This post was written by George Nkhoma.
My name is George Nkhomo and I work as a nurse and midwife in the rural district of Chitipa in Malawi. I grew up as a house boy, not knowing my real family. Then, after searching for my roots I learned that my mother died while giving birth to me. At that point I knew I wanted to do something to help other mothers and ultimately decided to become a midwife. I have been committed to make a difference for other mothers and babies ever since.
Malawian Midwives are among the most passionate and hardworking midwives in the world. In my District, most health centres operate with one midwife per facility. Most of these are dual qualified, which means they single handedly deliver all nursing and midwifery services to the whole catchment population. This means that providing services day and night, all month round, all year round is entirely his or her call. I am yet to know of another profession – in Malawi or beyond – that serves the population this much.
However, it is shocking how much our profession is understaffed. According to a 2016 survey by White Ribbon Alliance for Safe Motherhood Malawi (WRA Malawi), the country has only 3,233 bedside midwives serving a population of over 15 million. That means only one midwife per 1,200 women of child-bearing age, even as the World Health Organization recommends one midwife for every 175 women. While we often hear about the failure to achieve maternal, newborn MDGs and other subsequent goals, we hear less about the numbers of midwives we will need to achieve those targets.
Being one of those 3,233 bedside midwives, I have discovered throughout my practice that the current crop of professional midwives is determined to achieve results, however we work in a frighteningly poor environment.
We often work several 24-hour shifts for days in a row without a break. Recent government cuts have left midwives and patients without food. Our pay, the equivalent of $250 a month for those with advanced degrees like myself, doesn’t cover our basic living expenses so many midwives also have to farm or run small shops. We do not have the most basic supplies like sterile gloves; we lack fuel which can mean working in the dark or by mobile phone torch light.
The result of these working conditions is that women in our maternity wards give birth untended while midwives, often the only health worker on shift, rush between one life-threatening emergency and another.
It’s clear that Malawi has a critical shortage of all health workers. Yet while it is well known that we need doctors, clinical technicians, and nurses, the extent of the shortage of midwives is only now emerging.
If Malawi is to achieve its Sustainable Development Goals, this needs to be well looked into at the planning phase. Our government needs understand that we are not the same as nurses, and to train and employ more midwives.
Malawi did well in achieving some of the MDGs, including the reduction of child mortality, much of which was due to immunisations. However child mortality includes newborns as well as babies and children under five. Thirty percent of all child deaths globally are amongst newborns. Premature births in Malawi remain among the highest in the world at 18.1% according to the World Health Organization (WHO), and neonatal mortality remains unacceptably high. It is the skills of midwives which can prevent these deaths. Midwives can also prevent the needless deaths of far too many Malawian mothers who continue to die while giving birth.
Midwifery is the face of the health sector in any country, deserving of the utmost attention, not the status quo. The health indicators it drives are determinants of health for any nation. Yet with such low numbers of midwives, poor motivation and working conditions, limited openings for professional growth and declining supply of resources, the future of my profession remains uncertain. The pressures we go through, the dilemmas we encounter, the commitment we give, the good work we do is all unacknowledged and seemingly unappreciated by society. These conditions make it hard to give mothers and newborns the quality, respectful care they deserve. But we are doing our best, and we are making a difference.
There are regrettably a few midwives who are misplaced in this dear profession and who have given us a bad name. This is typical of individuals in every profession, but the wonder is – why has their behavior resulted in such negative generalizations about the whole of midwifery? There is an old Malawian saying; nsomba ikawola imodzi zose zawola, which means ‘one bad fish means all are bad’. But we are not fish, we are midwives, and all but a very few are highly admirable professionals.
At the pace we are going, we are unlikely to achieve Malawi’s national safe motherhood targets: to ensure that all pregnant women deliver at a health facility; no woman dies in childbirth; no newborn or child under dies; that all pregnant women attend antenatal care as early as they recognize they are pregnant. But the negative stories so often published in our newspapers are pulling against our efforts.
Instead, the media should be highlighting the need for our government to invest in midwifery. They should also promote health seeking behaviour in our people, and show how the best practices of midwives keep people healthy. Better to do this than to magnify one mistake made by one midwife and tarnish our whole profession.
This and more is why I recently took part in a workshop by White Ribbon Alliance, graduating as one of the first ever midwife Citizen Journalists in Africa. I am working to change the image of midwives by writing and speaking about the true state of my profession.
I am a midwife by choice, not by chance, and I am proud of my profession.
George Nkhoma is a passionate midwife and manager at Chitipa District Hospital in Malawi. His interest in midwifery grew from personal experience in that his mother lost her life giving birth to him.
George graduated from Mzuzu University in 2013 and joined Chitipa district hospital in May 2013, where he also serves as the maternity department unit manager and safe motherhood coordinator.
Featured image: Hospital in Malawi. Copyright White Ribbon Alliance