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Archive for the ‘India’ Category

By Andy Beckingham FFPH, Fernandez Hospital, Hyderabad

Giggling Girls!

The scope of our profession gives opportunities to branch out. These may not always look at first glance like ‘public health’.

In 2010, working in India on maternal mortality, someone asked over dinner if I thought UK-style midwifery might be useful in India where doctors provided all the care. “Perhaps if you try the bits that work for women,” I said. “And avoid the bits that the NHS got so wrong.” My dinner companion turned out to be the MD of India’s most famous maternity hospital, and I found myself designing her midwifery pilot programme.

The midwife who had run the UK’s most woman-friendly midwifery service (the Albany Practice, which achieved great outcomes for disadvantaged women) was inveigled into joining us as a mentor. Eight anxious trainees found themselves becoming India’s first evidence-based woman-centred midwives (pictured). They began to develop their own profession, promoting choice about labour and supporting and empowering women to have more natural births. They had to challenge established obstetric practice. Our hospital’s maternity care began to change. Babies had been routinely separated from the mother at birth, although this impedes attachment and breastfeeding. The midwives worked with paediatricians to change that. Now most mothers have immediate contact and breastfeed their babies in the first hour.

Now leaders in their own right, those first eight have since mentored other trainees to become strong professional midwives, supporting thousands of Indian women to have better births.

Like most countries, India has unnecessarily high rates of intervention in childbirth. A local public hospital’s c-section rate is 52%. A local private hospital’s is 90%. But thanks to the midwives, ours has come right down. Instead of epidurals being routine, midwives ask women what pain relief they want. They offer choice. Women get continuity of care. The outcomes are better. Satisfaction rates are high.

In 2017, the state government invited us to train midwives to work in their hospitals too. They want c-section rates to come down. But they also want compassionate, respectful maternity care for the large numbers of women who are mostly ‘below poverty line’. So maybe, just maybe, this could become a model for wider public maternal-health improvement in lower-income countries. I have to assess its impact.

Designing a midwifery programme and curriculum doesn’t at first look like a public health role. But it is starting to address unmet needs, inequalities and disadvantage, improve care quality and effectiveness, show that Indian women and their choices matter. Of course, it will need to be part of wider action on social and economic determinants of maternal health.

And now, this alternative to the medical model is available, and the state government is actively promoting compassionate, effective midwifery care and supporting us to roll out professional midwifery more widely, among very disadvantaged women.

Public health, in disguise.

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Health protection is a global issue – and there are lessons to learn and share from all incidents, wherever they occur. That was the message from the global health protection workshop at FPH’s annual conference in Cardiff on 19 July.

Delegates heard how the Health Protection Agency (HPA) has built a worldwide reputation for its work, in part because the global nature of health protection means that planning needs to go beyond national borders. The World Health Organisation has 10 collaborating centres in the UK, while the HPA has sent teams on international secondments to South Africa, India and Australia. One of the speakers talked about how the HPA had been involved in giving high-level advice to government agencies after the earthquake and nuclear power failure in Fukushima.

Closer to home, the delegates heard from Dr Sarah Finlay about how she and her colleagues from the charity Festival Medical Services dealt with an outbreak of H1N1 at the Glastonbury festival in 2009. The festival had a population of 135,000 ticket holders, and 35,000 artists and staff, many of whom were the kind of healthy, young people most likely to contract the virus. The infrastructure of the event meant that living conditions were poor. People’s behaviour, as would be expected at a music festival, was not typical. The combined circumstances meant that it was easy for communicable diseases to transfer.

Risk was mitigated by following the protocols for managing H1N1, having immediate access to antiviral stocks and good transport to the onsite medical facilities, despite the mud. Good advice was given to festival goers before, during and after the festival, stressing the ‘Catch It. Kill It. Bin It.’ message and the importance of using the hand gels that were available across the site.

Information was circulated via the Glastonbury festival website, music press and general media. Just as the HPA team working on Fukushima had regular updates throughout each day to share information, so the Glastonbury health team relied on situation updates three times each day.

There were six cases of swine ‘flu at Glastonbury in 2009, all of which were confirmed by laboratory test results and each of whom left the site for further treatment. One of these cases was a 16-year old girl who had been sharing a tepee with 12 other people, each of whom had to be tracked down in the chaos of festival life.

In the circumstances, the team felt the outbreak had been well managed, and the lessons learnt from this example of mass gathering medicine were shared with the organisers of the Berlin World Athletics and the Hadj.

Dr Finlay summed up by saying that the success of the festival’s approach to H1N1 was due to having a well thought-through approach, early detection, awareness of the issue and by sharing the lessons learnt.

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