Saving Lives through Training


Carmen received her certification as a competent, safe, and clean delivery provider.
Meet Carmen de Jesus Gusmao, a dedicated midwife and head of the maternity ward at the only referral hospital in Covalima, a remote and mountainous municipality in Timor Leste. Every day, Carmen helps deliver babies, provides antenatal care for pregnant women, ensures newborns get the care they need, provides family planning counseling and services for women, and manages the maternity ward staff.

Because Covalima is a bumpy seven-hour drive from Dili, the capital of Timor Leste, Carmen has not had many opportunities to update her midwifery skills since she graduated in 1997. In fact, since she started working, Carmen has never been assessed on her ability to provide any of the clinical services she performs on a daily basis.

Thanks to support from USAID’s Reinforce Basic Health Services Project, a maternal, newborn and child health project improving the quality of health services in Covalima, Carmen recently attended two competency-based trainings organized by the National Institute of Health (INS), Timor-Leste’s health worker training institution.

Clinically competent health workers are able to provide quality services and improve the health outcomes of the people they serve. Attaining clinical competency requires both knowledge and intensive practice in clinical skills labs and the work place, under close coaching and supervision from certified trainers.


During her clinical practice in Dili, Carmen calmly explains the delivery process to a young woman.
Carmen first attended an eight-day INS training on providing family planning counseling and services. She learned about the full range of available contraceptives and improved her communication skills to better counsel mothers and couples. Carmen was certified competent by the INS after she successfully inserted long-acting reversible contraceptives, which require higher clinical skills then other contraceptive methods. She had to practice many times, under the supervision of certified trainers, on both mannequins and real clients.

“Most women in Covalima want to space their children or have only a few so that they can live more comfortably, and for me it is important to be able to guide them in their choice of contraceptive,” said Carmen.

Attaining clinical competency with real patients took longer (as is the case for all trainees due to the limited number of patients available for practice), but in less than two months, Carmen was certified, along with 14 other midwives and doctors who participated in the training.


While the mother is about to deliver, Carmen methodically prepares her instruments and medicines to be used in the coming hour.
“Implementing the standards I learned during theory sessions and at the skills lab under close supervision gave me the confidence to apply them at the referral hospital,” said Carmen.

Carmen is a quick learner with great experience and newly certified clinical skills. The next step is for her to become a trainer in her municipality, Covalima. To fulfill demand for training among health workers, especially those who recently graduated, Timor-Leste needs trainers based in all municipalities. However, until she becomes a certified trainer, Carmen’s new knowledge and skills undoubtedly will benefit many families – and save lives – in Covalima.

A few months later Carmen was given a second training opportunity. Since most of her duties include assisting deliveries at the hospital (which accounts for half of the deliveries in Covalima), Carmen was selected to participate in a ten-day safe and clean delivery course in Dili. She successfully passed the theory with 98%, and under the supervision of certified trainers, she showed excellent skills practicing delivery techniques on mannequins, providing immediate newborn care and newborn resuscitation, and managing immediate complications during and after delivery.