Field Team Stories

Confronting tradition to save newborns: a community health worker in Bangladesh tells her story

by Rahman Mahmood

Shafia’s delivery pain started during her 37th week of pregnancy—her first. In Shafia’s remote Pashchim Dorpanagar village, in northeast Bangladesh, that meant she was due a visit by Ayesha, a young Community Health Worker with the study group Projahnmo. Ayesha was newly trained to conduct deliveries and resuscitate critically ill newborns if needed.

She soon realized she was in competition. Shafia’s mother-in-law called the Dai, a traditional birth attendant. Age-long traditional, cultural and religious beliefs made her suspect, and the Dai wouldn’t let her into the home.

After Shafia pushed the baby out, she fainted and the baby fell onto the floor. The Dai started pulling the umbilical chord to deliver the placenta. Suddenly Ayesha, watching the event minutely, observed that the baby had not moved or cried. Seconds seemed like days to Ayesha, who knew how swiftly babies should be resuscitated. She yelled at the Dai to let her in. But the Dai told the father to fill a Kalsi—traditional pitcher—with water and bring a bamboo pipe.

Could a water pitcher and bamboo pipe resuscitate the baby?   

The locals believed that the placenta of a baby not breathing or moving should be soaked in water without cutting the umbilical cord: the baby will inhale air and start breathing. Locals also try blowing air through a bamboo pipe—used to light clay stoves for cooking—into a newborn’s ear.

Ayesha begged the baby’s father to let her help save the baby before the Dai started her ritualistic maneuvers, which she knew would result in a fatality. Father’s heart melted: he knew Ayesha was also one of their community. All Projahnmo outreach workers are chosen from the same community where they will serve. This helps community members accept their suggestions for healthy behavior changes.  

The young bachelorette jumps into action

Ayesha was ready with her Clean Delivery Kit, which consists of a sterile chord clamp, towels, and a blade. The father told Dai to step aside and let Ayesha in. The Dai was furious and started explaining how the bamboo pipe and soaking placenta would help the baby breathe. But the father stood up for Ayesha and politely agreed upon that Ayesha would not cut the umbilical cord—and that if she failed, the Dai could finish her rite.

The Dai protested to the father that Ayesha was young, unmarried and inexperienced—she had no kids! But Ayesha was already in action! She wiped the baby’s nostrils and the mouth, gave mouth-to-mouth breathing, rubbed its back and properly positioned the baby. After desperately repeating these maneuvers for about 20 minutes, the baby coughed violently and started crying. Ayesha’s joy knew no bounds.

At last Ayesha cut the cord, wrapped the baby boy with fresh towels and brought him to his mother for the nourishing first milk, colostrum.

Leading baby to colostrum

But the Dai argued to not feed the baby with colostrum, what many there call the “Dirty and Pus-like” portion of breast milk. Exhausted, but still motivated, Ayesha started describing the importance of colostrum as she was taught during training. The baby was brought to Shafia. But Shafia was still unconscious!

As Ayesha laid the baby in contact with Shafia for breastfeeding and establishment of skin-to-skin warming (kangaroo mother care), the father and Dai sprinkled water on her. The mother recalls,

“I felt a bright light after opening my eyes and in my arms, there was my baby boy. I was so happy.”

Shafia’s husband offered 500 Taka (US$6.50) to Ayesha as a token of gratitude. She turned around and gave it to Shafia as a birthday present from the baby’s “Aunt” Ayesha.

Why is auntie crying?

Today, Nabil is twelve years old and one of four—Akhi, Shathi and Tanjil–all born under Ayesha’s care. Whenever Ayesha visits Shafia’s home, Nabil tells her about his friends, school and playground. While listening, Ayesha sometimes remembers the day that Nabil almost died. Nabil wonders why “Aunt” Ayesha has tears of joy.

The Big Picture

Today, almost all eligible women in the study site villages enroll in Projahnmo and rely on Ayesha and her team. Ayesha now supervises four Community Health Workers—all well respected and reliable women known in their communities. And the larger Projahnmo study group continues to design and evaluate culturally appropriate maternal and newborn health interventions that can be implemented in the community.

The group has found that low-cost home-care strategies like those used by Ayesha are effective in saving the lives of babies like Nabil—and if scaled up, could save the lives of more than a million each year.