Thursday, 18 July 2013

Conference Report

These last few days in Kenya I've spent at the 3rd Triennial International Confederation of Midwives East African Conference. I'm pleased to be here for a couple of reasons. One of those reasons is that I can further explore what's happening in the world of African midwifery, which is, after all, the main reason why I'm here, and the other is to have a little break before I leave. We won't count the weekend in Mombasa as that break, as that was unplanned and a bonus, kind of like the calories in the popcorn at the movies - it's part of the whole package!! 

See? You're relaxing just looking at that picture.... Nice break.

I'm interested to find out more about the progress of midwifery care, and what are the main issues, and I thought that you might be as well. So I'll give you a little overview.

Nearly every speaker makes reference to the Millennium Development Goals (MDG's - find a link in my first post) and the fact that Africa won't reach those goals, especially numbers four and five, within the specified time frames. They also all quote the maternal and infant mortality  rates as reasons behind the projects/research that they are compiling. 

The focus of many of the abstracts is improving maternity/midwifery care to meet the MDG's by enhancing skills and knowledge, enhancing care provision or by increasing care provision. 

It's all about healthy happy babies and mothers

I understand that midwives are not always midwives in Africa. I've come to understand that in Kenya, many midwives have chosen to work in a maternity capacity after the obstetric component of their nursing training. There are also midwifery courses as we understand them. I'm not sure how to tell the difference unless you ask someone. There are traditional birth attendants and there are midwifery assistants. All have a role to play. But it doesn't necessarily mean that women always have a skilled attendant.  In fact, many women don't, through necessity rather than choice. Hence the need for ongoing upskilling, or retraining. Or starting from scratch.

Happy mother and baby = happy midwife

Antenatal care seems to be a random event in Africa and not necessary, rather than the scheduled planned screening of pregnancy as we know it. Women may attend for antenatal care only to have their blood tests to ensure that they don't have HIV. Some may have no antenatal care. Some attend government facilities for antenatal care, providing their own hand held record as at 36 weeks they are told to find a facility to birth in, as the government facility doesn't provide that service. Some facilities are so over run that women assist each other to birth in the corridors, because the midwives are so busy.

Another beautiful moment

Two of today's presentations were in regards to treating women with compassion. The presenters talked about D&G, which stands for Disrespect and Abuse. A list of abuses was provided which included pinching, slapping, yelling, coercion, inappropriate touching of legs, thighs or genitals, rape. These things might seem foreign to us or at least a basic thing to avoid. I've heard one midwife explain it this way; 'I yell at the mumma's to be sure they give me a live baby'.

Feeding time at the Zoo - when life gets a little bit too crazy!!!

A couple of weeks ago, a nurse was reported in the local paper as having raped a burns victim. The victim, a woman, reported the rape to the nurse who took over her care on the next shift. That nurse cleaned up the mess, and proceeded to rape the victim again. How do these things happen in this day and age? Where is the Care, Compassion, Dignity, Respect and Mercy, that all humans should have for each other?

A random photo from Navaisha.... may or may not fit the text
- depends on your point of view really!!!

The White Ribbon Alliance is doing alot towards changing attitudes of midwives and nurses to the way in which they provide their care. But reading though the Charter and the brochure I started to wonder if midwives in a western setting might need a reminder of these basics. I know where I work we have a core set of values that we are encouraged to adhere to. However, are we adhering to these values when we don't completely inform a woman of all the risks? For example, it's routine to book an induction of labour, the reason being post dates, with the simplest of explanations; do we always fully explain why we are continuously monitoring a labour with a CTG; are we completely supporting the woman who is tired and frightened and not well supported when we promise them an epidural at the beginning of their labour; do we always get the OP position woman off the bed and dancing, explaining to her that she CAN do something to move that child; do we unnecessarily violate the woman's vagina in the second stage excusing our intrusion as helping her to know how to push? These are some of the things that commonly occur which bother me. 

I have heard of a young woman's heartache at the loss of a child at a very early gestation. For her this also meant the loss of a possible relationship with the married father of her child and the loss of possible emotional and financial stability from that relationship. But the subsequent accusations of self mutilation to force the loss of the child and then having to keep the fetus with her as some sort of bazaar cruel and unusual punishment is too much to comprehend. Did it really happen? Yes I think so.

Another of the presenters was Dame Tina Lavender who has worked in Africa for many years. She spoke of the simplicity with which a partograph can enhance outcomes in an African setting, if used appropriately. Not as a documentation of labour after the fact, not as a tick box approach which documents an obstructed labour that no one has recognized.  She states that there are so many different partographs in use (up to 52) it is no wonder that midwives are confused. I have seen partograph information ignored because of the solid belief that the woman WILL produce the child at some point, even when the evidence suggested otherwise. Dame Tina and I had a nice conversation in the coffee break.

Dr Khisha Western spoke well about obstetric fistula, but he essentially put the blame for most obstetric fistulae in the hands of unskilled midwives. Ok. Fair enough, however what about the occasion in the paper not long after I got here where a doctor had to be dragged from a local bar to perform a cesarean but was too drunk to close the patient and she died on the table? Or the occasion where the obstetrician was again unavailable because he had gone to another suburb to have dinner with friends. What happened to that woman? What happened to team work and the multidisciplinary approach? Or putting the woman first?

And neonatal resus is a hot topic. The Helping Babies Breath is a program that is cheap, portable and realistic. I think they are doing a good job. Thanks Laerdal.

Practicing neonatal resus at FreMo

The hand held ultrasound devices priced at $8000USD each however is a doubtful concept. I don't believe that they have the power to enhance midwifery care of the patient to a great degree. It will make midwives doubt their skills, which leads to further referral, which leads to increased costs to the woman. The concept that the research project was undertaken by the company producing the machines, and presented by their representatives seems to have been lost on this audience. 

And then there is Esther. Esther Madudu is a passionate midwife working in extreme conditions. Find out more about Esther and her nomination for a Nobel Peace Prize here. Can you imagine that? A world where midwives are valued, a world where womens' plights in all developing countries will be highlighted, a world where one person can make a difference. Click on the link and vote for Esther, and read more about this amazing woman. She invited me to go spend some time with her..... maybe next time!

And that was just today's sessions!!

This is why we do it.

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