Midwives-Defenders of women rights

Catherine Aanyu is a 26-year-old midwife from Katakwi, a small town in Eastern Uganda. She’s currently building her skills through Amref’s e Learning program.

Katakwi is made up of small villages and most residents rely on subsistence farming and grazing animals. Most of the town is not connected to a water or electricity supply. Catherine works at Katakwi General Hospital “in the many areas that they need me; antenatal, family planning, the labour suite – it depends on the day!”

My journey to becoming a midwife

“My mother was a Traditional Birth Attendant (TBA) and when I was young I would see women coming to my home to deliver. I remember my elder sister shouting because there was a mother almost dying; ‘Can’t you let this mother go and deliver in a hospital? Because of the midwives there, they are trained!’ So I understood: it’s the midwives who should be helping these mothers to deliver. My mother is so proud of me. She stopped [being a TBA] around 2002. She could see that when a mother goes to the hospital instead – where the midwives are – she comes back with a baby that is alive.”

Today, Catherine is studying for her diploma in midwifery through e Learning with Amref. Newly-qualified midwives are known as enrolled midwives, while the next qualification up is a diploma. “I wanted to get my diploma before the age of 28, that is my goal,” she says. “I needed this, I am the head of our family. I am educating my little sister, caring for my mother and my two nieces. I need to increase my salary, my skills, and further my career.”

Addressing an urgent skills gap

Catherine is one of just  20,000 midwives and nurses serving a population of 33 million: that’s one nurse or midwife to 1,650 people. The difficult conditions in which many health workers operate – a shortage of medicines and lack of basic amenities like clean water and lighting – coupled with limited opportunities for professional development, mean that health worker retention is a struggle. In Uganda, there is a lack of access to continuous development training, meaning most of the health workforce are relying on outdated training received several years ago. There are very few training courses available, and those that do exist are mostly expensive face-to-face courses which require long periods away from work and family.

The e Learning training courses that Amref runs are a powerful way of addressing these challenges. Their flexible nature means health workers don’t have to give up their jobs and can fit their studies around work and family lives. One-to-one support is provided by a dedicated e Learning tutor, visiting them at work. Plus, they can put their much-needed new skills into practice immediately.

“I was once working night duty and a mother came to us almost pushing,” Catherine explains. “But because she was not monitored, the baby was asphyxiated [lacked oxygen]. We desperately needed oxygen. In theater it was not there; the children’s ward, the maternity ward – all empty. I cared for that baby for three long hours, stimulating and transferring my own oxygen with a mask. I thank god, the baby survived. After that I kept reporting, reporting, reporting to say we have no oxygen. Even now, we have no oxygen.”

In an emergency like this, Catherine could refer patients to Soroti Regional Referral Hospital: but it is 34 miles away. Travelling there on the non tarmacked road can take one to two hours, which means referral carries significant risks. “We have one ambulance but the fuel is not provided for us. We have to tell our patients to find the money for fuel,” explains Catherine. “It is a poor referral system and it can lead to us losing babies, even mothers.”

“With this training I find myself handling our mothers and babies so well”

“I have learnt so much from my training,” says Catherine. “One thing is antenatal paternal involvement. There are really few men attending the appointments. But now we make sure that men are listening to the health education that we give. We want the men to stand up and say, ‘I too am involved.’ I really feel so happy and blessed, because with this new training I find myself succeeding and handling our mothers and babies so well.”

Amref began delivering e Learning training in Uganda in 2012 and since then, nearly 400 nurses and midwives have graduated. e Learners have consistently performed better than those attending the face-to-face course: 61% passed with merit, against just 40% of paper-based learners.

And for every newly-trained nurse or midwife, the ripple effect is huge. Her financial independence increases, she acquires new skills and knowledge to share with her peers, and she has newfound confidence to bring to each shift.

Catherine’s story illustrates the real, everyday impact of better training for women working on the front line of healthcare – and how we can help them prepare for their next emergency.

Catherine Aanyu, 26 years of age, is one of the midwives at Katakwi Hospital, enrolled for a diploma in e learning to improve her skills in delivering mothers hence saving lives.

Images (c) Sam Vox for Amref Health Africa UK

Lilian Mugisha