

Eventually we arrived at the health centre at Hatólia sub-district, built on a hillside looking out over the valley. Outside the clinic, one 36-year-old a pregnant woman with six children told us she was there for a pre-natal check-up. “I walked two hours from my village to get here,” she said. “I just want to make sure my pregnancy is good. I’ve also brought my youngest child for vaccination.”

At the maternity ward, we met senior midwife Ofelia Isabella Suarez, who had worked there since 2006. “Sometimes the women come and immediately deliver, other times they stay here for a few days,” she said. “We had two women with us last week. We cooked rice for them and their families brought them vegetables.”

Ofelia showed us round the health centre, which was spacious but fairly basic. “We can do normal deliveries here but we don’t have the equipment to deal with complications,” she continued. “Last month we had to send a woman to the hospital in Dili. We couldn’t get the baby out and she was suffering from hypertension. She delivered successfully in Dili and both mother and child survived.”

Village meeting

Pregnant women and new mothers at the community meeting
© UNICEF Timor-Leste/2012/Andy Brown

After another journey over treacherous packed-earth roads, we arrived at Suku Hatólia. Most of the houses were traditionally built out of bamboo and wood with thatched roofs. Children played on a swing and in the few patches of shade. Most of the villagers were already assembled in the town hall, including pregnant women, mothers and volunteers.

The community meeting began with one of the volunteers, 26-year-old Paul Soares, reading the outcome of the previous meeting, where they talked about problems and solutions related to women giving birth. Paul and the other volunteers were chosen by the community. They are responsible for monitoring pregnant women, taking them to the clinic when they’re ready to deliver, and helping care for children left at home. At the end of the meeting, Paul and another volunteer were each given a mobile with $15 credit so that they could call the clinic when mothers had to be brought to the health centre.

“Isabelle is my mother’s goddaughter,” Paul told us afterwards. “I want to help her and other pregnant women in the village. When Isabelle is ready to deliver, I will take her to the health centre. If there’s an emergency, I can call the health worker on this mobile.”

Paul (left) and another volunteer examine the mobile phones
© UNICEF Timor-Leste/2012/Andy Brown

Another volunteer, 40-year-old Ceasar Noronha, came from nearby Suku Aculausarae to address the community meeting. “My brother’s wife was pregnant during the Indonesian occupation,” he said, speaking passionately. “She could not deliver so the child died inside her. Then she died too. I don’t ever want to witness a repeat of that experience. So when this programme started, I wanted to take part. Now all the women in my family give birth at the health centre with support from health workers. They have all delivered successfully.”

The maternal health programme is still in the pilot phase and covers just a few villages and UNICEF is looking for additional funding to scale it up. “This is a good example of our equity approach,” Aderito said as we left. “Before, only the women who lived close to the clinic could go. Now all the women can, including those in remote areas.”

A boy plays on a swing at Suku Hatólia.
© UNICEF Timor-Leste/2012/Andy Brown