The Guardian March 8, 2011
Just found this article by Brigid McConville on a day when new President, Joyce Banda took a leaf from Bingu’s (the late President) notebook and banned Traditional Birth Attendants TBAs.
In the past 3 years few nurses were trained, as Bingu’s government failed to fund nursing student fees. So my question is where will the nurses come from. One of the most serious issues in Malawi today
Is there any chance of up-skilling the more skilled TBA’s in the short term?
• Brigid McConville is director of the White Ribbon Alliance for Safe Motherhood (UK)
In Malawi the risks of women dying in childbirth are among the highest in the world, and local women need to be empowered to press for change. Malawi is crucially lacking in midwives and nurses, with around three-quarters of staff positions vacant. On a fact-finding missing to Malawi, I can’t help noticing a 5 metre-high billboard at Lilongwe airport: a young woman in jogging gear and headphones advertising an offer of high-speed downloads, live TV, music and video calls. Mobile phone technology has truly arrived.
But midwives and nurses still haven’t. Around three-quarters of staff positions in Malawi are vacant, and sometimes women are arriving at health facilities in rural areas to give birth – to find only a cleaner to assist them. It’s only 50-50 that a woman in Malawi will have a midwife, nurse or doctor on hand in childbirth; the rest give birth alone or with only a neighbour to help.
In this small country, the risks of women dying in childbirth are among the highest in the world: 510 women will die for every 100,000 who give birth, compared with 12 in the UK. The loss of newborns is so common that they are not buried as other people are, but often in a nameless, limbo category of their own.
Lennie Kamwendo, a stalwart of the White Ribbon Alliance for Safe Motherhood and former president of the Association of Malawian Midwives, has been a newspaper agony aunt for many years. In a country where it’s difficult to talk about sexual health openly, she put her mobile phone number on her column and took calls from women day and night – at no charge.
Kamwendo is immensely proud of the profession of midwifery. Yet her colleagues, especially in the remote rural areas where 90% of Malawians live, are often working alone, day and night, to save women’s lives without the back-up they need. When things go wrong, they get blamed. When the health clinic is late to open because the nurse or midwife needed a few hours of sleep, lives are put at risk and communities are angry. When exhausted midwives respond rudely, word gets out and women don’t come – again putting lives at risk.
A few years ago, the government simply cancelled all training of health workers; the midwives trade union and others threatened a strike, and training was restored – but a year’s “crop” of health workers was lost. And that was only 500. Meanwhile, the system lacks accountability. A medic told me how this year, as in previous years, doctors knew that blood banks didn’t have enough supplies to get through the Christmas season. But their views were not heard, and women died as a result. Did a minister or senior civil servant lose their job as a result? No.
Why aren’t people up in arms about this needless loss of life? Levels of literacy in Malawi are low, and only around half of women can read. Midwives told me that women tend to think of professional healthcare as a privilege rather than as their right. So when things go wrong, they don’t complain.
Only when women are aware of the dangers of giving birth without skilled care, and know their rights to health services, can they press for change. Only when they are asked about their experiences – and listened to by policy-makers – will things move forward.
The White Ribbon Alliance in Malawi wants to make a film that will do just that – and show it in villages, on television, in parliament. Maybe the music will come from the charming permanent secretary at the ministry of health? Apart from his day job, he is a popular “selector”, known as Dr DJ. I heard about him from a young advocate in Lilongwe who regularly checks Facebook on her mobile phone.
So if phones and Facebook are available across Malawi, why not nurses and midwives?
The international community has promised resources to cut maternal deaths by three-quarters. The Malawian government has promised to invest in health workers. Let’s make sure these promises are kept.