Over the years, the role of Traditional Birth Attendants (TBAs) in most African communities has often been regarded as one operated outside of the formal healthcare delivery structure.
In view of this, the World Health Organisation (WHO) defines TBA as “a person who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs”.
TBAs are integral members of their communities and provide an important window to local customs, traditions, and perceptions regarding childbirth and new-born care.
The role of TBAs in improving maternal health has been heavily debated, especially within the context of a renewed focus on Millennium Development Goal (MDG) 5.
While trained TBAs are not considered skilled birth attendants (SBAs), their potential contribution has been recognised in diagnosing labour, ensuring clean delivery, detecting and referring maternal complications, providing hygienic cord-care and ensuring warmth of the new-born, supporting early exclusive breastfeeding, and providing advice on a number of issues.
While in most African settings a TBA is viewed as a traditional midwife, community midwife or lay midwife, who is a pregnancy or childbirth care provider, but they may also function within specific communities in developed countries too.
It is within this context that a Switzerland-based healthcare group, SUPPORT, decided to support health projects in West Africa, starting from Nigeria.”
Makoko/Iwaya Waterfront community is a marginalised sprawling century-old informal fishing neighbourhood on the lagoon of Lagos, Nigeria. The community accommodates upwards of 50,000 inhabitants comprising five ethnic groups coexisting in a peaceful manner.
The majority lives on wooden stilt-houses on the Lagoon. They have no access to basic infrastructure, reliable clean drinking water, electricity, sewage and other waste disposal, and conventional health care services.
The community repeatedly decries its high MMR and infant death, besides the prevalence of malaria, pneumonia, measles & HIV/Aids and frequent outbreaks of water borne diseases due to the congestive living and very poor hygienic conditions.
Members of the community have to go to healthcare centers outside the plan coverage area, what few seldom do. Most inhabitants rely on traditional healers (TH) and traditional birth attendants (TBA) for their healthcare needs.
SUPPORT came to Makoko/Iwaya Waterfront communities four years ago on the request from the Community for Assistance to implement aspects of its own “Makoko/Iwaya Waterfront Regeneration Plan”, to see how it could help contain and improve upon the non-existent healthcare services in this slum community.
According to Dr. Vincent da-Silva, President and founding Member of SUPPORT of Switzerland and Nigeria, the move aims at “helping to improve health conditions of the women, men and children with limited or no access to basic medical care in West Africa” such as those in Makoko-Iwaya.
So, the organisation came out with an innovative development project of integrated medical health project that brings Makoko-Iwaya’s Traditional Healers, (THs), TBAs and conventional medical health practitioners together to enable the communities achieve self-supporting and sustainable solutions to the problems in the local health care systems.
According to SUPPORT, “Help to self-help is central to our projects, because we believe that the essentials of solutions to regional problems should be sought after, primarily in local resources. That is why SUPPORT advocates local health projects and initiatives.”
Thus, the group collaborating with a newly formed local NGO, IROHES, embarked on a three-legged Project Proposal of Integrated Primary Healthcare System of Traditional Medicine and conventional Medicine. They would achieve this:
First, by Empowerment and Capacity building in Health Literacy through the Help of so called “Health Champions” who after Training, enlighten and acquaint the community members through regular Home visits, in the workings of conventional medicine. Secondly, the Target group of TBAs and THs who undergo a total of 4 Training Modules in which they are equipped with basic theoretical Knowledge and know-how of conventional medicine.
Secondly, a system of eight Community Health Posts – one in every subunit of the community (one doctor/5,000patients!) to cater for minor health needs and for counselling on health matters.
Thirdly, erection and operation of a functioning PHC as the Platform for the integrative healthcare service delivery.
Similarly, 20 young people were selected from the communities to be trained as health champions. These are youth leaders.
The project began in Nov.2016 with the Training of the TBAs and THs with the main themes of personal and environmental hygiene and pregnancy (in difference to the dire hygienic conditions in the community) as well as a number of common health issues.
They were instructed on a number of health issues and general healthcare. The training included issues like nutrition, immunisation, common diseases like Malaria and Diarrhoea and how to keep themselves safe from HIV infection.
The second and third modules of training workshops took place in May and September this year and lasted three days each for the THs and TBAs who constitute the target groups of SUPPORT to deliver and operate within the primary healthcare system.
