Hammocks, motorcycles and safe birth

CAMARINES SUR, Philippines—Evangeline Yumul, 26, who is six months pregnant, carefully lowers herself into a hammock tied to a bamboo pole and carried on the shoulders of her relatives and health workers of Barangay Old Caaluan in Tinambac town, Camarines Sur province.

On the first leg of the journey from the village to the municipal health center, 3 kilometers away, Yumul will be brought in a hammock from her house to a boat on the bank of the Tinambac River. The boat will take her across to the opposite bank where municipal health doctor Judy Reforma and public health nurse Heide Javier await her.

The woman is then assisted to ride on a motorcycle, one of the 86 privately owned and registered in the municipal government, which serve as ambulances during emergency.

In remote areas inaccessible to four-wheel vehicles, the motorcycle is deemed practical. It allows Yumul to continue her trip to the municipal health center with nurse Ann Lagarde.

Ordinance

Although she is expected to give birth to her fourth child in late December, Yumul has agreed to participate in a test and documentation of how poor people in some of Tinambac’s 44 poor villages transport pregnant women despite the challenges in transportation.

Mayor Ruel Velarde says a municipal law—the Safe Birthing Ordinance—prohibits giving birth at home with the help of hilot (traditional healers). The women should be brought to the health center and birthing clinic where midwives may ensure safe and clean conditions for normal delivery.

The ordinance seeks to reduce infant deaths, which were “quite high” in Tinambac in the past, Velarde said. The municipal health office listed at least 11 infant deaths in 2011, seven in 2012, and another seven in 2013.

“The danger (of deaths) among infants and mothers has been reduced to almost zero” since the law was implemented in August 2013, the mayor said.

Hammocks and motorcycles have been used by villagers to transport women about to give birth to the municipal health center and birthing clinic.

A motorcycle owner, Rene Lara, 31, gets paid P250 for each trip. He says he is extra cautious with every trip due to the poor road conditions.

Midwife Marife Emerenciana says the people walk 2-3 km to carry the expectant woman to a waiting motorcycle, which then drives through 5-10 km of rocky dirt roads that turn muddy during rainy days.

Birthing clinic

Emerenciana keeps watch over Sagrada Birthing Clinic and the barangay health center in Barangay Sagrada, 9 km from the town center. The facility caters to pregnant women and infants from Barangays San Vicente, Magsaysay (also known by its old name Campo Quarto), San Antonio, Caloco, La Medalla (also known as Milya Nueve), Agay-ayan, San Ramon and Pag-Asa.

In upland villages like Guguna and another, also named Sagrada, residents carry patients in hammocks and walk for 2 km to reach the birthing clinic.

“Other than the roads, we also have problems with communication because there are no phone signals in our upland barangays so they really have to take the patients to us,” Emerenciana says.

Health workers

The midwife says that since the ordinance was enforced, the local government has started training the same hilot to become legitimate health workers in their barangays. The law penalizes the hilot, mother and even the midwife, who allows unsupervised and illegal home births.

Any mother or couple found guilty of allowing the delivery of their children outside the birthing clinic or health center will have to pay P1,200 for the first delivery and an additional P700 for succeeding deliveries. The same fine is slapped on any person, including midwives or barangay health workers (BHWs) who have knowledge of the delivery.

In cases of deliveries outside the birthing clinic which result in the death of the mother, infant, or both, any party responsible will be held criminally liable.

Velarde says the hilot turned BHWs receive monthly allowances from the municipal government to compensate for income lost due to the ban on home births.

Under the ordinance, they are now referred to as “barangay birth attendants” who give support to expectant mothers in their villages under the supervision of any of the 12 midwives of Tinambac. They also aid in the vaccinations of mothers and infants.

The municipal health center has also started the training of more BHWs. They now number 127.

Reforma says these BHWs, three in each barangay, help assist the women in their prenatal and postnatal checkups, which are provided for free in the birthing clinic and municipal health center.

“The BHWs refer high-risk cases, such as breech birth in first-time moms, teenage births and pregnant women with hypertension and diabetes, to Bicol Medical Center in Naga City,” Emerenciana says.

Infant death reduced

Since Sagrada Birthing Clinic was established, infant deaths have decreased with only one case recorded this year, the municipal health center reports. Records also show fewer cases of mothers dying during deliveries, from two cases recorded in 2011, two in 2012 and one in 2013 to zero this year.

Zuellig Family Foundation’s two-year Community Health Partnership Program’s Cohort has provided funds for the birthing clinic. It also funded the construction of a maternal shelter or halfway house at the municipal hall compound, addressing the needs of women from villages near the town center.

The women stay for a few days in the halfway home, which is supervised by the municipal health center, prior to childbirth. Midwives attend to the deliveries of the women, but a doctor visits and checks on the women who have given birth.

Annie Marie Ortiz, the focal person for health services, says the maternal shelter has been utilized with 25 pregnant women from different barangays staying there. At the Sagrada facility, a total of 46 patients have been seen by the doctor-resident on duty, 38 of whom were assisted in the delivery of their babies while eight were referred to Bicol Medical Center.

Other towns included in the same program are Minalabac and San Fernando, also in Camarines Sur.

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