Announcement Archive

The 3rd Mother and Child Health Training Program in Mongolia: Over 2200 participants since 2008

Monday, May 24th, 2010

story from Tokyo Development Learning Center

The Mother and Child Health Training Program in Mongolia, jointly delivered annually by the World Bank Tokyo Development Learning Center (TDLC), Kitasato University School of Nursing, and the Mongolian Nurses Association since 2008, hosted its third Training on April 15, 2010. This year, a new partner, the World Health Organization (WHO) joined, and 543 Mongolian midwives and nurses participated in the training from six different locations including Mongolia’s capital, Ulaanbaatar and other provincial cities. To this date, a total of 2240 Mongolian midwives and nurses, a number equivalent to 30% of the total population of nurses in Mongolia have participated in this training program since 2008.

The training which begun a little after lunch time in Japan kicked off with an introduction by TDLC Manager, followed by speeches made by the Mongolian Ministry of Health officials, including Ya. Buyanjara and the President of the Mongolian Nurses Association, S. Altanbagana on the current Mongolian health strategies and on the significance of continuing this training program.

Representing the participants of the past trainings, A. Munhzezeg, a nurse who works at the Maternal and Child Research Center and Z. Unur, a midwife who works at the Third Maternity Hospital gave a presentation with many photographs and diagrams on the current status of their workplace, the changes that occurred at their organization after two deliveries of the training, and on priorities and future outlook of maternal and neonatal care in Mongolia.

In her presentation, Munhzezeg showed the photographs of the educational videos, study materials, manuals, and leaflets which were newly created in Mongolia after the trainings to Sonoyo Oka,  Kitasato University Center for Nursing Careers Development and Research NICU certified nurse educator, Yae Yoshino, lecturer of the same university, and to the others who had joined to observe the session.

Munhzezeg explained about the new procedures for premature infant care which were introduced at her hospital after learning about the practices in Japan through the past trainings: monitoring of vital signs, changing positions of the newborn, oxygen inhalation, management in closed incubators and prevention of communicable diseases, the use and management of indwelling needles, proper administration of medications, nutritional administration through tubes and IV, strengthening maternal education, and issuing of health record booklet containing the record of immunization shots of the newborn.

Yoshino of Kitasato University School of Nursing reveals that when she first went to Mongolia, she received many requests for financial assistance and new equipment and facilities from the health care providers at the visiting institutions. However, she says that over the last couple trainings—trainings that provide an opportunity for participants to learn how to help themselves—she says she started noticing some changes in the participants.

According to Yoshino, the biggest change that she saw in the participants was the improvement in the presentation skills of the nurses and midwives. In relation to this, she further commented that the Mongolian healthcare providers started taking initiatives in figuring out what sort of data were necessary and how the data should be collected to be shared across urban and rural cities in Mongolia to pressure policymakers within the country or to make a case for overseas donors. Then, recently , as was mentioned in Munhzezeg’s presentation, one nurse wrote up a proposal for establishing a facility for maternal education classes, and was able to secure funding from an American non-profit organization, “Samaritan’s Purse.” The classroom equipped with various types of equipments for maternal and child healthcare opened in January 2010, and about 300 mothers-to-be are currently taking classes at the facility.

After the presentations made by Munhzezeg and Unur, Oka, from Kitasato University, started her lecture on neonatal life resuscitation.  One of the highlights of the current training is that it includes some practical skills training in its curriculum while the previous two trainings were mainly centered on theories.

Before the training started, Oka had carefully laid out the resuscitation mannequin, masks, catheters and other tools, paying attention to how she should angle them and to which cameras in the studio she should face and perform the demonstration.  Videoconference technology is sometimes criticized as not being suitable for teaching practical skills and medical procedures, but thanks to Oka’s well-thought out plans and preparation, the demonstration went smoothly. Oka performed the artificial resuscitation on the mannequin and the camera zoomed in on the baby mannequin’s chest so that participants in Mongolian could verify the small rise and fall of the chest.  In such ways, multiple cameras and screens were used to capture Oka’s detailed maneuvers in cardiopulmonary resuscitation of an infant.

Another feature of the current training is that a video of an actual training session at the Kitasato University School of Nursing using the same resuscitation mannequin was shown to the Mongolian participants. This video clip was included in the lecture at the request of the Mongolian participants: it became clear from a need assessment conducted prior to the delivery of the third training that Mongolian nurses and midwives were keenly interested in the pedagogical methods used in nursing and midwifery education in Japan.

After a short break upon completing Oka’s lecture, Medical Officers, Dr. Matthews Mathai and Dr. Maurice Bucagu joining in from Department of Making Pregnancy Safer, located at WHO headquarters in Geneva, Switzerland lectured on the use of the WHO Partograph and diagnosis and management of preeclampsia and eclampsia.

The training was a densely packed eight hour session, but the participants on the Mongolian side maintained their attentive posture and remained seated all throughout the session. “They are a lot more motivated than Japanese university students”, said an impressed observer in Japan.  Some of the nurses and midwives on the Mongolian side had just completed their night shift or were going to their shifts after the training.

The hospitals and clinics can afford to allow only a certain number of their staff to join the training because of the need to maintain the institution’s regular operations. Not every nurse and midwife who wants to attend can join the training: the ones who could join generally go back to their institutions and share their newly gained knowledge with others who had to stay back in a informal or formal peer-education session at their home institution. Participating in the training itself has significance to the participants and becomes a source of pride for those who attend the training.

The “observers” in Japan who had also stayed attentive throughout the duration of the training were university students who are training to become midwives and are determined to work overseas in the area of international medical cooperation.  The students commented on the lack of educational opportunities within Japan that have an international development focus within their discipline and seized their opportunity to ask questions directly to the Mongolian participants during the Q&A portion of the training.

Mother and Child Health Training Program in Mongolia is an ever-evolving training program which is expanding and improving its content based on needs assessments, post-training surveys and feedback from participants. We have started receiving feedback from participants that hint a desire to gain new perspectives from other countries and a demand for peer learning opportunities. One participant wrote, “(the training) would be better if it were scaled up so that nurses in other countries can also join and learn from each others’ experiences.”  Another wrote, “(The training) should involve other Asian countries.”

Yoshino, who has taken part in similar training programs in the past and have conducted post-surveys remarked at the speed of the participants applying their newly acquired information and skills and how quickly the information gets passed on to their peers. She stressed the importance of implementing a follow-up session to make sure that correct knowledge was acquired and that it is retained over time, and that correct knowledge gets passed on to others.

As expectations and demands from Mongolia grow, TDLC strives not to see each training delivery as an independent, one-off event, but as a cycle that should be planned, implemented, and evaluated with a long term perspective.