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Even before becoming a Certified Midwife, Zarway was an advocate for justice, peace, and healing in her community. Trained in counseling as part of a women’s program to promote peace and justice in post-civil war Liberia, Zarway developed her listening and communication skills in a context that ignited in her a passion for healing and being of service to others.
Last Mile Health CHW uses the timer application on her mobile data collection device to count a patient’s respiration rate as part of a sick child screening. Photo: Last Mile Health
Zarway completed her midwifery training more than 15 years ago in Grand Gedeh County, Liberia, and has since served in a number of midwifery positions across two of Liberia’s most isolated counties.
In June 2016, just as Last Mile Health was beginning to scale CHW programming to Rivercess County, the Ministry of Health’s Rivercess County Health Team hired Zarway to serve as the Maternal and Child Health Supervisor at the Neezuin Clinic, a small primary care facility in a remote region of the county. In this role, she delivers babies and administers antenatal and postnatal care services to new and expectant mothers. She also conducts six outreach visits per week to the remote communities in the clinic’s catchment area to deliver antenatal and postnatal care, family planning services, and childhood vaccinations. Having completed additional training through the Ministry of Health, Zarway is also responsible for facilitating and monitoring treatment adherence amongst patients with TB and HIV/AIDS. When she travels out to the villages by motorbike for her weekly outreach visits, Zarway carries a vaccine cooler containing essential medicines and a backpack with tools and supplies, including a stock of prenatal vitamins donated by Direct Relief that she distributes to new and expectant mothers.
In a highly remote context where many women live hours from the nearest health facility, it is of particular importance that pregnant women receive antenatal care – including supplementation with prenatal vitamins and early identification of potential complications – to ensure that they have healthy pregnancies. As a result of the challenges that women living in remote communities face to accessing care — especially in emergencies — maternal, neonatal, and child health are critical. In these areas, Last Mile Health’s CHW program and the Ministry of Health’s outreach activities complement one another to bridge the gap between remote communities and the public health system. This collaboration results in lifesaving impact across the continuum of care.
When Zarway identifies that a patient is at risk of complications or nearing the time for delivery, she advises and supports the patient to travel to Neezuin and find temporary accommodation near the clinic, so they have access to a safe, facility-based delivery. When it comes time for delivery, essential supplies like sterile instruments, sutures, and necessary medications provided through Direct Relief Midwife Kits ensure that Zarway has the tools she needs to conduct safe delivery.
Once they complete their training on maternal and neonatal health services later this year, Last Mile Health’s CHWs in Rivercess County will begin counseling the women in their communities to further encourage uptake of the antenatal care and facility-based delivery services that Zarway and her fellow midwives provide. CHWs will also be trained to recognize danger signs in mothers and neonates, and will be empowered to facilitate timely referral to the nearest clinic where necessary.
In the meantime, Last Mile Health’s CHWs in the Neezuin Clinic catchment area are already building on the work that Zarway is doing by providing integrated community case management (iCCM) of childhood illnesses including malaria, diarrhea, pneumonia, and acute respiratory infection in children under five. Where Zarway’s outreach and facility-based work are ensuring that women living in and around Neezuin have access to the care they need to safely give birth to healthy babies, Last Mile Health is ensuring that the babies Zarway delivers do not suffer from preventable and treatable illnesses on account of living far from facility-based care.
Not long ago, many believed that providing high-quality health services to Liberia’s remote communities was simply too difficult. Together, with the Liberia Ministry of Health and partners like Direct Relief, Last Mile Health is already achieving impact as it works towards its vision of a health worker for everyone, everywhere, every day.
This article was contributed by Last Mile Health’s Rachel Larson.
About Last Mile Health
Last Mile Health recruits, trains, equips, manages, and pays Community Health Workers (CHWs) who provide lifesaving health services to their fellow villagers in Liberia’s extremely remote “last mile” villages. CHWs serve as a critical link between isolated communities and the public-sector health system. In addition to providing basic maternal, neonatal, child, and adult health services, CHWs ensure that patients requiring advanced care are referred to the nearest clinic or hospital and that all expectant mothers have access to safe, facility-based delivery.
To advance its mission of saving lives in the world’s most remote villages, Last Mile Health has partnered with Direct Relief and the Liberia Ministry of Health to provide Midwife Kits and prenatal vitamins to public clinics and hospitals in remote regions of Liberia to ensure that all expectant mothers have a healthy pregnancy and safe delivery. The following profile of a Certified Midwife named Zarway illustrates the value and importance of investing in maternal health interventions to serve women and their babies in last mile communities.
To learn more about this incredible organization, visit lastmilehealth.org.
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