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When Umi Reston rode into the health center in Riung village on a motorbike at 8:45am one day in July, she was well into labor. The staff at the health center barely had time to get her to the birthing room before her baby was born 15 minutes later.

But once the team of midwives and nurses delivered the baby, they noticed something was wrong. The baby boy was underweight and didn’t cry out. When they checked his heart rate, it was only 60 beats per minute, compared to the normal 100-160 beats per minute.  So the team shifted into emergency mode.

“We followed the standard operating procedure (SOP) that we learned last year in our PONED training,” said Nurse Martina Lenan. “The baby’s heart rate increased and then we continued checking it again every 30 seconds.”

Umi Reston breastfeeding her baby boy a week after he was born underweight with complications. His birth was handled by the PONED Team, who say he is on track to normal development

They cared for the baby by placing him inside a warming box to maintain his body temperature. Typical of a rural health center in this poor province of Indonesia, they could not give the 1.8-kilogram baby oxygen to help his condition, as the supply had run out, but he was able to breathe without further help. During the next few hours, the team monitored the baby’s condition closely and gave all care according to the clinical standards they had learned. As his condition improved and he started breastfeeding, they showed Umi how to keep him warm using skin-to-skin care, or Kangaroo care, and she continued to nurse him in this way.

When the boy continued to improve and his weight had increased to 2.25 kilograms, he was taken home by the family - still small but in much better condition.

“We are really following the sequence of SOPs now,” said another nurse, Yanti Jeria. “That baby was probably saved because we were skilled and confident enough to act quickly and apply the SOPs.”

This team of midwives and nurses at the health center, Puskesmas Riung, are some of the 561 health staff trained in emergency skills through the Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH), which works to decrease the high number of maternal and neonatal deaths in 14 Districts in Nusa Tenggara Timor Province (NTT).  

AIPMNH-supported PONED training covers comprehensive emergency obstetric neonatal care and emergency First Aid, teaching midwives and nurses how to handle obstetric and newborn complications, care for low birth weight babies, post-abortion care, and infection control. In this training, health staff learn to quickly assess and follow a set of SOPs related to each emergency situation.

“This training is totally different,” said Midwife Ni Wayan Kariasih. “Before, we just learned generally about complications, but this training was really a complete package on how to handle all emergency cases.” Puskesmas PONED have been around for years, labeled as such to inform patients that a health center offers emergency services. However, patients would sometimes discover that “PONED” was simply just that – a label without the skills to back it up.

“Now we’ve learned that you don’t just name a puskesmas “PONED” without it really meeting the requirements,” said Mrs. Marselina Fono, Head of the Maternal and Neonatal Health Division at the Ngada District Health Office, which covers the sub-district of Riung.

“It really has to meet the criteria and follow the whole process,” she said. “We had training before, but it was incomplete. With this training, we can see the whole process of PONED, and we now do monitoring every six months.”

Members of the PONED Team at Puskesmas Riung, Ngada District, NTT

Now, Puskesmas Riung can proudly say that it meets that criteria. Its staff is trained to handle emergencies, and it offers PONED services 24 hours a day to the rural communities it serves.

For Umi, the skills of Puskesmas Riung’s PONED Team could very well have saved her son’s life.

“I was scared, but I felt that the midwives and nurses really knew what they were doing,” she said. “I believed that I was in good hands.”

AIPMNH is managed by Coffey on behalf of the Australian Government

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