Malawi’s missing midwives

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.

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Mothers who die, and worse, on International Women’s Day

We brought a new mattress, but the sooner we have a new building the better.

We brought a new mattress, but the sooner we have a new building the better.

Because I am not someone who reads books my family sent me off with loads of appropriate articles for my two week break in Madeira, knowing that I won’t stop working anyway.
One series from the New Internationalist has me in tears, having learned earlier that it was International Women’s day, whatever that may mean, when it’s at home! The old Malawian priest, who had spent most of his days in California, was engaging on this, and on transfiguration, which was the gospel for today.
In February, Charity, our human relations guru in Malawi told us of one of our women (she lives where we work in Lusangazi) who assists villagers, with the birth of their children in her home. She is a birth attendant and has got some government training. The news came on the last day of our visit and we are relying on pictures for the visuals.
We asked how W4Z could help her out. The shopping list was short and shocking; she needed plastic for the roof to keep the water out, a plastic apron, plastic gloves if it was possible, wellingtons, a torch and later a mattress. This to me, looks like the biggest big step backwards from the stable Bethlahem.
This women needs all the help we can give, like a new building, a water pump for clean water, a concrete floor, hygienic walls, a little equipment, not to mention drugs, painkillers. You might well ask, how would I know, but when I had kidney stones recently, the nurses told me that the pain is something like child birth; I wouldn’t wish it on my worst enemy; I wanted to die it was so bad.
We didn’t commit to Malawi to do anything for thousands of people, we thought in terms of one at a time; one well, one pump, one dam and now alleviating the suffering of one woman or one newborn.
You might think it simplistic, but should we wait for someone else, the government maybe, UNICEF or the UN, who will spend fortunes on research and white jeeps; no, we’ll give it a try and we are now on it.
BUT it is not that simple. Most, 34% of maternal deaths are as a result of haemorrhage, which needs serious consideration, as does the whole package of HIV/Aids, Infection, Hypertension, Anaemia or Obstructed labour. Childbirth seems natural and simple yet it’s not.
Thankfully advice and help is on the way from homebirth midwife and daughter in law, Melissa and friend Johanna.
If this program is to expand, we need training for these remote, rural, birth attendants, Midwife help, ante and post natal clinics and of course an ambulance service.
In Malawi, there are 16 maternal and 37 neonatal infant deaths every day. Drastically understaffed, 95% of the country’s midwives are based in urban centres while most of the population, and deaths, are in the countryside. Nurse midwives are scarce in rural areas, because the work can be seven days a week, as babies don’t recognise weekends. People with such qualifications prefer to work for NGO’s, with less work and more pay, if they stay in Malawi at all.
In Malawi, most rural women give birth at home as a result of the long travel distance and the poor roads; the average travel distance is 20km, on foot, on a bicycle or a wheelbarrow!!
Now comes the worse bit!
The most demeaning nightmare any woman could suffer is what is called an obstetric fistula, caused by prolonged labour where pressure of the child’s head on the pelvis tissue creates a hole which leads to an inability to control urine and faeces. A practice in parts of Malawi which exacerbates this is that the decision to seek medical help is in the hands of the Uncle. You can imagine what happens if he is not cooperative, not around or drunk.
Another traditional or chosen belief is that the first born should be born at home, so that the father should attend, believing that complications indicate infidelity. Pregnancies at a young age, also adds to the number.
Finally Malawi has one doctor and four clinical officers, qualified to carry out fistula repairs in all of Malawi, for 16 million of a population.
Oh! About 8 million won’t ever have this problem.
Every child born is a miracle, but every fistula repaired must be the greatest miracle of all for those women who are chased from their homes, banished by their communities to live and die destitute.
Malawi will tell you it’s the warm heart of Africa, what a load of rubbish
If our little action saves one life, then it will be worthwhile.
Would you like to help us?