Portrait Midwife and Kader

In an attempt to improve access and quality of care in the remote villages of Asmat district, southern Papua, MSF worked closely with the Ministry of Health to strengthen a network of Kaders and train nurses and midwives based in the villages. Kaders are local health workers selected from among villagers. They support the health centres' outreach activities of routine vaccination and midwifery services. They have no formal health qualifications but serve as a focal point for patients seeking healthcare. Trained by MSF to recognise serious conditions, they will direct patients either towards a nurse or midwife or take the first step to refer those who need it to the health centre in Agats. Kaders know the local culture well and are key people in health promotion and alerting health authorities of outbreaks of disease.
 
Nicolas Bindiwu - Kader, Yepen village

I have been working as a Kader for 22 years, when the first doctor from the Ministry of Health came to Agats and began recruiting us. I decided to join because I'm from this village and I wanted to help my community. In the past, we had many problems. There were no nurses and no doctors but things have now improved. MSF has trained us. MSF's mobile clinics and the puskemas staff come and visit the village regularly. Training has been very useful. We learnt about the treatment of malaria and the use of bednets. We have many cases of malaria here.

We also used to have many problems with difficult deliveries, when the arm of the child comes first for example. But now we can identify serious health issues and help them reach the midwife as soon as possible or began organising a transfer to Agats if necessary.

We help the population understand western medicine, make sure they come for vaccination campaigns or treatment. There can be cultural issues for our people. They are not very familiar with western medicine.  Traditional medicine often remains the first choice and if it doesn't work, people will then turn to the midwife. They use razor blades to cut the skin where it hurts, for example on the forehead; in the past we used sharpened shells or bamboo. They also burn themselves with a special wood. You can see that many people here bear scars and still use traditional medicine.

Augustina Anastasia Kamao – midwife, Yepen village

I have been a midwife for nearly 12 years. I come from another district called Mapi where I trained as a midwife at medical school.  I moved here to help the villagers. They live in the village and have little access to healthcare. When I first came here, women use to deliver their children on their own; now we have a midwife house or polindes, where they can come to give birth.  If there is a problem like retention of the placenta or post-partum haemorrhage, I refer the case to the Agats health centre.

There are on average one or two births per month. People here are not used to seeking healthcare so they tend to wait too long before they come, and sometimes it's too late. For cultural reasons, women are not allowed to deliver in their own home. The blood they spill is believed to be a source of disease for other members of the family. So villagers sometimes built a separate house for the delivery. We had to push them to come to the midwife house but now most of them come. Since MSF came and trained us, morbidity and mortality in women and children fell and we have more medical knowledge. The villagers know this and they are now coming for ante- and post-natal care, but of course it takes time and some health promotion for them to be fully convinced of the benefit.