Matthew Rodieck

Afghan Amputees for Bicycle Rehabilitation And Recreation,Afghanistan

Abstract Title: Afghan Midwifery in Remote Areas: A Pilot Project of Asynchronous Telemedicine in Rural Bamyan Province

Biography:

For over 35 years Matthew has worked and volunteered in planning and management of medical services and Health System Strengthening, in education as a teacher and Higher Education as a manager, guiding research and evaluation, delivering training and skills development, advising on policy and advocacy in disability inclusion, and engaging in Disaster Risks Management in settings as varied as the US, UK, Saudi Arabia, and Afghanistan. He has now spent more than half his career in Afghanistan and is currently focused on Afghan Maternal and Newborn Health and Health Systems Strengthening as they relate to Midwifery and Midwife development.

Research Interest:

Afghanistan continues to endure some of the world’s highest rates of maternal and neonatal mortality. While reliable data is difficult to obtain under current Taliban rule, it is well-established that Bamyan Province, a rural and mountainous area, has long struggled with limited availability of medical services due to low investment in development of the health system, poor road infrastructure, and social-cultural barriers restricting women’s independent mobility outside the home. Following NATO’s withdrawal and the Taliban seizing power in 2021 the ongoing lack of skilled female medical providers, an uncoordinated referral system, and persistently low community awareness have further endangered pregnant women, adolescent girls, and newborns. Preventable complications remain undetected and unaddressed for many women, leading to avoidable deaths and ever-lower levels of trust in the already weakened health system. During 2022, Afghan multi-Sector NGO “AABRAR” (Afghan Amputees for Bicycle Rehabilitation And Recreation) designed a pilot project in Bamyan to confront these difficulties with practical solutions. After assembling a team of 22 qualified Midwives from the local community, AABRAR provided community-based Midwifery that utilized asynchronous telemedicine to link home-based services with a Supervising Midwife-led clinical hub. Each Community Midwife’s husband was also recruited as a Community Midwifery Assistant (CMA), functioning as her required “mahram” (escort) to overcome Taliban restrictions on women’s independent movement. Project Midwives received further training to develop their clinical, technical, and professional skills; CMAs were trained in practical approaches to health communications and social change to promote improved knowledge, attitudes, and behavior among men and boys in each patient’s household. Each Midwife-CMA pair was assigned a catchment area within designated “white areas” of Bamyan where primary care or Midwifery was unavailable. Telemedicine supported Midwife-CMA teams successfully guided households on referral pathways to access higher levels of care, timely decision-making, and risks management for expectant Mothers and newborns.