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Reflections on PRONTO Training in Bihar

DSC_0101Over the past 10 days, I’ve heard some heartbreaking stories from doctors and midwives in Bihar that provide a glimpse into just how dire the situation is here. One of the midwives told us about a time when she had just delivered a baby who required resuscitation for birth asphyxia. After a successful resuscitation, the baby was taken over to the mother and mother in law, who immediately asked the gender of the baby. When the midwife informed them it was a girl, the mother tried to throw the baby onto the floor. Her emotional recounting of this story almost brought me to tears. We saw a personal video one of the doctors took at a rural clinic in which someone is literally pouring ether into a face mask with no intraoperative monitoring whatsoever. In another personal video, we saw a neonatal resuscitation by a midwife… It consisted of hanging a baby upside down and jackknifing him until he started to cry. Most disturbing of all, we learned that it is not uncommon for patients’ families to attack, and sometimes even kill, health providers when a patient dies. One of the doctors told me, “The state of health in Bihar is a daily manmade disaster.” It’s hard to believe, but sadly it’s true.

Yesterday, I made the journey to Bodh Gaya, the site of Buddha’s enlightenment. The abundance of beautiful temples and serene monasteries brought to mind a Dalai Lama quote… “There is no need for temples; no need for complicated philosophy. Our own brain, our own heart is our temple; the philosophy is kindness.” This certainly resonated in Bodh Gaya as I reflected on the experience of training 55 midwife mentors on obstetric and neonatal emergencies. These thoughtful and dedicated women will now go out into the field and use simulation to train midwives and other health providers in district hospitals and clinics across Bihar. I also had the opportunity to reconnect with the midwives we trained last May. They relayed many stories of how the knowledge acquired through PRONTO training has allowed them to practice and teach clinical skills in emergency situations, overcome traditional Indian hierarchy to improve patient care, and ensure availability of essential supplies in facilities in Bihar over the past 8 months. Hearing these stories and witnessing the tremendous growth in leadership and clinical skills among these midwives is inspirational. Further, it leaves no doubt in my mind that this program will have a lasting positive impact on the people of Bihar. I feel so fortunate to work with a phenomenal group of young Indian women, who have left their homes to come to Bihar to help improve the lives of mothers and newborns. Moreover, I feel privileged to work with amazing colleagues who have put in countless hours of work over the past year. It is very exciting to see our work coming together and to finally embark on this incredible project. To borrow the words of my Bihari friends, this is an experiencewaa I’ll never forget… Dhanyavaad!

Melissa Morgan, MD MSc
Division of Neonatology
University of California, San Francisco

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