We started in Minas, early, on Monday morning. We went to the main puskesmas to meet the chief midwife, Bu Yuni, and the District Health Officer (DHO), Dr. Rani. We needed Dr. Rani’s blessings to conduct our research and Bu Yuni’s knowledge and networking to help us plan our week. Bu Yuni would accompany us to most of our field visits, since she’s in charge of all of the midwives at the pustu, or assistant puskesmas, or at the village level, and also supervises the community health workers. She was very accommodating in trying to get us the exact number of women that we needed, even if it meant waiting until 4 PM to eat lunch – which it often did.
Puskesmas of Minas - smaller puskesmas' are typically one building, so I was impressed that this facility was 4 or 5 buildings.
Labor and Delivery Room - only space for one woman to deliver at a time, and if another woman needs to deliver, she delivers in the ER (see below)
Maternal waiting room - I can't think of what this is called in English, but after the women deliver, this is the room they stay in. Indonesian women typically only stay at a facility for 2-6 hours, unless there are complications.
The Emergency Room - seemingly well-equipped with the bare essentials, but it leaves a bit to be desired, from a Western stance.
Ambulance - this one is out of commission, but was previously used for emergencies
A bit about Minas: Minas is one of Jhpiego’s Chevron sites, meaning they get funding from Chevron to conduct their work. From what I understand, the majority of the work they do here are trainings for the health staff. For example, two weeks after our visit, Bu Ita, from the Jakarta office, will be visiting to do trainings on infectious disease control. Though I don’t know the extent of what Chevron is doing, in terms of their social responsibility, I do know that everywhere we drove, the beautiful landscape was broken up by nonstop oil pipelines and oil refinery stations. There was even a military-like base for the expat Chevron employees and their families. Additionally, when we drove to each of the 6 sites, we were driving on primarily paved road – and some of these sites were 30 to 40 km in the bush. Since it’s my first site visit, I don’t know how the others will compare, but I do know that Minas’ infrastructure must be a lot better off than many other districts, because of Chevron’s investment. I also learned that the research we’re doing may be helpful in writing the next proposal for Chevron’s funding in terms of supplying the health clinics, so that’s potentially good news.
One of Chevron's oil refineries, maybe 20 km from the city
After meeting with Dr. Rani and Bu Yuni, we headed out to Mandi Angin. One of the activities that Jhpiego and Chevron supports are Mother’s Groups, similar to centering groups in the US for pregnant mothers. Centering groups, I learned this past year, are similar to antenatal care checks, but instead of visiting the doctor’s office a couple of times and having 15 minutes to discuss any questions or issues, you meet with a group of women and learn from and support one another. In America I thought it sounded like a great idea, and something that would be really interesting to implement in Mali – since most women sit around and talk anyway! – but it was exciting to see it in action here. Despite not understanding Bahasa Indonesia, there were photos and workbooks that the women were all working with, and it seemed like it was working well. It’s a newly implemented activity here, so it’ll be interesting to see if/how they’re monitoring the activity and what progress the groups make. All that said, the first group of women we met were a Mother’s Group, some pregnant and some postpartum.
Mother's Group
Our research questions begin by asking some simple demographic questions to determine religion, ethnicity, education level and income level. We already assume we know certain things: women of a lower education level and lower income level are less likely to go to a facility and more likely to give birth at home. For every interview, I hoped that the women would prove this assumption wrong. In Mandi Angin, we interviewed 13 women, most of whom either planned to give birth at home or had already given birth at home. The interviews were becoming a little tedious, until we met this one woman:
My day one hero who associated facilities with increased safety
We don’t ask names during our interviews, but this women was the first of the surprises during the week. She’s in her mid-thirties and educated only though elementary school. She was one of the few postpartum women who had delivered at a facility – at the pustu – and when we asked her why she chose to deliver at the facility, as opposed to home, she responded that it was safer for her and her child. I was so pleased, I almost came to tears! After 10 interviews, I was beginning to doubt I would ever hear those words, and I was beginning to wonder if women thought or even knew it was safer to deliver at the facility.
An older postpartum mother
It was a really long first day of interviews, but it ended with sitting on a straw mat, eating rice and fish with my hands, surrounded by a group of midwives and community health workers. It felt good to be in the field.
The midwives and village health workers who were very accommodating
