BEING A MIDWIFE IN MALAWI Presented by Rose Piaroza Chamanga MSN, RNM Principal Lecturer Malawi College of Health Sciences International Day of Midwives Aberdeen,Scotland MAY -5, 2014

Presentation outline Background of Malawi Context update Midwifery in Malawi Being a midwife in Malawi A day in the work of a Malawian midwife (scenarios) Lessons learned Conclusion`

Background of Malawi Meaning ‘flames of fire’ is named after the shimmering effect of Lake Malawi in the sun It is a land locked country in south eastern Africa, about 118,000 km² Has a population of about 15.4 Million 85 % of this population live in rural area, and depend on agriculture for their livelihood

Context update Total fertility rate 5.7 Life expectancy 48 years (male) 50 years (female) Unmet need for family planning is 42% Births attended by skilled personnel is 71 % Neonate mortality rate is 31 per 1000 live births HIV prevalence among adults (15-49)is 11.8 % Maternal mortality rate per 100,000 live births is 675

Malawian Midwife: Training 3 Cadres of nurse/midwives ◦ Registered nurse/midwives  BSc in nursing/midwifery  Diploma in nursing/midwifery  Kamuzu College of Nursing, Mzuzu University and Malawi College of Health Science (MCHS) ◦ Nurse/Midwife Technician  College diploma in nursing  Christian Health Association of Malawi (CHAM) colleges and MCHS ◦ Community Midwife Assistants ◦ 18 months training ◦ CHAM colleges and MCHS Nurses and Midwife council of Malawi regulates the nursing/midwifery training and practice

Being A midwife in Malawi Both a fulfilling and challenging profession

A day in the work of a Malawian midwife Scenario A ◦ Midwife R at a health centre receives a 14 year old teenager with incomplete abortion ◦ She prepares her for Manual vacuum Aspiration but discovered that the syringe was not functioning and there was no valium for sedating the patient ◦ The midwife called for an ambulance, but it never came ◦ Advised the mother to take the daughter to the District Hospital (DH) which was 22km away from the Health Centre (HC)

Scenario A cont. ◦ Three weeks later the adolescent was brought to the health centre very sick with pusy PV bleeding which was green in colour and foul smelling, in shock and very anaemic ◦ She died within few minutes of her arrival to the health centre while the midwife was trying to resuscitate her

A day in the work of a midwife Scenario B ◦ A midwife arrives at a central hospital for her night shift in the labour ward ◦ There are only 2 nurses on duty with 40 patients to attend to ◦ She attends to a cubicle where the woman is in second stage as she starts to assist that patient, the patient on the next bed starts screaming for help. ◦ After the midwife has finished with the first delivery she moves to the next bed where she finds the baby already out lying on the bed. The woman is also bleeding profusely

Scenario B cont.. She calls for help, but the other midwife had gone to theatre to receive the baby after caesarean section of another patient She takes the baby who is cold and needs observation in a heater. She can not take the baby to nursery because she wants to go back to put an IV line in the mother She places the baby on the heater and rushes back to resuscitate the mother She manages to put an IV line and takes blood for FBC and cross match. She also finishes up management of third stage. She informs the doctor who is in theatre performing a caesarean section

Scenario B cont.. Patient continues bleeding despite uterine message Dies in the theatre at the resuscitation table while waiting to be taken into theatre for examination under anaesthesia

A day in the work of a midwife; Lessons learned Health facilities in Malawi are running with critical shortage of nurse/midwives and other medical professions e.g. physicians. They also lack medical supplies, essential drugs and equipment. Its referral system is also poor This makes the provision of patient care especially the vulnerable groups such as pregnant women very difficult, and the midwife is ended up frustrated, distressed and demotivated

A day in the work of a midwife Scenario C ◦ Midwife H is on day duty at the central hospital ◦ She receives a referral from the health centre of a multigravida with high blood pressure ◦ As she is receiving the patient, the patient starts to have convulsions ◦ The midwife calls for help, of which a student nurse/midwife responds ◦ Together they are able to place an IV and start the woman on MgSO4

Scenario C cont.. Further evaluations reveals she is fully dilated with a descent of 1/5 The Midwife is able to perform a vacuum extraction and extracts live male infant birth weight of 2700 grammes, Apgar scores of 6/10- 8/10

A day in the work of a midwife; Lessons learned Midwives in Malawi are knowledgeable,skilful and competent in the way they carry out their duties They are able to make right decisions regarding their patients’ care and carry out procedures to save the lives of mothers and babies

CONCLUSION With 675 maternal deaths per 100,000 live births, 11percent of HIV seroprevalence, severe shortage of human resources for health at every level of service delivery, and critical shortage of medical supplies and equipment, a midwife in Malawi face almost impossible challenges to provide optimal care to the women However, despite all these challenges, a Malawian midwife surpasses all those odds and challenges and still provide care to the mothers.

Conclusion cont… She is able to do that because she is courageous, knowledgeable, skilful, competent, self motivated, patriotic, and able to cope up with stress. She therefore works amidst and above those enamours challenges and difficulties in order to provide care to the mothers! THIS IS WHAT IT TAKES TO BEING A MIDWIFE IN MALAWI!!!!!!!!

A Malawian Midwife

THANK YOU FOR YOUR ATTENTION!