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Bilma: projecten

The Foundation Bilateral Matters (abbreviated BILMA Foundation) initiates health care projects in Southern Ethiopia, in the Southern Nations, Nationalities and People’s Region (SNNPR). The Foundation is working in cooperation with the SNNPR Health Bureau in Hawassa, the capital of the southern state.

In the years 2010-2011 a board member investigated a verifiable level of maternal mortality in the different zones of SNNPR, to which the University of Hawassa granted support. It is demonstrated that the maternal mortality is more than two times higher than the latest UN estimate. In response to this, we developed a project in 2014 to educate young women as a midwife in far away districts, which was launched in January 2015.
See the map for the health centers involved in our study in 2011.

January 2015
August 2019 - Six midwifes graduate August 2019
Seven students are now in extra training October 2018

10.2018 Seven students are now in extra training

10.2018 vier South Omo studenten met links de opleidende vroedvrouw
10.2018 Four South Omo students meet their training midwife (left)
Earlier this year Bilma Foundation informed the SNNP Regional Health Bureau about the low number of deliveries that our students have assisted when they graduate. This low number is not helping for the building of self-respect at the start of their job of the midwifery students. So Bilma Foundation expressed firmly her concern about this lack of experience and concluded that the continuity of the training project would be at stake if nothing was done. In turn the SNNP Regional Health Bureau started to investigate the average number of deliveries that each midwifery student has performed during her training until graduation. It must be said that the Ethiopian Government during the last five years invested a lot in the training of medical personnel that will work at her Health Centers. Even the total number of new constructed Health Centers has been doubled and that, in turn, includes a human resources training problem.
De ziekenhuis directeur geeft twee opleidende vroedvrouwen instructies
The hospital C.E.O. instructs the two training midwives to help with the new course
The norm in Ethiopia for midwifery students which are trained in the field is to perform 15 normal deliveries and learn what they must do when a delivery is expected to be not presenting normally. In urban areas the norm for the training is 20 deliveries. In the Netherlands the norm for graduating midwives is 40 deliveries. But the Health Bureau investigation turned out that the midwifery students do not come close to the norm, and perform on average a number of four deliveries. As a result of these conclusions a two month’s during “Enhanced Training” is established for the students in the Bilma Foundation Assisted Midwifery Training Project. This training takes place just after graduation. This extra training never would have been established without the intrinsic cooperation of the SNNP Regional Health Bureau. The costs for this training will be provided by the Zonal Health Department. Bilma Foundation will continue the payment of the monthly student’s allowances for sustainment.
10.2019 één van de studenten onderzoekt een uitgerekende zwangere avrouw
10.2019 One of our students is examining a pregnant woman in labour
The training will place at the General Hospitals from the zonal capitals where the students originate from. Till now our students are recruited from two provinces (Zones) South Omo Zone and Bench Maji Zone. Next year (2019) the selection of students will be extended with Segen Area Zone. In the year 2020 Dawro Zone will be the fourth Zone to be added for the recruitement of new students. Already before this year ends, all five students from South Omo Zone have visited Jinka General Hospital and the two students from Bench Maji Zone have returned to Mizan Aman General Hospital to join the two months enhanced midwifery skills training established by the SNNP Regional Health Bureau. In both hospitals daily ten or more deliveries are performed. This number indicates that all students at the end have at least performed the minimum number of deliveries, and even can reach the double number of deliveries.
10.2019 een student onderzoekt de hartslag van de baby
10.2019 Another student is examining the heart rate of the baby
Our five students from South Omo have started their enhanced training course on Tuesday 2 October. In the same week they travelled up and down to Arba Minch to pass COC exam. All five students passed their exam. This COC exam is mandatory for admittance to work at a Health Center. The two students from Bench Maji Zone still are busy with the COC exam course and they are expected to start their extra training in two weeks. Attached are several photographs of the students during training at Jinka General Hospital.
Seven of our midwifery students graduate September 2018

On 01.09.2018 Seven students graduate and on 05.10.2018 five students pass their C.O.C. exam