The training sessions this time focused again on ‘Basics of microbiology and hygiene as well as challenges to waste disposal and Management in Makoko/Iwaya Waterfront Community, infection control, including the spread of diseases, standard precautions, water treatment, wounds and care.
On the other hand, the themes on pregnancy involved the anatomy and physiology of pregnancy, nutrition and care during pregnancy as well as management of complications of pregnancy.
A special group of youths of the community also began training for the first time to become “Health Champions”.
They are youth leaders who must have at least high school education and have not had formal education in health related matters but are well embedded within the community. They will be tasked with going into their communities at least twice monthly to educate and instruct their people on health matters.
Prior to this they were taught the art of effective communication with people during a two-day training workshop.
The main facilitators for the September trainings were Ms Chris Mohr, on Hygiene and infection Control and Ms Eliane Hinderling on pregnancy and Management/(Referral) of Complications. They are both from Cantonal Teaching Hospital, Aarau Switzerland.
Others were Mr. Rahman Adigun, traditional medicine, Lagos State Traditional Medicine Board (LSTMB) and Dr. Ismail Morayo, Primary Health Care, Medical Officer of Health, Yaba, Lagos.
Following the September 18 to 22 training workshops, an outreach programme was organised in Maokoko/Iwaya each on land and on water that included doctors, nurses and other medical professionals, including Laboratory technicians.
They examined Hundreds of people, among whom were nursing mothers who brought in their babies for immunisation as well as general examinations that included weight/length and body mass index (BMI). Adults were tested for hypertension among other things, and those who consented took tests for HIV.
It was during these tests that four HIV persons tested positive and later referred. These patients now undergo treatment after counselling. Those with pathological findings were referred to hospitals immediately for further assessment and treatment.
It was not surprising, therefore, that by the end of the September training, both the Lagos State government, and the Yaba Local government where Maroko/Iwaya are located, became fully supportive of the project that is being implemented by Iroko Healthcare Support (IROHES).
IROHES are partners of the Swiss SUPPORT group in Africa. The communities have allocated land for the erection of a Primary Healthcare Centre of their own, and the Primary Healthcare Centre formerly operated by the Medicines Sans Frontiers (MSF) was also offered to IROHES. But the building abandoned after the MSF left, needs extensive refurbishment.
da Silva said: “This is a positive development and an encouraging one for that matter”, while also stating that the building will be renovated by next year in order to house the Integrated Primary Healthcare Centre. This will enable the THs, TBAs, as well as the conventional medical practitioners operate under one roof.
Treatment at this centre will not attract any extra charges and will make it possible for patients to choose where they want to be treated.
One of the advantages of this setup is that the traditional practitioner that will encounter any complication with patients could easily seek conventional medical attention. They would thus also share their experiences.
Speaking to Africa Link, da Silva said SUPPORT is not a charitable organisation. “We believe in developmental aid, whereby the beneficiaries – in this case Makoko/Iwaya communities-and IROHES, have to work together.
Each has its own responsibilities and commitments to deliver in every transaction such as the land and structure for the centre, which meant that, “Makoko/Iwaya owned the project, and together we formulated the operational conditions.”
He said IROHES had started to work with the local and state governments on the conditions of handing over the building at Aiyetoro to the organisation.
He added: “We want the governments to renovate it, after which we will furnish, equip and operate it. We hope to fund the personnel for a while. This collaborative effort would be an example of private, public, partnership (PPP) in Healthcare.”
The minimal fees that patients will pay for services will help cushion the running costs. The fees that patients pay for both services –traditional health services and conventional health care delivery – will be the same.
The trainings will be completed next year before the envisaged Integrated Primary Health Centre (PHC) is ready.
You can impact discipline positively
Positive discipline is essentially when you focus on your child’s behaviours and choices as good or bad and reward the good behaviors. There is no such thing as a “bad” kid when it comes to positive discipline, and a lot of schools and parents are taking on this way of rearing, raising, and helping kids grow.
Still, there are the naysayers — especially parents of the previous generation — who say that perhaps we are all “too soft” on our kids with this positive parenting nonsense. To the older generation, this is us going too easy on our kids.
“Back in my day, kids behaved the right way!” “A good spanking got you and your siblings to behave!”
Although each generation of parents tends to have its own unique method of parenting, for some reason, the previous generations seem to believe that children can’t learn to behave unless they are frightened to death or scared. And perhaps for some kids, the scare tactic approach works.
