Maternal Child Health Clinics

Since Sri Lanka is a public health system, it was really important for me to see how the clinics are run in the community. We were lucky enough to go to 2 different Maternal Child Health clinics (MCH clinic). Each MCH is run by the Medical Health Officer (and Public Health Midwives if it's an antenatal clinic). The first MCH clinic was a Muslim clinic where we saw antenatal checks and child immunizations. The child vaccination rate is up to 98% here in Sri Lanka. Impressive! No one over here is claiming autism or other ridiculous reasons for not vaccinating their children. They've eradicated polio (despite having India as their neighbor) and several other serious illnesses thanks to their vaccination programming and ease of the MCH vaccination clinics. 

In addition to the child vaccination clinics, we were able to go to an MCH clinic in Gintota, outside of Galle, to observe an antenatal day. Here, the Public Health Midwives run the show with an OBG consultant either on call or present at the clinic. The Public Health Midwives are trained much like our Nurse Midwives, though they rarely do deliveries outside the hospital unless the mother cannot make it to the hospital in time. Sri Lanka has a 96% institutional delivery rate, a vast improvement thanks to several government educational outreaches. With the increased hospital deliveries has also come a drastically decreased maternal mortality rate. In basic language: Sri Lankan women are now being educated on prenatal and postnatal care and getting themselves to a hospital for a safer delivery. 

MCH Clinic in Gintota
Antenatal clinic day

Paperwork with measurements, education checklist, vaccinations and other checkpoints for  all pregnant mothers. Completed by the Public Health Midwife. The PHM and patient each keep a copy and have to bring to each visit. 

Patients entering the clinic and waiting to register. 

After registration, a nurse documents their vitals. 

At the MCH appointments, the midwives are responsible for tracking fetal heart tones and measuring the fetus' growth. There are no dopplers or ultrasounds however, so they use a pinnar (like an ear trumpet). This plastic funnel looking instrument is pressed into the mother's abdomen after performing Leopold's for the fetal positioning and finding the shoulder. I had a really hard time hearing the fetal heart rate (which sounds the same as through a doppler), but after a few tried, I was able to properly line up my ear canal with the open tube of the pinnar and hear the sounds! Success! We are so reliant on technology in the US it's sad. What a simple and low-cost way of hearing the fetal heart tones. I'm glad I was able to acquire this skill. 

Patients lined up outside the exam room.
Waiting to be seen by the Midwife.

Public Health Midwife measuring the fundal height. 

Public Health Midwife using a pinar to hear  the fetal heart tone.