Cooperation between midwives and dukun (traditional midwife) succeeded in significantly lowering the mortality rate both for infants and mothers in Takalar and Bone, two regencies in South Sulawesi. Takalar is the first regency to implement bylaws regulating the modern and traditional midwives partnership in Indonesia. Tempo English Edition filed a report on the two regencies last month.
A HAPPY atmosphere prevailed on the veranda of one of the hotels in Makassar. On the veranda dozens of midwives and dukun were gathered. The Regency of Takalar in South Sulawesi intended to use the event to promote an understanding of the dukun-midwife partnership in childbirth. Most of the midwives present were still relatively young. The traditional midwives on the other hand were a lot older as they were mostly over 50 years of age. In the hotel rooms midwives and dukun were partnered off together. This proved to be quite an effective strategy. Nurinayah, 35, who hails from the district of Galesong, felt that it was then that a special bond began to form between the midwives and dukun. “Slowly a bond was forged between most of them rather similar to that of mother and child,” she explained to Tempo.
According to Nurinayah, this bond grew from small things. “The midwives helped the dukun who were not accustomed to using hotel bathrooms. The dukun were not familiar with how things were done in hotels and the midwives helped explain things to them.” The bond between them continued growing right on into the delivery room-and that has been no mean feat.
Since 2007 delivering mothers both in Takalar and Bone have generally been assisted by both a dukun and a midwife. It was the Department of Health which first introduced this partnership in an attempt to lower the mortality rate during childbirth. In eastern Indonesia the regencies of Takalar and Bone were the first to use this approach. Both regencies have been in partnership with regard to this with the United Nations Children’s Fund (UNICEF).
Before this program began, the rate of infant mortality in Takalar was quite high namely 159 people in every 100,000 births. “Even one death is too high for us,” declared a UNICEF health officer in Makassar. After this program was put in place, the number of mothers dying during childbirth gradually decreased. Three deaths in 2007 was brought down to no deaths in 2009. In Bone the number of deaths of mothers giving birth also shrunk drastically from 13 deaths in 2006 to three in 2009.
The cause of death for mothers was usually due to complications such as bleeding and infections-matters which cannot be handled by a dukun. One solution is to teach dukun how to conduct a normal birth using hygienic methods. However, this does not entirely solve the problem because complications cannot be predicted which is why a person trained and experienced in using medical equipment and medicines is needed during deliveries. However, according to Tempo’s source in the UNICEF, it is not possibly train the dukuns to perform blood or saline transfusions. Especially, as many of them cannot read or write.
The midwives did have the ability to treat complicated births, however they were not without certain disadvantages: the community was reluctant to trust midwives who are mostly still relatively young and inexperienced. They had more faith in the traditional midwives who have all been helping to perform deliveries for years, as well as from generation to generation.
So the dukun-midwife partnership was created in order to overcome the weaknesses of both sides. Takalar was the pioneer for the program. Midwives and dukuns began to be trained together. It was then that the dukuns started to realize that they had only limited means for handling complications during childbirth. So the two groups entered into a joint agreement after the training. Namely, that the midwives would handle all medical and technical aspects of childbirth, whereas the dukuns would concentrate on the psychosocial aspects of childbirth alone.
For example, when a dukun came to know of a pregnant woman she would encourage her to have regular examinations by the midwife until the time of delivery. “Usually the first to know that a woman is pregnant is the dukun and not the midwife,” the source added. During childbirth technical the aspects of the birth such as pulling the baby out, getting the placenta out and cleaning the baby afterwards are performed by the midwife. The dukun performs the traditional rituals and beliefs to help the mother. For example they give them water to drink that has had prayers and spells read over it which are believed to help the process of childbirth. The presence of the dukun calms the mother who is about to give birth and helps her feel secure.
Another advantage of the dukun is their ability to provide help to the mother and her family. Before the birth the dukun will cook and wash the clothes of the expectant mother. After the birth the dukun will cook, wash and iron both the clothes of the mother as well as her family.
Not everything however went well. In the beginning there were dukuns who were uncooperative. “In the beginning there were some
who refused to enter into partnership with midwives,” explained Daeng Siang, a dukun who is about 55 years old. However, after the village heads used various approaches to convince them to work together, they finally came around to doing so. The imam (worship leader) in the mosque also assisted by explaining the importance of the partnership in their sermons.
Daeng Siang says that now she is happy to be assisted by a midwife. “Having a midwife with me actually lessens my worries of helping at a delivery. I’m grateful to have one there because she can help if there are any difficulties with the birth and I don’t get overly exhausted with the delivery,” she explained. The midwives are also happy to have the dukuns present to help them. “It’s difficult to handle complications during a delivery because we don’t always have saline solutions and blood with us for transfusions,” says Nurinayah. Now however, the dukuns bring expectant mothers to the government health clinics. “And that really helps us,” adds Nurinayah.
According to Tempo’s source, the dukuns are happy because they feel that they are valued and also part of the system. The midwife-dukun partnership is proving effective in these two regencies because it is conducted within the Sipatakau culture which is held in very high regard in South Sulawesi. In short, both sides respect each other and trust each other.
Where do the weaknesses in such an approach lie? If a village does not have a midwife then such a partnership is obviously not possible. The traditional midwives then handle the delivery in the same fashion as before the intervention of medical science. However, this weakness should spur the government to increase the number of midwives available: it is a form of indirect advocacy to the government to increase the number of midwives.
The Regent of Takalar, for example, has replicated this program in all the districts of Takalar and has allocated funds from the regional budget for the program. His regency has also created regional bylaws governing the dukun-midwife partnership which came into effect as of January 2010. Takalar is the first regency in Indonesia to have such a bylaw.
In the Regency of Bone, the regional government provides scholarships for the children of dukuns to study to become midwives. Does this mean that the position of dukuns will gradually be eliminated? “We have no intention of eliminating them from the birth process. They can always be in partnership with midwives and help each other,” says Tempo’s source in the UNICEF.
In Takalar where dukuns pass on their knowledge to their descendants, they are starting to allow their children to study to become midwives as well. According to Murinayah, they allow their children to study to become midwives but they also provide their children with the knowledge of the supernatural that is possessed by dukuns. “So later they can become ‘midwives plus’!” exclaims Nurinayah. “We help them to register at schools for midwives,” she adds.
The partnership between dukuns and midwives appears to be here to stay.
— Sadika Hamid (Takalar and Bone, South Sulawesi)
Source: Tempo Magazine, No. 36/X, May 05-11, 2010