Advances in Labor and Reducing Mortality (ALARM) course held:Combating maternal mortality in Yemen [Archives:2003/633/Health]

April 27 2003

A three-day course on “Advances in Labor and Reducing Mortality” (ALARM) was organized in April at al-Thowra Hospital's National Tertiary Maternity Center in Sanaa and was sponsored by the Association of Obstetricians and Midwives of Yemen and Canadian International Development Agency (CIDA).
The course comes in direct response to Yemen's needs to tackle this problem as it is with one of the highest maternal mortality rates in the world. In Yemen, the lifetime risk of dying from a maternity related complication is extremely high. One in nine Yemeni women will die from a maternity related complication (this can be compared to Canada where the risk is only one in 6,600). Preventing maternal mortality and reducing the risks of maternity complications by providing training to locals in Yemen was the major objective of this specific course.
Trainers of the event included three Canadians: Dr. Jean Chamberlian, Dr. Ahmed Ezzat, Dr. John Smith and a Yemeni: Dr. Shamsaa Al-Awar. Organizers of the course believe that there are two essential steps to be taken to improve maternity health in Yemen. Those are education of trained health care personnel and the facility and equipment enhancement and supply.
The course had targeted those who do need to know more about maternity problems and cures. They include Physicians, midwives and maternity nurses from the Sana'a governorate. Participants were invited from various hospitals and maternity units (private, public and NGO based centers as well as primary and tertiary units). A cross-section of maternity health care providers was also involved. The course provided training to around 40 participants.
The course started globally in the mid 1990s by members of the Society of Obstetricians and Gynecologists of Canada (SOGC- a Canadian NGO). To date, over 1,000 physicians, midwives and nurses have participated in the course. The major causes of maternal mortality are common worldwide and the basic treatment for each threat to life is basically the same.
Due to its adaptability and relevance to international women's health, the SOGC in cooperation with local NGOs have held the ALARM course in several countries over the past two years (Uganda- over 120 participants, Haiti-80, Guatemala-40 participants). The course has been warmly received and is expected to gain greater momentum in all of these countries and is sponsored by CIDA.
The course is based on adult education principles with various components:
a) Didactic lectures (participants have copies of the lecture notes)
b) Small group workshops
c) Hands on demonstrations with mannequins
d) Evaluation of participants' knowledge acquisition (multiple choice exam and oral structured clinical examination) and
e) Evaluation of the course by participants.

The input of the ALARM international course in Yemen is summarized in:
1) Review causes of maternal mortality
2) Review treatments of life threatening pregnancy related diseases
3) Acquire hands on skills- which save women's lives

On the other hand, the course is expected to yield the following:
1) Initiate change in maternity units (including the use of the pantograph, maternal mortality audits, development of protocols for treatment)
2) All participants will receive the ALARM manual which is an up-to-date review of causes and treatments of maternal mortality based on the course content

The three day course for trainees was followed by a one-day course for instructors to get them familiar to the subject of ALARM and its objectives. It is interesting to note that due to the importance of this course for Yemen, it was extended one more day to become three days unlike what has been assumed for it earlier. Furthermore, the Al-Thowra Hospital was chosen for its adequate facilities for lecture and workshop components.