Seven of our students graduate on the same day - Saturday 1 September 2018 - at two places in the Southern Nations, Nationalities and People’s Region in south Ethiopia. Two delegations from the Regional Health Bureau have been travelling to the graduation ceremonies.
left to right: Amarech Tesfaye, Ribeka Alemayehu, Kibralem Wudie en Aster Abera
left to right: Amarech Tesfaye, Ribeka Alemayehu, Kibralem Wudie and Aster Abera
Five students graduate at the Arba Minch Health Science College. While four years ago two students dropped out, we added two extra students in the year 2016 to become a midwife. Arba Minch is situated at the centre of the state SNNPR, the Southern Nations, Nationalities and People’s Region. All students from South Omo Zone, studying with a scholarship and selected for our programme, join their studies at this Health Science College. At the Arba Minch Health Science College a ceremony had been organized while five hundred of their students graduate. These are laboratory assistants, pharmacy assistants, ict students, nurses and midwives, all graduating at the same time. Our five students, graduating at Arba Minch Health Science College, originate from South Omo Zone (one of the 14 provinces). Each Zone is subdivided in Weredas.
the students are swearing their oath
the students are going to take the oath
Two students, from Mallie Wereda, are Amarech Tesfaye, 21 years old, and Kibralem Wudie, also 21 years old. Both speak two local languages: Mallie and Gammo. Two other students originate from South Ari Wereda. Those students are Aster Abera, 22 years old and Ribeka Alemayehu, 21 years old. Both speak the local languages Ari and Benna. The fifth student is Hanna Mettena af, 20 years old and originating from Benna Tsemay Wereda. Hanna speaks Benna and a total different language Wolayita (the mother language of both her parents). Wolayita is not spoken in South Omo, but the fact that she speaks this language indicates that she also might work at Wolayita Zone. Then, two students graduate in a totally different place at Mizan Aman Health Science College, situated at the north-west of the state SNNPR. The head of the SNNP Regional Health Bureau, Dr. Abraham Alano, travelled to the ceremony this Health Care Training Facility and brought his approval to our students. The students from Mizan Aman are Elsa Birega, 24 years old, originating from South Bench Wereda, and Genet Habtamu, 19 years old, originating from Meinit Goldia Wereda. The languages that Elsa speaks are Bench and Shekko; Genet on her turn speaks Meinit and Bench.
Five graduates, the College Dean and Bilma F. Representative
Five graduates, the College Dean and Bilma F. Representative Mr. Tebeje Misganaw
For our training programme it is very important that the students origin from very remote areas (where at this time no midwife is active), and that the graduated midwives speak the local language that the pregnant women speak who are visiting the Health Center. At last we can inform that all five South Omo students passed their C.O.C. exam. And when they pass this exam, they are allowed to work at a Health Center. All students will work at least three years at a Health Center in the region where they originate from. This is a compulsory element for admittance to the Bilma Foundation Midwifery Training Project.
Four students graduate at two Training Institutes December 2017
Today a great festivity took place: four of our students - the first from our programme - have graduated.
Netsanet Abebe (21) - left, Elshaday Antneh (18) and Jemila Seleh (22) - right
Netsanet Abebe (21) - left, Elshaday Antneh (18) and Jemila Seleh (22) - right
Already on the 25th of August 2017 Arme Ayika Gashua, 22 years old, graduated at Arba Minch Health Science College. She started studies with two other students, but two of them dropped out. So she was the only one or our students graduating at Arba Minch College from the year 2015. Arme Ayika originates from Benna Tsemay Wereda (in the neighbourhood of Jinka, the capital of South Omo Zone - one of the two remote provinces from where we select our students. Arme Ayika speaks Benna and Tsemay, the two languages from her native area. The dropping out of the two students led to more strict rules for the admission of students, and no more incidents took place. However, this dropping out needed to select two extra students in the 2016 course, so eight new students were accepted in the programme to study in the year 2016.
alle studenten leggen tegelijk de eed af
all studenten take the oath simultanously
On 23rd of December 2017 three more students from Mizan Aman Health Science College graduated (see the photograph on top). Elshaday Antneh, almost 19 years on her graduation day and so she is the youngest of our three students. She originates from Maji Wereda, de region around the capital Maji of Bench Maji Zone (the other region from which we select our students from). Elshaday speaks Dizi and Meinit, two (from many) languages in this Zone. Netsanet Abebe, 21 years old, originates from one of the remotest areas in Bench Maji, which is called Surma Wereda. At the time of her graduation only one single midwife was assigned at the only Health Center you can find in the whole area. A set of new Health Centers will be constructed in due time. Another three new students from this Wereda have been admitted recently in the Bilma Foundation assisted midwifery training programme. Netsanet Abebe speaks Surma and Dizi. At Surma Wereda a huge segregation between two groups of inhabitants can be observed between the ‘highlanders’ and ‘lowlanders’. When a pregnant woman from the ‘lowlands’ experiences that a ‘highland’ midwife is taking care for her at a Health Center, this lady will not open her mouth and probably will reject professional aid at all. The recently admitted students in our programme originate from both ethnic groups. Our last student is Jemila Selih, also 22 years old and residing at Bero Wereda (almost half way between the capital Maji and the place where she now has been trained as a midwife. Jemila speaks Dizi and Surma. She will also be able to work in Surma area. As a matter of fact, all students speak Amharic - the common language in Ethiopia - with which each people understands each other. (But not in the remote areas, where they speak local language)
All students have to pass a mandatory exam two weeks after graduation, allowing them to be assigned at a Health Center. When you don’t pass, you are not allowed to work in the public sector. The only option is passing this exam. We are going to investigate (and upgrade our information) in which Health Center our students are going to work. At least our students are obliged to work in the public sector for a minimum of three years in the region of origin. When they don’t, the government will be able to take sanctions, like a reduction of payment of salary. But all students have promised to stay a longer time working in their region of origin. And there is also a very practical reason for this: they speak the local language of the pregnant women.
January 2017

