The MOM Project:
“Mobile Obstetric Medic”
Maternal health interventions
among IDPs in eastern Burma:
Blood Transfusion
Thomas Lee, MD MHS
Director, Global Health Access Program (GHAP)
Adj. Associate Professor of Medicine, UCLA School of Medicine
Luke Mullany, PhD
Director, GHAP Monitoring and Evaluation
Assistant Professor, International Health / Center for Public Health
and Human Rights
Kate Teela, MHS
MOM Project Coordinator
Funding: Bill and Melinda Gates Institute for Pop and RH
Eastern
Burma
Context
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Minimal access—
CBOs only
HRVs and
conflict: 600k1,000k IDPs
Limited mobility,
long transit times
IMR 91, U5MR
221, MMR 10001200 *
*Lee T, Mullany L, et.al. TMIH 2006
MOM Project Rationale

Ethnic minority CBOs
– No bricks and mortar
– Mobile clinics and “backpack” teams
– Health workers

Adapt RH interventions to existing
service delivery models
– Emphasis on mobility of providers to bring
services to communities
– Community-based providers with variable
skill sets—training based on intervention
MOM Selected Interventions
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BEOC
– Kiwi, MVA, Magnesium, Misoprostol,
Antibiotics, Manual removal placenta

Focused ANC
– Deworm, ITN, Malaria Screening, Fe/FA
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Clean Deliveries, PNC, Family
Planning
Transfusion
3-tiered provider network
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Maternal health workers (MHW)
– 8 months training in RH department
– Complex services (such as transfusion)

Health workers (HW)
– Some BEOC, ANC/PNC

Traditional Birth Attendants (TBA)
– Link between community and
MHWs/HWs
– Some basic services
Transfusion Needs High
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Trauma: landmine-specific mortality
rate = 1/1000 persons/yr
Falciparum malaria prevalence >10%
Malaria cause of death >40%
Maternal anemia >60% (Hg<11)
PPH leading cause of maternal death
Transfusion Program
Key Components


Rapid diagnostic tests for low resource
settings
“Walking Blood Bank” concept
– Blood taken from donors at time of need

Community Education
– Program acceptance, Donor Recruitment
Transfusion
Technical Issues

Rapid Diagnostic Tests
– Heat stability
– Capillary blood vs plasma (centrifuge)
– Adequate sensitivity
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No cross-matching (Type-specific)
Blood typing
“Walking Blood Bank”
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Donor list and map with blood types
Donor recruitment during ANC:
standby during time of delivery
Not anonymous
Counseling/treatment for screened
diseases
Donor screening
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Sequential testing
– avoid testing for less treatable or more
stigmatizing diseases
– resource conservation

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Simultaneous testing for emergencies
Goal of screening is blood safety, not
necessarily diagnosis
Conclusions

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Rethink appropriateness of limiting
transfusion to referral centers (“Basic” vs.
“Comprehensive” dichotomy)
Transfusion may be easier than some
elements of “Basic” EmOC
Mobility of service provision to the
population rather than centralized services
accessed by the population
Flexibility in “toolkit” for different types of
providers
Kiwi problems
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Technically challenging for health workers
Inadequate training time
Kiwi mechanical problems
– Connection between pump and cup breaks too
easily
– Suction decreases with reuse
– Belt loses consistency (too elastic) after
decontamination
– Too many pieces (multi-use model)
Future Avenues
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One-sample donor screening test
“Black-box” donor screening test
– safe or unsafe

Heat stability studies
Thank you
Partners
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Burma Medical Association

Karen Department of Health and Welfare

Shan Health Committee

Karenni National Health Organization

Mon Health Department

Mae Tao Clinic
Colleagues

Palae Paw

Lin Yone

Eh Poh

Eh Kalu Shwe Oo

Cynthia Maung

MOM Administrative staff
Technical Advice/Oversight
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Luke Mullany

Catherine Lee

Kate Teela

Nicole Franck-Masenior

Chris Beyrer
Funders
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Bill and Melinda Gates Institute for Population
and Reproductive Health

Hussman Foundation

Foundation for the People of Burma

Global Health Access Program

Burma Border Projects