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By Sabine Clappaert
(WNN) Deauville, FRANCE : “I came here to stand up for the voiceless mothers of Africa,” says thirty-one-year-old Ugandan nurse midwife and woman’s advocate Esther Madudu at Global Meeting 2011 of the Women’s Forum for Economy and Society in Deauville, France.
She begins with murmured conversations dying down to hear her speak. “When people ask me: ‘What can we do to help you do your job?’ I answer: I need more of me. Every year, more than 200,000 women in Sub-Saharan Africa die during pregnancy or childbirth, just because medical care was too expensive or difficult to reach.”
The facts in much of Uganda and Sub-Saharan Africa present a harsh reality: only 28% of all health centres have the required supplies and equipment to offer basic emergency obstetric care, while 32% of hospitals in the districts have the supplies, equipment and staff to offer patients caesarean sections.
Madudu knows the dusty plains of the Soroti district in eastern Uganda like the back of her hand. She has lived there all her life. She has walked its trails and knows what the vast distances of Africa mean to the reality of its inhabitants. “I was eleven when I saw a woman deliver her baby next to the road,” she says.
The incident made a huge impression on the young girl, who decided to become a midwife. “I wanted to save mothers and babies,” she adds.
Saving mothers and babies is proving more than a full-time job for Esther, who now lives next to the local hospital, in a house she shares with three other families. Esther works as one of two midwives that attend to pregnant women throughout the region.
Getting up every morning at 5:30 Esther prepares breakfast for herself and her two young children. She then also prepares their lunch and dinner. “I don’t have time to come back home during the day so I prepare everything before I go to work,” she outlines.
Some days are busier than others and on the really busy ones, Esther can see up to forty women in a day. “And you know that more babies are born at night, so I have to be ready all the time,” she outlines.
But things are looking up: the hospital now has a doctor and Esther has heard rumors of an ambulance.
“Recognizing the importance of the role of midwives in improving maternal health, the professional scope of midwives has been expanded to include responsibilities that were previously reserved for medical doctors,” said Uganda’s Makerere University Institute of Public Health in 1999. “The administration of intravenous fluids, prescription of antibiotics, manual removal of the placenta and use of manual vacuum aspiration machines in post-abortion management are some of the new responsibilities that have been transferred to midwives,” continued the Institute of Public Health.
Conditions for much of Uganda’s medical facilities is basic at best. “Everything you take for granted in western hospitals, we don’t have,” says Madudu. “No electricity, no running water. It’s hard to encourage a woman to push with a mobile phone clenched between your teeth to cast some light (in the room),” she adds.
In the glaring stage lights of an assembled international press, Esther sits (at the Global Meeting 2011 conference), surrounded by other dignitaries. She sits calmly; her hands folded neatly in her lap; her eyes scanning the audience from behind plain wire-rimed glasses. Swathed in a sunny orange sarong her face is framed by a turban, with a ‘cheeky bow.’ Madudu looks like a beautiful exotic peacock here among the demure grey of the Western European delegation.
Everyone on the panel speaks; of the need to educate local communities; of the urgency in building decent medical facilities; of the hardships they have witnessed on their trips to Africa.
When Esther is handed the microphone her voice booms confidently through the darkened hall.
“The only medicine we have to give women is ‘Verbacane’,” says Esther explaining the practice for Uganda’s nurse midwives of providing emotional reassurance to a client by talking to and physically soothing her. While women living in remote rural areas are used to having little access to health care or medicines, they are also the ones who are often at risk of dying from complications in childbirth.
For the women there is often little to no access to qualified health personnel or well equipped facilities. Where access to skilled midwives, antibiotics, obstetricians and medical intervention, are taken for granted, they are regarded as luxuries in many regions of Africa. Uganda is only one country of many particularly in need in Africa.
