Ende’s stunning coastline, lush forests and fertile hillsides belie its struggles with poverty and maternal and neonatal mortality.
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At the Ende District Hospital, midwives like Aliosia Ernesta treat more than 130 women a month, who travel by foot, motorbike and ambulance - if they’re lucky – in the hopes of finding someone who can handle a complicated delivery.
The scene is not new to Aliosia. As a child in Wolojita, a village 90 kilometers away from the city of Ende, Aliosia remembers women being carried on bamboo stretchers to the village midwife’s house to give birth in the most basic of conditions.
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Aloisa Ernesta counseling a patient at Ende District Hospital
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To her, that midwife in her uniform was someone with the strength to give a child safe passage into the world.
More than thirty years later, Aliosia is Head Midwife at the Hospital, doing the same for others. And with the training provided by the AusAID-funded Australia-Indonesia Partnership for Maternal and Neonatal Health (AIPMNH), she is equipped to handle complicated deliveries, which just a year ago she considered well beyond her capacity.
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Over the last year, Aliosia has been trained in normal delivery care, comprehensive emergency obstetric neonatal care and emergency first aid , courses that teach midwives and nurses how to handle obstetric complications, care for low birth weight babies, post-abortion care, family planning and infection control.
“The trainings have really helped me – and all of us here - to be more efficient when handling emergencies” Aliosia said.
“I learned how to prepare oxytocin to stop excessive bleeding during delivery,” she explained. “And I’m more confident to handle cases like
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Mothers at the Ende District Hospital using the kangaroo care method. During kangaroo care, low birth weight babies have direct skin-to-skin contact with another person at all times. This contact regulates the neonate’s temperature and establishes an emotional bond crucial to a baby’s development.
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asphyxia and eclampsia on my own and to know when to immediately refer the patient to the doctor.”
With hemorrhaging and asphyxia as two of the leading causes of maternal and neonatal death in the province of Nusa Tenggara Timur (NTT), it’s skills like these that Aliosia and her colleagues are using to save lives.
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Aliosia is one of hundreds of health workers trained with the support of AIPMNH in more than 14 districts throughout NTT. She and her colleagues have also received on the job training through AIPMNH’s Sister Hospital Program - a partnership where a team of health workers from nationally renowned hospitals are contracted to provide on-the-job training to staff in six district hospitals throughout NTT so that they can eventually provide 24-hour emergency maternal and child health services.
Skills and facilities aren’t everything though.
Aliosia, herself a mother of two, described some of the cultural constraints that women in this area face.
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Midwives and nurses from the Perinatal Unit at the Ende District Hospital. The Hospital is one of six participating in AIPMNH’s Sister Hospital program, where doctors from national hospitals spend six months providing on-the-job training to health workers at poorly-resourced hospitals in districts of East Nusa Tenggara province (NTT).
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“Women here often lack decision-making power,” she explained. “They have to wait for their husbands or in-laws to permit them to go to a health centre or hospital to give birth.”
“By the time that happens, it may be too late,” she said.
Nutrition and awareness of the danger signs during pregnancy are also big issues, as evidenced by the number of premature and low birth weight babies in the perinatal care unit at the hospital.
That’s why Aliosia and her colleagues also educate mothers, who may come from remote areas, about tracking their own health during pregnancy so that maybe next time around they can give birth at a health center closer to home and with fewer complications.
“Women here still face some of the same issues that I saw growing up,” Aliosia said.
“But we know better now how to help women have a safer delivery and a healthier baby.”
Sarah Gray, Communications and Public Diplomacy Specialist, AIPMNH
Read more about the AIPMNH program
