I am the newly arrived Midwife Program Manager for Phase III of the Plenty/Ministry of Health TBA Project. I am actually not new to Belize, however, as I set-up and directed a USAID-funded Child Survival Project with Project HOPE in Belize in 1986-1988. During that time, I married a Belizean and thus I have continued to frequently visit Belize.

I began a relationship with Plenty’s TBA Project in January 2002 when I visited Toledo and met with Christina Kahlou, the previous Plenty Midwife Trainer. Christina’s contract was completed with the graduation of the second TBA group at the end of February, 2002. Since then, there have been periodic TBA continuing education classes carried out by local health personnel. I volunteered to assist Plenty in June and conducted, with Belize Ministry of Health Nurse Hazel Cayetano, the continuing education sessions for that month. I also made additional village visits and met with other MOH staff. Nurse Cayetano subsequently joined me in June in attending a week-long conference in Mexico on the Role of the Professional Midwife in Central America.

In October I accepted a six month consultancy with Plenty to assist with the support and follow-up of the 22 trained village midwives. I began intensive village-level evaluation of the TBAs to assess general acceptance by their communities, as well as their knowledge and skills, motivation, and any problems they may be having. I found that at this point there is considerable variation in acceptance by different villages and in practice levels on the part of the TBAs. One TBA has delivered 14 babies while a few have had no cases. The majority have done a few births each and have been involved in difficult cases that needed referral to the hospital. Most significant is the fact that several TBAs have been called when there has been an emergency and they have successfully managed undiagnosed breech deliveries, retained placenta, and asphyxia in the newborn.

I was impressed with the urgent need for home based birth attendants to gain additional skills to manage difficulties in the early newborn period. Of the recent village births that were reported to me by the TBAs three had resulted in newborn deaths. There are also continued problems with infants who are not being closely followed in the early postnatal period. Last month, we saw a one-week old premature baby delivered at home by a 17 year old mother (the TBA was not called) who was being formula fed rather than breast-fed and was doing very poorly. I visited a 3 week postpartum mother with the TBA. The mother had been appropriately referred to PG hospital, but in the following 3 weeks at home, the baby had lost weight and was being breast-fed only 4 times in 24 hours. The TBA assisted with breast-feeding counseling and agreed to follow that baby closely. There is currently no government nurse or health worker in this village.

These are just a few examples of newborn babies, on the road to trouble, who with the help of the newly trained TBAs may now do all right. The Toledo District remains a critically under-served area for many mothers and young babies. Villages are remote and transport is difficult to arrange. This is one district where home-based life saving skills can save lives. Breast-feeding practices still need a great deal of improvement as well. I anticipate the next 6 months to be very busy and I look forward to working with these very new and very dedicated and very needed Traditional Birth Attendants!