Azerbaijan Interviews: Susan Rathe

From a collection of Azerbaijan Interviews, April 1999. Susan Rathe is responsible for Reproductive Health Programs
  • Been in Azerbaijan 3 and a half years
  • Working for MSF in Azerbaijan since November, 1995
  • Nationality: Swiss Can you outline some key points about your work, which you consider valuable for the people of Azerbaijan? All kinds of health issues concerning women still present a difficult situation in Azerbaijan. Access to medical care is not obvious everywhere. And maybe due to their Muslim backgrounds, women are kept at home and it is not obvious that they would be taken to the doctor. Because of the economic crisis, it is very often difficult to be able to afford to go to the doctor, and when I came here there was practically no modern family planning available in the country. What women mostly used was abortions and very often back-door abortions, because they cost less than the official ones - it's legal to go for an abortion in Azerbaijan, but it costs quite a lot if you have it done legally. So this is what we begun with - we tried to offer alternatives to these abortions. Then we gradually extended - trying to improve all the obstetric practices at a village level in order to offer better services for the women in the villages. And then we extended to other gynaecological services. Under the old Soviet system, it was arranged so that there was some kind of medical person in every village. On average, you would find one midwife per one thousand inhabitants. Those were the people who were sought out for medical help, not just for obstetric help, but for other things as well, as they were the only person who had some medical training in the village. So this system was established, but these people worked without equipment, no drugs, no supervision, no additional training or these women could not attend the training as they were wives, mothers and farmhands as well and they also had the village to look after. So if you took them away for a refresher course, everything in the village would have collapsed. So, given these circumstances, we thought to introduce regular visits to these midwives for supervision, for training and supply of equipment to allow them to be able to do what they were supposed to do under better conditions. Can you think of a specific example during your work where you really thought to yourself that it is worthwhile? This happens regularly. We have built up this reproductive health system in 2 districts - it's now under the supervision of 2 local doctors, and it works. All the midwives are participating. They are coming for the seminars and we have regular outreach consultations of the governmental gyneacologists going to the villages to do consultations for women who cannot afford to go to the central hospital - and these are things that did not happen before, and they now work automatically. It is also integrated into the functioning of the governmental services. The biggest challenge for me was to encourage the government staff to care for their population and to take initiative. For example, the Chief Gyneocologist of the Imishli region. I first made contact with her as I wanted to work with her developing a family planning program. When I first met with her, she was a frustrated woman who had worked for 20 years in a maternity department with staff who were difficult to work with - very corrupt, not listening to their chief - so she had practically retired to her room and had as little to do with her staff as possible. So we started to talk about family planning, and gradually she agreed that something may be possible. And then we got permission from Baku to undergo training together so that afterwards we would have the authorisation to build up a program in the region. After some hesitation, she did come to this training, and she went back very enthusiastic after seeing a sample of a family planning clinic. She went back to Imishli, and she talked with the chief doctor of the region and she said 'I want a family planning clinic in this hospital as well.' And under their own initiative, the two doctors together gathered the money needed and they used part of the maternity wing of the hospital which they weren't using anyway, and they installed a new family planning centre. This centre was more beautiful than many houses in the region! They made all the publicity about it and she opened the family planning centre. And when the Ministry of Health at the central level heard of it, and called and complained, they said we have opened it, we see a need for it and we will definitely not close it again. So you'd better accept it. So this shows the change. And she used to stay, and she still says, if you Susan have come from so far to care about the women of my region, I should be ashamed if I don't do as least as much as you. And now she is motivated, she likes her work and she does a great deal of news things that she never did before. How has speaking Azeri helped in your work? That it helped was quite obvious for the work with midwives in the regions. This work would never have been possible with a translator, because these are very personal relationships. We not only talk about pure work, but about their houses, children etcetera. It took a while to build up trust and a feeling these talks would be confidential. In the very beginning I tried to find out something about abortions in the region. I made conversation with some midwives and asked 'how many abortions happen in your village in a year?'. After 5 minutes the midwife told me that it is about 2, after 10 minutes she said 15, after 30 minutes she said 50, and the next time she said 200. They have to be sure that you won't tell another person about it and will keep it confidential.