For me it didn’t, and for many other kids it doesn’t work (in my opinion). I truly think that for positive parenting skeptics, they ought to open their minds to the idea that perhaps children can learn to make great choices without being afraid. That rewarding good choices and focusing on the positives of each individual child can result in a healthy, strong adult.
Focusing on the bad brings on the bad; Doing the opposite brings on the good!
Think about it logically. When you focus on something bad that happens to you, the rest of the day seems worse. Do you really think it’s any different in regard to behavior? If you focus on all of the bad things your kid does, I can guarantee you your child will do more bad things. Why? Well, he or she will grow to assume that he or she is only capable of doing bad things and therefore is not a worthy person.
When you place your standards and expectations of someone low, he or she is bound to match those standards. Positive discipline works because it teaches a child that he or she has so much worth and is capable of doing great things. A child who has self-worth is a happy and well-behaved child most of the time.
Fear teaches kids to retreat or fight
If you scream at someone, what happens? The person typically either screams back, runs away, or possibly hits. Anger only begets anger. Or worse, retreat. Your child will indeed fear you if that’s what you want, but how does fear teach a child to develop self-esteem and monitor his or her own actions later in life? Simply with fear. There is a difference between fear and respect. Respect makes you want to honor a person, even if you don’t always agree with him or her. Fear makes you want to avoid, scare, or protect yourself from someone.
Scaring kids into behaving doesn’t mean they will become a good adult as time goes on! Positive discipline allows parents, teachers, and caregivers to reinforce good behaviors, extinguish bad behaviors, and maintain respect without weighing on fear to do the job. The other factor is eventually fear can turn into one of two things: complete avoidance or complete rebellion. What happens as your child grows older and, in some cases, bigger than you? All of your fear tactics will hold a lot less power as your child grows into a teen. And it would be worse if your child was so afraid of you that in the long run, he or she doesn’t turn to you when there are problems and issues in his or her life.
Positive discipline does not reward bad behavior
If you shower a kid with negative attention most of the time, that kid is going to behave badly in order to get your focus. When a teacher or caregiver uses positive discipline, the good behaviors have center stage. When you give a child a lot of attention for being good, there is a reward for them to repeat these great choices.
Focusing on the behavior — not the child — teaches kids to work on their choices
It’s not fun feeling like you “messed” up or are not liked or respected. When you use language that focuses on children’s choices and not who they are intrinsically as people, you give kids the chance to focus on their actions. The reality is we all have to make a choice each second of each day. So if we and our children feel as though we have opportunities to tweak and build on the choices that we have made, we can then feel good about ourselves in the learning process!
Letting children know that while you love them, you don’t always love their choices also lets them feel loved for who they are — imperfect and flawed! If you tell a child she’s “bad,” do you truly think she will work hard on her choices to change, or will see feel defeated or like a bad person?
Can women really do it all?
It’s 6:30 p.m. and Miriam, a cash officer in one of the top banks in Lagos, is totally exhausted. She had has to attend to a myriad of customer cash issues all day long, she was feeling the pressure to ensure accounts are balanced and there is cash available for ATM transactions.
Thankfully her neighbour who is also a fellow parent at her children’s school was able to pick up her 4-and 6-year-old daughters from their after-school program, since she wasn’t going to make it there in time.
It took a 75 minutes drive and a near collision before she finally pulled into her compound. Frazzled and drained, she trudged through her neighbour’s door and sighed. She thanked her and took her kids upstairs to her own apartment, all she wanted to do was put her feet up and rest.
But there was dinner to make, the girls needed help with homework, and the some chores she left undone in the morning, before her husband gets home from work around 9:30 p.m. And then she would have kitchen cleanup, paperwork from the kids’ school to go through, lunches to pack for tomorrow and a mountain of laundry needing to be folded and put away. Whew!
If she’s lucky, she will be done by 10:30 pm, so she can at least spend 30 minutes relaxing while watching a bit of the late night news and she has to get some rest before the alarm wakes her up at 4:30am to prepare for yet another day.
On weekends, there’s always a lot to do, from shopping, attending church programmes and stopping at the beauty salon with her daughters to get their hair done, to an endless list of household chores, including cleaning, laundry, ironing, meal planning and cooking for the coming week and of course reporting to the office when the need arises.
Miriam is one busy woman! But as packed as her life seems to be, her story is nothing out of the ordinary. Millions of other women including yours truly, live the same kind of hectic lifestyle – scrambling to run two lives—one at home and one at work, and another online, for those of us who choose to be ‘21st century women’. We want to be good wives and mothers, but we also want to be intellectually stimulated by a challenging career in addition to contributing to the household.