Challenges for midwives with transportation, improper or non-functional medical equipment and lack of doctors and supporting medical staff are ongoing. Engaged campaign donations, along with specific state management and follow-through, are key to improving these and other conditions, including conditions that may lead to an increase in maternal mortality.
“The lack of midwifery health cadres in remote areas together with poor pre-service education are key bottlenecks that need to be further addressed in Uganda’s health policies. For instance, only 55 percent of facilities offering deliveries have a trained provider on site 24 hours per day, while 1 percent have a skilled provider on call 24 hours a day,” said the Millennium Development Goals Report for Uganda 2010.
While proper medical equipment is a tangible challenge, “Evidence suggests that only 5 percent of facilities have a vacuum extractor (used for assisted vaginal delivery) and only 10 percent have the kit needed to remove a retained placenta,” continues the 2010 report.
“But we can fix this,” outlines Esther as she talks about the specific function midwives hold for women who need their assistance, “if we invest in building proper health facilities, educate women to come to our clinics for check-ups and when they go into labor and if we can train more midwives, we can fix this.”
I talked with Esther in northern France as she attended the Women’s Forum Global Meeting to launch the AMREF – African Medical and Research Foundation “Stand Up for African Mothers” campaign, which aims to educate another 30,000 midwives throughout Sub-Saharan Africa by 2015.
With 50 years experience in health development, AMREF was founded in 1957 by three surgeons: Thomas Rees, Sir Michael Wood and Archibald McIndoe who were known as the Flying Doctor Service of East Africa, which later became AMREF, one of the continent’s most respected health development organisations.
Following the Women’s Forum for Economy and Society press conference and an official signing of the campaign’s petition to applause and flashing cameras, Esther and I sat down to talk in a quiet corner away from the crowds, dignitaries and PR people.
It was Esther’s first time outside Uganda. It was also her first time on an airplane. She flew – alone – from Kampala via Nairobi to Paris. “I’ve never seen an airport like that one in Nairobi,” she says shaking her head in disbelief. “So big and so busy! But I told myself: ‘Esther, don’t panic. Just do one thing at a time.’ And so here I am,” she smiles.
During our interview we talk of her job as a midwife and what her perfect day looks like (one in which none of the women she attends to is HIV positive); about flying and the feeling take-off leaves in one’s stomach; about her wayward husband and two kids that should have been three.
“I am here because I want the world to understand the importance of midwives in Africa,” she says. “When I was 29, I lost a baby because the only two midwives at our hospital were in the theatre (field) busy delivering babies. There was no one left to look after those of us in labor. My baby died because it went into distress and couldn’t be delivered quick enough. That is no reason for a baby to die…”
During a moment of silence Esther is lost to her memory which cocoons us. I am silent, helpless to offer any meaningful words to her. “I don’t want that to happen to any woman,” she outlines. “The lives of those women and babies are (now) in my hands.”
As an AMREF representative walks over to whisk Esther away from our interview and off to lunch, I ask whether she has bought any presents to take back home to her family. She shakes her head, eyes cast to the ground. “No, I don’t have my own money here so I can’t buy presents.” An uncomfortable silence follows as I realize that my question spotlights my own comfortable western life. “But they’ll be so happy to see me when I get back home, that is my present to them!” she beams.
Improving conditions for women who enter careers as nurse midwives must now include combined efforts inside and outside Uganda to properly recruit, train and enable midwives to reach their oftentimes vast miles of travel needed to serve districts that span rural areas. Following a Ministry of Health directive to improve education in Uganda then years ago nurse midwives now take three years to complete their studies as many women face uncountable conditions of hardship in the field. In spite of this, numerous women are not offered promotions to higher positions within the medical community.
“In order to achieve the best maternal health outcome there is need for skilled personnel with midwifery skills and a well functioning referral system,” says the current outline in the Millennium Development Goals Report for Uganda 2010.
Esther Madudu’s tireless work and desire to improve conditions for women inside Uganda is invaluable to her community and to the rest of the world.
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