Assessing the implementation of emergency obstetric and neonatal care (EmONC) in low-resource settings in Jember, Indonesia: a mixed-methods study

Maria Cellina "Celline" Wijaya, MBBS, MD, MMSc '24 (expected)

Maria Cellina WijayaCelline Wijaya is a medical doctor from Indonesia who is passionate about health literacy and education. Prior to joining the Master of Medical Sciences in Global Health Delivery program, she worked as a general physician in a primary care clinic and as a public health researcher in the Indonesian Obstetrics and Gynecology Association. An educator, Celline has published several op-eds in national newspapers and is active as an educational content creator on social media. Her most recent project, Healthworks Indonesia, aims to educate the Indonesian public on how the health system works and how to correctly access and utilize healthcare services.

All study participants gave permission for their photos to be taken and shared. Caregivers gave consent for children to be photographed and for their photos to be shared. 

Anahi Strader interview 2023

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Celline posing in front of her research site, Puskesmas Ambulu, a health facility in Indonesia.

The photograph showcases the first facility that I visited, which is named Puskesmas Ambuluhis. A Puskesmas is a community health centers, and the site of Celline's research. I visited several of these health facilities around Jember, a small town in East Java, in order to assess their implementation of the EmONC (Emergency Obstetric and Neonatal Care) program. Most of these facilities are situated approximately one hour away from the town center of Jember.

Celline pictured surrounded by 5 community members, all but one wearing green/brown hijabs. One woman is wearing blue and a matching hijab. Celline is seated 4th from the left. They are all seated in a clinical setting.

This is a photo of the individuals in the community who I collaborated with during my field project. The majority of them are experienced midwives. In the context of Emergency Obstetrical Services, and more generally, birth and delivery processes in Jember, these midwives possess knowledge surpassing that of OB/GYN specialists. When I initially arrived, I anticipated discussions with doctors, but I soon realized that the most insightful information came from these midwives. Many have over a decade of experience in assisting with deliveries. They have firsthand experience with the evolving maternal health policies in Jember's political landscape.

"This field research has profoundly altered my perception of midwives. I've come to regard them with heightened respect and deeply value their contributions to maternal health." ~Celline

Two young women wearing head coverings in a clinical setting. One holds a baby. Celline is seated talking with them.

In this photo, I am interviewing a postpartum patient. She was diagnosed with a high-risk pregnancy, and she had to deliver her baby in the community health center. In Jember, the prevailing culture still favors home deliveries or those at a midwife's house due to a pervasive distrust of health facilities and fear of being referred to a distant hospital in the city center. The patient expressed her gratitude that the community health center, being the closest health facility to her residence, provided a safe place for her delivery. She attended the interview with her healthy baby.

Two photos. Both of Celline interviewing a woman who is seated behind a desk.

These images depict my engagement with key informants during qualitative research. Captured within these moments are two distinct interviews: to the left, I am in conversation with the Chief of Medical Services at the Jember Health Department, and to the right, I am consulting with a coordinating midwife at a healthcare center. These visuals serve to illustrate the interactive process integral to gathering data for my thesis.

Two images. On the left, I stand before the Jember Health Department's signage, displaying the authorization letter for my research. Adjacent to this, on the right, is an image capturing the moment post-discussion with the Mayor of Jember,

The final postcard presents a visual narrative of my fieldwork. On the left, I stand before the Jember Health Department's signage, displaying the authorization letter for my research. Adjacent to this, on the right, is an image capturing the moment post-discussion with the Mayor of Jember, reflecting on the potential impact of her research on reducing maternal mortality rates in the region and in his town.

These photographs underscore the collaborative and official engagements pivotal to my study. This field research experience has granted me invaluable perspectives on the potential deficiencies in Jember’s maternal healthcare system. Moreover, it has facilitated the establishment of significant relationships that are essential for the future application and influence of this research.

Read more about the Master of Medical Sciences in Global Health Delivery program here.