Midwife Diaries
Anane Johannes, Midwife:
"My day begins at 8am when my first job is to check if anyone in the
delivery room has begun labour. My priority is to care for and support
the women during labour.
At 8.30am I accompany the doctors on their ward round, if I am not
required in the delivery room. The round is usually carried out by the
Surgeon.
During
the ward round all the women are assessed and their care is discussed.
If it is appropriate the women are discharged. It is my role as a
midwife to provide the women with the information they need for a safe
discharge. This covers hygiene, breastfeeding, nutrition, family
planning and the immunizations their baby requires.
I attended the Goba Nursing School where I was awarded a diploma in
Midwifery. I have worked for Maternity Worldwide at the Gimbie Hospital
for the last two years. At times the job is difficult, but I find my
work deeply fulfilling."
Moya Crangle, Midwife:
"Gimbie is a dusty town in western Ethiopia at an altitude of
approximately 2,000 meters and has approximately 26,000 inhabitants.
The house I live in is located within the hospital compound. The
100-bedded general hospital provides 24- hour health services,
including obstetrics. Since the beginning of October, there has been,
on average, 64 deliveries a month. Over the last two years, Maternity
Worldwide has been upgrading the hospital to provide Comprehensive
Essential Obstetric Care services, health education in the outlying
villages and implementing a voucher scheme (Safe Birth Fund) to allow
the most deprived women to access maternity services.
As part of my work as a midwife I have been providing health
education in the local communities about the major causes of maternal
mortality: prolonged obstructed labour, haemorrhage, eclampsia and
infection. I have been holding sessions to raise awareness of the
danger signs, encouraging the use of maternity services and advising
women and their family to prepare in advance for such emergencies.
Preparation includes: arranging transportation, care-providers and
potential blood donors for emergencies. I have come to learn that some
people don't get medical help, even when they need it because they are
afraid of the cost associated with it. It costs about £15 for a normal
vaginal delivery and up to £90 for a caesarean section.To encourage
people to get treatment for maternity problems, we inform them about
the voucher scheme.
Going out into the rural communities makes one realize just what it
takes for a labouring woman to get to the hospital. The terrain is very
rough with rocky footpaths, steep hills, cliffs and wobbly bridges made
of logs. There are no phones, no electricity and no cars. A group of
10-20 people are required to carry a woman by stretcher to the hospital
so that they can each take turns during the 2-5 hour hike to get to the
hospital. By the time the woman and her husband realise that she has a
problem, find the necessary money to pay for health services, assemble
the chair with poles to use as a stretcher, gather the group of people
necessary to transport her and then make the journey itself, many vital
hours have passed. When a woman with delivery complications finally
arrives she is usually fully dilated, sometimes has a ruptured uterus
and quite frequently the baby has died.
It's amazing how these women endure the birthing process that we regard
as a 'normal physiological process' in the West. However, since I've
been here, I have counted three maternal deaths that occurred just
outside the main doors of the hospital. The one that upsets me the most
was a mother of three and a teacher - a valuable member of her family
as well as her community. I was standing in the front hall of the
hospital when she arrived by public bus and was pronounced dead on
arrival. She came from a village health clinic that is only 45 minutes
away, but on that day it took her five hours to get here. It was a
preventable and treatable death that wouldn't have occurred in a 'high
income' country. There's nothing more horrible than hearing the wailing
of friends and family with the sad news that a mother has died.
But there are also very happy moments. For example, when a women came
into the hospital with eclamptic fits, one of the biggest killers in
pregnancy. We were fortunate enough to have the necessary medications,
protocols and experienced staff available to help her. At home it is
extremely rare to see someone fitting, because most women receive
antenatal care and are delivered before a problem develops. The
majority of women here do not receive antenatal care because they
cannot afford it (it costs about £1). It was amazing to see her recover
after the birth of the baby.
My experience as a midwife in Gimbie is like a roller coaster
with up and down moments. There are moments when you feel quite
frustrated, trying to deal with the language and cultural barriers on
top of the lack of resources. It is joyful when you see the difference
that your work has made. Even the smallest gesture of changing the
bedsheets or giving a women a bar of soap so that she can shower is
rewarded with 'gallatoma' (thank you), a grateful smile and a
handshake.
Working out here makes one appreciate those things that we take for
granted back home: universal health care, phones, electricity, paved
roads, cars/ambulance service, education, nutrition and better
socio-economic status for women. The most amazing think I find is that
despite all the poverty and hardship that the Ethiopians face, they
don't complain very much. One thing I have come to realize living out
here is how little a person requires to be happy. I feel that I'm doing
some worthwhile work, I am in good health, I have good food on the
table and a stable roof over my head. Life feels pretty simple out here
and I feel very fortunate."
