NEWS Feature | Essential Intrapartum and Newborn Care in San Juan, Batangas

by Romelyn April P. Imperio, Straight Intern in Family and Community Medicine, UP-PGH 

Dr. Beverly Lorraine C. Ho, Project Staff, Team EINC

Through the auspices of the UP CDHP-San Juan Partnership and assistance of UP College of Medicine together with San Juan’s Municipal Health Office, EINC Training was held in San Juan, Batangas on February 18, 2011. The EINC Training was organized to broker the necessary path and support for the municipality’s rural health units, its staff and midwives to improve maternal and newborn health in the area.

Dr. Nestor Alidio, Municipal Health Officer of San Juan and Nurse Len Comia set up the logistics of the training invited all midwives working in the barangays. Meanwhile, DFCM Straight Intern Romelyn Imperio then communicated the training request to University of the Philippines College of Medicine alumni Dr. Beverly Lorraine Ho and project staff of Team EINC.

Maternal Health Care in San Juan

The municipality of San Juan has numerous lying-in clinics. Each lying-in clinic is equipped with a delivery bed and necessary equipment and supplies. These clinics provide antepartum, intrapartum and postpartum care as well as family planning services. The intrapartum care services in particular are handled by resident physicians and midwives. Furthermore, an Obstetrician and Gynecologist, Dr. Aileen Calalo-Lim supervises the lying-in clinic operations. The community holds the staff of the lying-in clinic in esteem and high regard as they entrust the lives of their wives, children, mothers and sisters, with the belief that their judgment and skills will bring the miracle of life to fruition.

Dr. Calalo-Lim had her residency training at Dr. Jose Fabella Memorial Hospital. She believes in the importance of continuous medical education in order to render the best possible care to patients. Because she maintains close ties with her training institution, she became familiar with the Essential Newborn Care “Unang Yakap” Protocol. While on a discussion with the rotating interns, Dr. Calalo-Lim expressed that perhaps it is about time that the lying-in clinic midwives of San Juan undergo training on the new protocol.

EINC Training in San Juan

Dr. Maria Asuncion Silvestre, an esteemed neonatologist, consultant of the U.P.-Philippine General Hospital and Convener of Team EINC, led the team of neonatologists, obstetricians, pediatricians and general practitioners to conduct the training module to a group of 40 midwives, nurses and doctors of San Juan’s RHU and District Hospital.

The Team left Manila at dawn and arrived in San Juan at around 9 in the morning. Mayor Manalo and Dr. Alidio warmly welcomed the team and expressed their commitment to provide the people of San Juan with simple, effective, low-cost and evidenced-based medical care – precisely what EINC is all about. Likewise, he articulated the municipality’s desire to share in achieving to meet the Millennium Development Goals (MDG) for 2015, particularly in curbing maternal and child mortality.

The training began with a team/project introduction facilitated by Dr. Ho.  Then, project staff of Team EINC visiting from Cotabato and General Santos City presented a skit mirroring the usual scenario of a mother undergoing labor and delivery in the Philippines. This was followed by a Metacards session on prevalent intrapartum and immediate post-partum practices. Participants were asked to classify whether particular practices were done “Always,” “Sometimes” or “Never.” They were reminded to check out the list while the evidence lectures were being presented to see whether their current practices were in line with the evidence-based protocol.  Dr. Cynthia Fernandez-Tan, an obstetrician from Dr. Jose Fabella Memorial Hospital and seasoned trainer of midwives and obstetricians through her work in the Philippine Obstetrical and Gynecological Society (POGS), gave a comprehensive lecture on intrapartum practices. She dispelled myths and misconceptions, and assured participants that going back to the basics of delivery is indeed the safer and more mother-friendly alternative. This heavyweight lecture was followed by Neonatologist Dr.  Pinky Imperial’s eye-opening lecture on neonatal care in the first hours of life. The lecture, which featured overwhelming evidence that invalidate “popular” and widespread practices such as routine suctioning, immediate cord clamping, routine separation of newborn, alcohol-based cord care and even footprinting, was met with “oohs” and “ahhs.” Before lunch was served, everyone agreed on one thing – current practices were not so safe nor mother-baby friendly after all!

Mothers’ Breastfeeding Class

Meanwhile, Dr. Silvestre, together with Dr. Trinia Asuncion and Dr. Renee Tana were in another room, teaching about 25 mothers and a few barangay health workers (BHWs) the benefits of and principles behind successful breastfeeding. Breast models were utilized to educate mothers about the anatomy of the breast, and dolls were used for mothers to demonstrate the proper positioning. Mothers also sang to an educational karaoke session of breastfeeding-friendly songs “borrowed” from LATCH, a partner breasfeeding support group.

After lunch, Dr. Silvestre shared the experiences of EINC’s pilot hospital, the Quirino Memorial Medical Center (QMMC). She highlighted how willpower truly changes things for the better as proven by the improved maternal practices, decreased NICU admissions and reduced sepsis rates in QMMC. She then continued with the EINC Step-by-Step lecture, outlining the necessary steps to implementing the EINC practices. The participants were then split into 8 groups of 4-5 participants each. Provided with dolls and instruments and with the guidance of a facilitator, they took turns in playing the role of the health care professional and the patient.  Then, one member was asked to keep track of the time and evaluate the performance of his/her group mate.

Amidst initial qualms and uncertainties, optimism and determination was clearly felt among the participants. After the session, Mayor Manalo and Councilor Maalihan expressed their gratitude by awarding Certificates of Appreciation to the lecturers and facilitators. Furthermore, they reaffirmed their commitment to making Unang Yakap EINC a standard program of the municipality.

Post-Training Experiences

One week later, Dr. Calalo-Lim ran into Dr. Cynthia Tan in Manila. The question of whether the EINC training was being applied was answered with smiles. The midwives shared their positive Unang Yakap experiences.  The lying-in staff consciously followed the protocol, and the midwives were very pleased with their Unang Yakap experiences. Although they have acknowledged that there are hiccups along the way, these were not enough to make them feel discouraged. They believe that in time, EINC practices would be almost second nature. What is more encouraging is that no resistance was met from the mothers. A feedback session was conducted last April 8, 2011 by the straight interns as part of their final exit report.


Reflection

The EINC training methodology is impressive in its ability to change health worker behavior in the course of one day. At the same time, EINC is actually an activity by the people and for the people. Thus, there is much work to fully incorporate the EINC protocol into the healthcare practices in San Juan, Batangas. Perhaps the EINC should be formalized and incorporated as well into the training practice of those in Community Medicine. Moreover, closer and stricter monitoring and evaluation of and by the stakeholders is definitely in order to ensure its sustained execution and become the new norm.