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Ahwa Gretek breaks out a big smile, her teeth jutting from her jaw like dark crimson stalagmites, weathered and stained from decades of chewing the mildly narcotic betel nut.

Aged somewhere ''between 50 and 60'', Ahwa - a dukun bayi, or traditional birthing attendant - is sitting beside Nurhayati, stroking the expectant mother's hands, chuckling as she relays her advice.

Best of both worlds … Nurhayati, left, is expecting a child and will be reassured by dukun bayi Ahwa Gretek, second from left, while midwife Aimum, centre, will take care of the medical side. Photo: Hansel Nashyo

''This time, don't go on a diet. You eat whatever you like,'' she says before becoming serious. ''I think she's OK but that's why I am bringing her here, just to be sure.'' 

Nurhayati, a 20-year-old part-time primary school teacher, lost her first child three days after he was born. She does not want to repeat the dreadful experience and she and Ahwa are participating in a new program reducing the high rate of maternal and neonatal deaths in Indonesia.

Like much of rural Indonesia, mysticism still holds sway for many of these inhabitants in Nangapanda, a village in Flores in eastern Indonesia.

For centuries, the dukun bayis - literally, baby shaman - have delivered babies using a mix of massage, herbal remedy and incantations to the supernatural.

Hugely respected and trusted figures, dukun bayis work well when the birth is straightforward but are often unprepared if there are complications.
Nutrition and hygiene in villages is poor. The umbilical cord is cut with knives fashioned from split bamboo or rusty razors. Infection is commonplace and haemorrhaging during childbirth frequently leads to death.

''We often use different types of leaves, ginger, turmeric,'' Ahwa says. ''We warm the body with a potion and we use egg yolks to help with the pain.
''Sometimes, we just ask them to pray, that can be the best. We also give them water, but we will pray to that, too.''

At 17 deaths per 1000 births, Indonesia's neonatal mortality rate is poor but its maternal mortality rate is even worse, two to three times higher than that of comparable countries such as Vietnam and the Philippines.

An Indonesian mother is 40 times more likely to die in childbirth than an Australian mother. There are a variety of reasons for this but the central role of poorly trained dukun bayis is a major factor.

This time, Ahwa and Nurhayati are taking a different approach. They are working with Aimum, a trained midwife.
It is a partnership they have all signed with an imprint of their fingers. Ahwa continues to be involved in the pregnancy, providing her remedies and words of advice but also pre-arranging a blood donor and transport to get the expectant mother to a health clinic or hospital as soon as her contractions start.

The birth itself, however, will be overseen by Aimum at the clinic, where medicine and equipment is available should there be any kind of emergency. The dukun bayi is there at the birth too, offering soothing words and then resuming her care after the birth.

Bringiwattu Batbual, the head of the midwifery training school in Kupang, says the new arrangement is working well, although it has not been without challenges.
''The dukuns are old, wise and respected,'' she says. ''The midwives are young and sometimes [the dukuns] don't like it.
''You have to show them that it's not a competition … It is also a big challenge convincing the villagers that the midwives can be trusted.''

The new program, partly funded by AusAID, replaces a Suharto-era scheme, which aimed to place a midwife in every village but failed miserably. The young graduates from midwifery schools were considered lowly and the dukuns would not embrace the new techniques.

The results have been impressive, according to Jacqui De Lacy, head of AusAID in Indonesia. ''We are saving hundreds of women's and babies' lives,'' she says.

''Given the high levels of trust that the community has in dukuns, we have to work with them to get the women into health centres. It can be intimidating to go to these centres for many women.''

Publisher :  The Sydney Morning Herald

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