Busy workload for today’s woman is not just the same old story as children’s schedules have gotten busier too. Now parents in the bid to have a chance to show off our ‘super star’ kids are busy all weekend shuffling our kids to all the different activities – music, sports, drama, painting, board games and what have you.
One former working mom said she used to drop her three kids ages 1, 3, and 5 off at school and day care at 7 a.m. and pick them up at 6.30 p.m. every weekday. They would get home around 7:00, she would make dinner and the kids would go to sleep about 8:30 pm. She started thinking, ‘Hey, I’m only seeing my kids for two hours a day. If that’s all I was going to see them, then why did I even have kids in the first place?’ So she quit her job and put her career on hold to be with her kids until they are older.
While that may be the wish of most working moms, not many can take such a decision or the kids may not have the next meal. It’s almost like a constant spinning of plates to get through the day to honour our commitment not only as mothers but also as employees, and everything else. But how do we manage to juggle the overwhelming demands of family and career? Most women would just give a smile shrugging their shoulders.
Gender equality: The unfinished business of our time – UN
We are at a pivotal moment for women’s rights. The historical and structural inequalities that have allowed oppression and discrimination to flourish are being exposed like never before. From Latin America to Europe to Asia, on social media, on film sets, on the factory floor and in the streets, women are calling for lasting change and zero tolerance for sexual assault, harassment, and discrimination of all kinds.
Achieving gender equality and empowering women and girls is the unfinished business of our time, and the greatest human rights challenge in our world.
The activism and advocacy of generations of women has borne fruit. There are more girls in school than ever before; more women are doing paid work and in senior roles in the private sector, academia, politics and in international organizations, including the United Nations. Gender equality is enshrined in countless laws, and harmful practices like female genital mutilation and child marriage have been outlawed in many countries.
But serious obstacles remain if we are to address the historic power imbalances that underpin discrimination and exploitation.
More than a billion women around the world lack legal protection against domestic sexual violence. The global gender pay gap is 23 per cent, rising to 40 per cent in rural areas, and the unpaid work done by many women goes unrecognized. Women’s representation in national parliaments stands, on average, at less than one quarter, and in boardrooms it is even lower. Without concerted action, millions more girls will be subjected to genital mutilation over the next decade.
Where laws exist, they are often ignored, and women who pursue legal redress are doubted, denigrated and dismissed. We now know that sexual harassment and abuse have been thriving in workplaces, public spaces and private homes, in countries that pride themselves on their record of gender equality.
The United Nations should set an example for the world.
I recognize that this has not always been the case. Since the start of my tenure last year, I have set change in motion at UN headquarters, in our peacekeeping missions and in all our offices worldwide.
We have now reached gender parity for the first time in my senior management team, and I am determined to achieve this throughout the organization. I am totally committed to zero tolerance of sexual harassment and have set out plans to improve reporting and accountability. We are working closely with countries around the world to prevent and address sexual exploitation and abuse by staff in peacekeeping missions, and to support victims.
We at the United Nations stand with women around the world as they fight to overcome the injustices they face – whether they are rural women dealing with wage discrimination, urban women organizing for change, women refugees at risk of exploitation and abuse, or women who experience intersecting forms of discrimination: widows, indigenous women, women with disabilities and women who do not conform to gender norms.
Women’s empowerment is at the heart of the 2030 Agenda for Sustainable Development. Progress on the Sustainable Development Goals means progress for all women, everywhere. The Spotlight initiative launched jointly with the European Union will focus resources on eliminating violence against women and girls, a prerequisite for equality and empowerment.
Let me be clear: this is not a favour to women. Gender equality is a human rights issue, but it is also in all our interests: men and boys, women and girls. Gender inequality and discrimination against women harms us all.
There is ample evidence that investing in women is the most effective way to lift communities, companies, and even countries.
Women’s participation makes peace agreements stronger, societies more resilient and economies more vigorous. Where women face discrimination, we often find practices and beliefs that are detrimental to all. Paternity leave, laws against domestic violence and equal pay legislation benefit everyone.
At this crucial moment for women’s rights, it is time for men to stand with women, listen to them and learn from them. Transparency and accountability are essential if women are to reach their full potential and lift all of us, in our communities, societies and economies.
I am proud to be part of this movement, and I hope it continues to resonate within the United Nations and around the world.
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