Russell and Eileen's Church Missions: ASSESSING MATERNAL NEWBORN CARE IN MOLDOVA

Approximately two months ago I (Eileen) was copied in on an email from a doctor in the U.S. to our humanitarian couple in Moldova. He was interested in pursuing a maternal newborn care project in Moldova and wanted our couple to be the eyes on the ground so to speak. The name of the doctor was the same as someone I knew 40 years ago while in nursing school. I responded back to him and asked if he happened to be the same Rob Clark who lived on the SLC avenues in 1977 and was married to Anne Clark. As it turned out he was someone who was in my student ward when I was in college. I was in the Relief Society Presidency of that ward and his wife was the Relief Society President. We later spoke on the phone and it was fun to catch up and hear about their family, and in turn he also asked about ours. Many years ago I left nursing school to go have a spinal fusion. At that time, I was released from my calling in the Relief Society Presidency and moved back to Colorado for the operation. Rob and Anne were married, and I don’t believe I have communicated with either one of them since. This interaction was a reminder of what a small world it is within the church.

One of the major initiatives for LDS Charities is a program entitled Maternal Newborn Care (MNC). This program aims to teach appropriate medical skills to physicians, nurses and midwifes in countries where perhaps the training is lacking. The programs include training the providers with training in areas such as Neonatal Resuscitation (NRT), Essential Care for Every Newborn (ECEB), Advanced Life Support in Obstetrics (ALSO) and, Helping Babies Breathe (HBB). Each program is structured to have a different level of intensity to meet the varying needs of the providers in the country where training will take place. While we were in Indonesia we worked for over a year to implement an HBB program for over 500 midwives and a few dozen doctors and nurses in a rural area. We were released from our mission just six weeks before the program was formally initiated. Although we would have loved to have seen the training, we were pleased when a picture of the doctors we had worked with ended up on the front page of our church’s newspaper (the Church News).

Dr. Clark has been heavily involved in the MNC program for many years and has done training programs in India, China and Nepal. This is the first year he will be working in any European country. He also has his own practice in addition to being on several committees. He is extremely busy. When he discovered that I was a former Newborn ICU and Labor & Delivery nurse he asked if I would be willing to visit Moldova and assess the needs there. This was a huge pleasure for me as I have missed my nursing profession immensely. I had the support and encouragement of my manager in Frankfurt and also my husband, which was a blessing.

The history of Moldova is complicated and it has changed hands over the years from being a Russian and/or Romanian territory to being independent. Most of the people speak Romanian while some in the South and East speak only Russian. The Russian Orthodox Church is prevalent there and it was very common to see onion domed churches with glistening golden roofs in almost every village. Statues of Jesus on the cross are commonplace, even on the sides of the roads away from what would seem to be other signs of community. When we first rode in the taxi to our hotel I was surprised to hear the singing group BeeGees on the radio. We soon found that American/British music from the 70s and 80s seemed to be played everywhere, and often quite loudly.

Elder and Sister Vogelsberg have been serving in Moldova for a little over 18 months. Elder Vogelsberg did an excellent job of navigating the roads from one town to another. Some of the roads off the main highways were covered with potholes. He would sometimes swerve to miss them and on occasion had no choice but to drive over them. A portion of our journey was over dirt roads. This gave us the opportunity to see the villages, which we always enjoy doing. It seemed that about half of the homes had an outhouse in the yard. I was told by our translator that many homes do not have running water, but rather obtain their water from a nearby well. Local wells were decorated ornately with a handle and a pulley to obtain water from a bucket. Many of the wells have become contaminated due to runoff from the fertilizers used in the nearby farming fields. There have been several clean water projects in Moldova implemented by LDS Charities over the years.

We visited six hospitals trying to get a feel for the needs of each local unit. The hospitals in Moldova are divided into three levels. We found that the lowest level (Level 1) hospitals were smaller with fewer patients, however their staffs still tried hard to have the appropriate equipment and care for their patients. Unless there is an emergency, these hospitals only take patients who are beyond 36 weeks gestation, with Level 2 hospitals taking patients from 32-36 weeks gestation, and the three large Level 3 hospitals looking after the more critical obstetric patients and neonates. Dr. Clark had asked me if I would be willing to visit a few of the smaller local hospitals to learn more about the need for training, if any, in the rural areas.

We found that the hospitals were clean, with much of the necessary equipment needed for care of the mothers and newborns. There was one location where the director of the hospital was a little skeptical and was reluctant to give us information or allow us to see his units. In all of the other five hospitals the doctors seemed proud to tell us about the care they were delivering and more than willing to show us both their Labor & Delivery and Newborn Care units. In one location the neonatologist had posters lining the walls of her unit. These posters were algorithms about what to do in case of an emergency. In this particular hospital they were in Russian. We were pleased to see the LDS Charities logo in the corner of the poster. This doctor had attended an NRT seminar/training sponsored by LDS Charities in 2011, and is still using the training manikin and written training materials which were given to her. This was great news for us as the whole purpose of the program is to “train the trainer,” then have the trainers reach out to do training in their communities.

We do not know at this point if or what kind of program will be implemented in Moldova. That decision will be made by Dr. Clark when he visits in May. We did have multiple requests for NRT, HBB and maternal emergencies training by the physicians. For me, it was extremely satisfying to be back in a hospital again. I was grateful for my good husband and companion who not only took notes for me while I interviewed the staff, but also is savvy enough that he could prompt me in certain situations to notice something which had gone unnoticed earlier. In one instance we were told by the director of the hospital that many deliveries were done with forceps rather than a vacuum suction. While in the delivery room, Russell asked me what a certain piece of equipment was. It turned out it was the vacuum suction machine. When I questioned the obstetrician as to whether forceps or vacuum suction was used in their deliveries she looked in shock at us and said “ NO FORCEPS!” I was grateful for this good catch by my husband, the accountant. I also appreciate the efforts the Vogelsbergs took to transport us around and give us their insights. Our interpreter, Doina was extremely valuable. She is a member of the church (only one of about 100 who are actively involved in the church in Moldova). She speaks Romanian, Russian and English fluently, and didn't hesitate with any of the medical terminology. Her services were very needed as the only individuals we met in our travels who spoke English were a family in one of the patient rooms. The mom had just given birth the previous day and her husband and nine year-old son were there visiting. Interestingly they all spoke English. We admired their beautiful baby and congratulated them on their new addition. Families with multiple children seem to be something we don't see often in Europe, other than in Moldova.

I was grateful for the opportunity to be involved in a small way with this future MNC project. I am hoping that perhaps it might take place before our departure next fall. Maybe we would be able to meet again some of the good people we met on this visit.