Digital Health for Migrant Mothers Network: Maternal Care in Dadaab Camps

我们的网络名为“移民母亲的数字健康”，在联合国、非洲和英国的学术界、工业界（非洲虚拟现实公司“黑犀牛”）和助产士之间建立了一个创新的合作，以探索如何使用数字化工具来加强难民营环境中的孕产妇护理。联合国指出，尽管全球趋势有所改善，但生活在难民营等人道主义环境中的妇女的孕产妇和新生儿死亡率仍然不成比例地高。这一挑战的核心组成部分是缺乏训练有素的助产士，应对妇女孕产妇保健面临的这些紧迫挑战已被战略性地确定为可持续发展目标的一部分（5和3）。我们的项目建立在以前的GCRF资助的研究（“在边境出生”PI Bagelman），并解决了世界上最大和历史最长的难民营之一的这些挑战：肯尼亚的达达布难民营，与索马里接壤。达达布难民营目前收容了40多万难民（40%的育龄妇女），孕产妇发病率和死亡率非常高（Gee等人，2019年）。我们的项目提出了一个创新的网络，汇集了一个多元化但一致的团队，共同设计一个数字健康应对措施，以应对长期流离失所环境中移民母亲面临的紧迫挑战。我们的项目本质上是合作的，采用灵活的参与式研究模式，而不是从上面强加模型。鉴于迫切需要助产士在孕产妇护理的数字化提供和教育方面发挥更大的作用，我们的项目将开发一个参与网络，以探索“培训”助产士的可能性，通过设计联合国支持的助产教育数字“教学工具包”来提高他们的数字素养。与该地区其他艰苦地区相比，孕产妇和新生儿死亡率高得不成比例（Gee等人，2019）。研究表明，这种差异是由于难民营内产妇护理系统性脱节造成的：虽然大多数难民妇女依赖助产士（因为她们认为助产士提供情感和文化敏感的支持），但只有少数受过训练的助产士可用（Bagelman等人，即将出版。参见CV）。尽管助产士在支持难民进行产前和产后护理方面发挥着关键作用，但助产士培训仍然资源不足，而且是临时性的。虽然为促进生物医学从业者的数字化学习和培训专门拨出了大量资源，但助产士主导的健康教育平台仍然支持不足（世卫组织，2016年）。特别是，大多数助产士仍然无法使用数字健康工具。例如，虽然虚拟现实（VR）已经在生物医学界作为一种富有成效的学习和教学机制得到了很好的建立，但助产士几乎没有机会使用这些工具。这一数字鸿沟之所以成问题，主要有两个原因：（1）数字技术的缺乏削弱了妇女提供护理的能力;（2）直接影响到难民营中依赖-有时完全依赖-助产士接受护理的难民妇女。总之，我们的网络将非洲的数字专业知识放在首位，在其方法中考虑了性别因素，并以那些在数字辩论中经常被边缘化的人为中心，以促进应急营地地区的创新和敏捷响应。Vargas，J.和Foster，A.M.，2019.“探讨社会文化背景的作用以及对肯尼亚难民署支助的难民营中索马里难民孕产妇和新生儿保健护理的看法”。冲突与健康，13（1），第11页。

Our Network entitled 'Digital Health for Migrant Mothers' establishes an innovative collaboration between the UN, African and UK-based academics, industry (African-based VR company 'Black Rhino') and midwives to explore how digital tools can be used to enhance maternal care for refugees within camp environments. The UN has noted that despite improving global trends, maternal and neonatal mortality rates remain disproportionately high for women living in humanitarian settings, such as refugee camps. A central component in this challenge is the lack of trained midwifes with Combating these pressing challenges facing women's maternal health care has been strategically identified as part of the SDGs (5 & 3). Our project builds upon previous GCRF-funded research ('Birthing at the Borders' PI Bagelman) and addresses these challenges in one of the worlds' largest and longest-standing refugee camps: Dadaab camps in Kenya which borders Somalia. The Dadaab camps currently host over 400,000 refuges (40% of reproductive age) where maternal morbidity and mortality is notably high (Gee et al, 2019). Our project proposes an innovative Network bringing together a diverse but coherent team to co-design a digital health response to the urgent challenges facing migrant mothers in an environment of protracted displacement. Our project is collaborative in nature, employing agile participatory modes of research rather than imposing models from above. Given the urgent need for midwives to have a more empowered role in the digital provision and education of maternal care our project will develop an engaged Network to explore the possibilities of 'training up' midwives, enhancing their digital literacy through the design of digital 'teaching toolkits' for midwifery education supported by UN.Despite significant international funding spent on reproductive health in Dadaab, maternal and neonatal death rates are disproportionately high as compared to other hardship areas in the region (Gee et al, 2019). Research demonstrates that this discrepancy is due to a systemic disconnect in maternal care within the camp: while most refugee women rely on midwives (as they perceived to provide emotional, culturally-sensitive support) there are only few trained midwives available (Bagelman et al, forthcoming. See CV). Despite the key role that midwives play in supporting refugees in pre to post-natal care, midwifery training remains under-resourced and designed on an ad-hoc basis. While significant resources are earmarked for promoting digital learning and training for biomedical practitioners, midwifery-led health education platforms remain under-supported (WHO, 2016). In particular, digital health tools remain inaccessible to most midwives. For instance, while Virtual Reality (VR) have been well-established within biomedical communities as a productive mechanism for learning and teaching, midwives have little access to such tools. This digital gap is problematic for two main reasons: 1) the absence of digital technology underprivileges women in their ability to provide care 2) and directly impinges upon refugee women in camps who rely - sometimes exclusively - on midwives in receiving care. In sum, our Network places primacy on African digital expertise, is gendered in its approach and centres those often marginalised in digital debates to promote an innovative, and agile response in emergency camp geographies.Reference: Gee, S., Vargas, J. and Foster, A.M., 2019. "exploring the role of sociocultural context and perceptions of care on maternal and newborn health among Somali refugees in UNHCR supported camps in Kenya". Conflict and health, 13(1), p.11.