A communications gap

Traditional birth attendants (TBAs) are a plentiful, important resource for delivering high quality birth assistance and other health services. To integrate TBAs and modern health programs, however, is not easy. While TBAs offer the advantage of being accepted, trusted figures in village life, training presents challenges since they are often illiterate and unfamiliar with, or unconvinced of, the utility of western ways of looking at health and disease. The following experience underlines these difficulties and, incidentally, emphasizes the absolute need to pretest educational techniques and aids for each particular audience. We conducted training classes for dais, local traditional midwives. In a nutrition class, dais shown 25 accurate color illustrations of commonly available vegetables recognized an average of only 4 illustrations/person. In another class, 4 dais out of 30 could recognize a photo of an eye. To some it was a leaf, to others it was a flower or fish. Some of the cleverest dais associated the visual aid with their (midwifery) training program: they held the picture vertically and said that this was a picture of a vagina with the head of the fetus showing through.