Last month, a 30-year-old pregnant woman went into sudden labour and was rushed to a sub-centre in Pune district’s Amrapur village.
Sunita Gadekar was the auxiliary nurse midwife (ANM) on duty and she facilitated the delivery. However, the baby girl was unresponsive. Ms. Gadekar sprung into action and rubbed the baby’s back. When the baby still didn’t move, Ms. Gadekar placed her on an artificial manual breathing unit and began pumping oxygen into her body. A few seconds later, the newborn let out a loud cry.
In her 24-year-long career as an ANM in Maharashtra, Ms. Gadekar never had the confidence of handling such emergencies. However, a skill-building training she underwent last year changed her approach. Ms. Gadekar was one of the 400-odd ANMs from rural blocks in Pune who received hands-on training in dealing with emergencies.
They also attended conferences and workshops, and visited other health centres to understand different work models.
Ms. Gadekar said, “Our first reaction during emergencies was to call the medical officer or transfer the patient to a higher centre. Now, I have the confidence to handle certain emergencies. I can now stabilise the patient before seeking further referral.”
Mangala Chincholkar, an ANM from a sub-centre at Khireshwar, said, “The training using mannequins helped us tremendously. The fear to handle emergencies has gone down drastically.” Soon after attending the training workshop, Ms. Chincholkar was able to resuscitate two newborns and handle a placenta retention case. She said, “I was taught how to manually remove the placenta on a mannequin. I was able to use that skill when I got this case.”
ANMs are village-level female health workers and handle childbirth and its related complications in Primary Health Centres and sub-centres. Dr. Shilpa Karvande, research officer with the Foundation for Research in Community Health (FRCH), said, “The training helped them refresh their skills and apply them in serious cases. They are now confidently putting their new skills into practise.” The training was organised by FRCH in collaboration with the Liverpool School of Tropical Medicine and the Maharashtra government. The initiative was funded by HDFC Limited.
Dr. Karvande, who presented the post-training observations on Saturday, said, “There was more than 80% retention of knowledge, which is a positive outcome. More than 50% improvement was seen in life-saving skills like newborn resuscitation and eclampsia [onset of seizures in a pregnant woman].”
Keshav Desiraju, former secretary, Ministry of Health and Family Welfare, said at the event that ANMs are the first cadre of community health workers and their role has to be better defined as they grapple with more roles than just midwifery.
Dr. Nerges Mistry, director of FRCH, said that it was important for the government to be truly involved in such innovations. She said, “The system should move beyond a one-time curriculum and keep innovating for continuous training.” Dr. Mistry said that one short training is not enough and a consolidated effort is needed to move ahead.
