The difficulties of midwives in the highlands of Nghe An

Working for free

In the evening of mid-November, the family dinner had just been served when Ms. Xong Y Tru (39 years old), in Truong Son village, Nam Can commune (Ky Son), received a phone call asking for help. On the other end of the line was a Mong woman she had never met, living in Huoi Poc village, asking Ms. Tru to come and help deliver the baby of the family's young daughter-in-law. After listening to the phone call, Ms. Tru had to let her children eat first and go to do the unpaid work that she had been accustomed to doing for many years.

Huoi Poc is the most remote village in Nam Can commune. From Tru's house in the commune center, it takes nearly 2 hours to get there by motorbike. In the middle of a cold, rainy night, Tru had no choice but to beg her husband to go with her. They were not relatives, nor acquaintances, and she was not even paid a penny, but for many years, every time she received a call asking her to help with a baby, Tru was always enthusiastic. Regardless of whether it was the middle of the rainy night, regardless of whether the destination was a village deep in the ravine, with difficult and dangerous roads.

After helping the mother give birth successfully, it was past midnight, and after receiving handshakes of thanks from the family, Tru and her husband trudged back to their small house in the center of the commune on their old motorbike.

Many times I asked my husband to go with me in the middle of the night, but he complained. He kept saying that he was working for free, and that he didn’t have any money for gas, and the only thing he got was a thank you from their family. Sometimes I felt discouraged, but in this commune, everyone knew I was a midwife, and every time they called to ask for help, I couldn’t refuse. I kept thinking, if I didn’t go, they wouldn’t have anyone to help them, and if something happened, I would feel guilty.

Ms. Xong Y Tru - Truong Son village, Nam Can commune (Ky Son)

In 2013, after 9 months of studying in Vinh City, Tru started working as a midwife. In the first years, she received a monthly allowance of 200,000 VND, which was not enough to cover gas for each trip. However, since 2016, that small amount has been cut.

Cleaning the equipment of the village midwife who has been with her for the past ten years, Ms. Tru said that Mong and Khmu women in this border commune rarely go to the hospital to give birth due to economic difficulties and embarrassment. According to Ms. Tru's statistics, since the beginning of the year, nearly 100 women in the commune have given birth, but about half of them gave birth at home.

“Since the beginning of the year, I have been to the homes of 17 mothers to deliver. In addition, there are many mothers who came to the health station to give birth but the midwife did not arrive in time, because my house is near the station so I asked her to help. Up here, partly because of custom, partly because economic conditions are still too difficult, the rate of giving birth at home is still high. Many cases are far away and do not have means of transportation so they cannot go to the station. There are cases because they are poor, they do not have a few hundred thousand dong to go to the health station to give birth. Basically, most of them are poor, so after each birth, the only thing I receive is a thank you,” Tru said with a smile.

According to Tru, midwifery is not as difficult as persuading Mong women in this border area to come to the commune health station to give birth. This is also what makes her worry and decide to stick with the job. “We don’t expect much, we just hope to be paid the same monthly allowance as before so we don’t feel sorry for ourselves,” Tru confided.

Need to be noted

In Nam Can commune, in addition to Ms. Tru, there is also Ms. Ngon Thi Huong (46 years old), from Khanh Thanh village, who also works as a midwife. Ms. Tru is Mong, so she often helps Mong women give birth, while Ms. Huong is Kho Mu, so she is responsible for supporting her fellow countrymen. These are also two ethnic minorities that account for more than 90% of the population in Nam Can commune.

When we arrived, Ms. Huong had just returned from a half-hour motorbike ride to the house of pregnant woman Lu Thi Vien. Before that, when she knew that Vien was pregnant, Ms. Huong often visited her house to ask about her health, give advice on reproductive knowledge, and at the same time, advised Ms. Vien to have regular check-ups and go to the commune health station to give birth. But near the due date, Ms. Vien agreed to go to the commune health station to give birth according to Ms. Huong's advice, but suddenly went into labor a week before the due date, and had to call Ms. Huong to come to her house for support.

Khanh Thanh village is home to the Khmu people. Women here are used to giving birth at home, some go to work in the fields and give birth in the hut, rarely going to the commune health station. Witnessing many difficult births, in 2018, Ms. Huong decided to attend a free 6-month village midwife training course at Vinh Medical University to support women in giving birth. In nearly 5 years of working as a village midwife, Ms. Huong cannot remember how many cases of "mother and child are safe" have been helped right at home.

“When I was in school, they told me that when there was a project, there would be support, but I didn’t see anything,” Ms. Huong said sadly. There were times when she thought about quitting the job, but she couldn’t quit because she loved the job: “My relatives also said that there was no salary, and it cost money for gas, so why bother working so hard, but now I’m used to it, I try to do housework and help people at the same time.”

Opening a small notebook that was almost completely filled with writing, Ms. Huong said that this was a list of pregnant women in the village that she had compiled. Every month, she regularly visits each house to examine, provide reproductive advice, and encourage pregnant women to go to the hospital or commune health station to give birth. She also advises pregnant women to stop drinking alcohol, smoking, and limit heavy work during pregnancy to give birth safely and healthily.

Mr. Nguyen Trong Huong - Head of Nam Can Commune Health Station said that although there is no subsidy, the two midwives in the commune are still very active, contributing greatly to improving reproductive knowledge for women in the border area. In addition to promoting and mobilizing pregnant women to give birth at medical facilities, the midwives also come to the health station to support pregnant women in giving birth, for example, as interpreters. Mr. Huong said: "The station has 4 employees but no one can speak Khmu or Mong, so we have to call midwives to translate and guide pregnant women in taking deep breaths and pushing."

Not only in Ky Son district, but also in many other mountainous districts in Nghe An, the role of midwives is still very important, especially in remote villages. In Khe Nong residential area, Chau Khe commune (Con Cuong), every time there is a birth, Mrs. La Thi Hieu (66 years old) is the first person that people remember. This is a residential area of ​​Dan Lai people, isolated in the forest, about 30 km from the commune center. Not only is the distance far, but up to now, women here often do not have the habit of going to the medical station to give birth.

Mrs. Hieu has been a midwife for nearly half a century. Most of the villagers are midwives. From the age of 20, Mrs. Hieu was taught the midwifery profession by her mother, and has been doing it ever since. Although she never went to school, for decades she has always helped women in the village have a safe delivery. “There is no money here. After the delivery, the mother’s relatives will bring a chicken to the midwife’s house to pay her and hold a ceremony to ward off bad luck for the midwife according to the Dan Lai custom,” Mrs. Hieu said.

Mr. Sam Van Hai - Director of Ky Son District Medical Center said that in the past, there was a monthly subsidy of 200,000 VND, so there were many midwives in the district, almost every commune had one. That allowance was paid by the Preventive Medicine Center, but in recent years, after merging with the District Medical Center, this amount of money no longer exists. Therefore, the entire Ky Son district has only 7 people doing this job, all of them working for free.

“Many villages are in remote areas, and it takes a whole day to get there, so the village midwives still play a very important role, especially in Ky Son district. Moreover, this is a force close to the people and knows the local language, so propaganda and mobilization are easy and effective,” said Mr. Hai.