Background: The Ministry of Health and Family Welfare of the Government of Bangladesh developed a midwifery education strategy in 2011 and starting in 2013, BRAC University developed a three-year Diploma in Midwifery. A survey was developed to understand the challenges of the newly graduated midwives and to identify resource and educational needs. The survey feedback will help develop and strengthen curriculum for primary and postgraduate midwifery training. Methods: A 30-question survey was given to midwives at the Hope Hospital in Cox's Bazar and at the birth centers in the surrounding rural communities. Questions explored the midwives' clinical experience, patient problems in the prenatal, intrapartum, and postnatal period, and asked about what education; training and clinical resources were needed. Results: Thirty-two midwives answered the surveys. The midwives' average time from graduation from the midwifery diploma program was sixteen months. All the respondents felt comfortable managing most maternal issues but felt further training was important. They also identified the lack of many clinical resources including blood products, medicines, vaccines, and ultrasound. They identified significant maternal health issues among their patients including adolescent pregnancy, malnutrition, anemia, sexual violence, pregnancy-induced hypertension, hemorrhage, low birth weight infants, prolonged and obstructed labors. Conclusion: Training and increasing the number of midwives are crucial strategies for reducing maternal and neonatal mortality. There is a significant need for long-term placement and commitment of midwives to rural areas in Bangladesh. Health systems and organizations employing midwives must be accountable for the continuing education,
Since August 2017, a massive influx of over 800,000 Rohingya refugees have arrived in Cox’s Bazar, Bangladesh. The Rohingya state is one the poorest states in Myanmar, with ghetto-like camps and a lack of basic services and opportunities. In 1982, a new citizenship law was passed, effectively rendering the Rohingya stateless. As a result of this law, their rights to access health services have been restricted. Now, many Rohingya are living in Cox’s Bazar in tent-based refugee camps under extremely poor conditions without access to proper medical care, hygiene, sanitation, food or education. Lack of proper maternal health care, together with early marriage, malnutrition, poverty and the physical characteristics of the women in this community (small body shapes), exposes Rohingya women to a very dangerous position with high chances of developing obstetric fistula during childbirth. HOPE Hospital provides clinical care for women affected with obstetric fistula and is the only provider and referral center of fistula care in the region. Since the influx began, many fistula repairs have been carried out on Rohingya women at HOPE Hospital. This paper looks at fistula care and the psychosocial impact of fistula on victims in the refugee population, amid a massive humanitarian crisis.
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