Financial support for training of midwives in the SNNPR June 2014
Signing memorandum of understanding
Signing memorandum of understanding
Bilma Foundation is going to help with the training of midwives in remote areas of the Southern Nations, Nationalities and People’s Region (SNNPR). In the densely populated northern and eastern parts of the SNNPR a sufficient number of midwives are trained and active. But in the southern and western, remote and scarcely populated areas, a too low number of trained midwives are active to check pregnant women and to help them with delivery.\n\nBilma Foundation will financially support the training of young women in the remote areas to become a midwife with training at a Health Science College (at Diploma level). The candidates must have finalized 10th grade before application. For the implementation of this project a Memorandum of Understanding has been signed with the SNNP Regional State Health Bureau. According the project plan a yearly number of six candidates from the remote areas will be trained in three years. Bilma Foundation and her partner Stichting Adopteer een vroedvrouw will provide the financial means. When the project turns out to be successful, the yearly number of candidates will be upgraded.\n\n In the month May 2014 a Memorandum of Understanding has been signed, which turns a belonging project plan into effect. In this project plan it is stated that the midwives will work a mandatory period of three years in the area from where they originated. After resigning from this area the Regional Health Bureau is held to look for replacement of the midwife.
project plan
Memorandum of understanding
Non-clinician training of surgeons September 2012
Surgeon from Mozambique
Surgeon from Mozambique
Bilma Foundation is trying to help establish a three years bachelor’s training of surgeons at Hawassa University, the capital of the state Southern Nations, Nationalities and Peoples Region (SNNPR). It is allowing nurses and midwives with at least ten years of experience to apply for the training to become a surgeon, as this is practiced in many other countries already. The reason for the ten years of experience is that those who are admitted to the training will mostly have started a family. Which then is a good reason not to emigrate to United States or other developed countries. In Mozambique a similar training has been established for already 25 years, with comparable good results as physicians who became a surgeon.