Courage, Leadership and Resilience: The story of an antenatal clinic in Myanmar

The healthcare system in Myanmar is on its knees. UNICEF has reported that about 600,000 newborns are not receiving essential care, a million children are missing out on routine immunisations, and more than 40,000 children are no longer getting treated for malnutrition. Pregnant women and other vulnerable groups face new obstacles in reaching essential care and basic services. Necessary acute, chronic, and preventive care for their communities is an immense challenge for healthcare providers.

Healthcare professionals continue to show immense courage, leadership, and resilience in providing medical care for their communities in defiance of the military crackdown in Myanmar and the need for healthcare workers to adapt and innovate has never been more crucial.

Doctor Alex

Dr Alex*, a GP in Myanmar, recognised that access to hospitals and clinics in their locality, especially for the poor and for those seeking antenatal care, was becoming extremely difficult. The clinics and hospitals that were accessible were either run by the military or were private and beyond the reach of the poor. Dr Alex witnessed a series of events relating to maternal and neonatal morbidity and mortality that mirrored the UNICEF report, and the idea for an Antenatal Clinic for the poor was born.

The Clinic

The clinic was set up in September 2021. Funding from a number of sources including the wider Myanmar diaspora in the UK, a charity bike ride of 21,600 miles involving 50 cyclists, and other charitable donations predicts that the clinic will currently survive another 12 months.

The main objective of the clinic is to reduce maternal and foetal mortality by early intervention while the government hospitals are not fully functioning. More than 100 pregnant mothers have been registered and have delivered their babies under the specialist care of obstetricians in the clinic.

The clinic runs in accordance with WHO guidelines. Every mother, registered in the first trimester,

receives a total 8 outpatient visits before delivery, and basic investigations and imaging are provided throughout.

Medical conditions during pregnancy are also treated, for example, gestational diabetes, asthma, hyperthyroidism and anaemia. In the antenatal clinic, complications are also successfully prevented, including mother to child transmission. Recently one new mother, who was retro positive, has been detected and treated.

Continuous monitoring of pregnant mothers, for example those at risk with polyhydramnios, foetal distress, twin pregnancy, and pregnancy induced hypertension, has resulted in successful deliveries without complications.

Health Education and Training

Pregnancy can cause financial stress and hardship for families. Dr Alex recognised that exacerbating factors included the lack of family planning and failure to attend postnatal appointments. Family planning is now encouraged, regular new-born check-ups by paediatricians are provided by the clinic, and early detection and referral of neonatal jaundice are facilitated. The clinic is also a training centre for medical students and nurses.

The Team

The clinic has progressed to 4 GPs, 1 Obstetrician and Gynaecologist (2 days a week and available on call), a paediatrician and surgeon available on call, and a radiologist who visits the clinic weekly. Additionally, there are 5 medical students, a retired nurse, and 2 volunteer cleaners.

Stories from the clinic

• A mother with Type 2 Diabetes and a previous history of caesarean section was closely monitored. Her diabetes was well controlled and her baby was born at 38 weeks gestation by Caesarean section without complications.
• A mother with a history of asthma was registered early at the clinic and was under the joint care of an obstetrician and a physician. A healthy baby was born at 39 weeks gestation by elective caesarean section.
• Mothers with pregnancy induced hypertension are closely monitored to prevent pre-eclampsia.
• A retro positive mother (HIV) has been referred for specialist care to prevent mother to child transmission.

Feedback about the clinic

The patients self-refer through peer recommendation. They find the medical team kind and supportive and they appreciate the financial support. They like the ‘one stop’ service, the regular follow up provided and they recognise the benefit of health education. The Antenatal Clinic has become a clinic that more and more pregnant mothers rely on.

The Obstetrician has said it is gratifying to do something for their community, while Dr Alex has said as a GP and responsible person for the clinic, they have realised the importance of leadership, the power of the team, and the improved outcomes through multi-disciplinary care.

The medical students have said the clinic is more practical than theory-based and is ‘beyond the textbook’. They now understand the importance of risk assessment during antenatal care and the importance of family planning. They also have learnt about sympathy, empathy and responsibility.

*Names have been changed to ensure anonymity.

Image source: STR/AFP