Nanton midwife’s experiences in Iraq unforgettable
Marjorie Middleton, a midwife from Nanton has just returned from a sixweek tour in Mosul, Iraq where she worked within Doctors Without Borders to provide medical help to the locals.
“Mosul is a very sad place right now,” Middleton said. “Imagine Calgary; we know it often as North and South Calgary, right? Now, blow up all North Calgary. Destroy the hospitals, the schools, and the homes. Imagine that everyone left North Calgary coming back after such destruction. This is what Mosul is like: a city with half of it destroyed. Mosul is a city that people had to flee from, but now they want to return to their homes. As they return, though, they also need basic services, which have been decimated.”
Middleton says that all but one of the hospital facilities have been destroyed in East Mosul, so Doctors Without Borders (or Médecins Sans Frontières) went to a small clinic and converted it into a little hospital. The group also added an operating theatre, emergency room, as well as inpatient facilities to the clinic.
“Conflict settings are tricky,” Middleton said. “People tend to forget that war zones aren't just about bullet wounds and bombs. Of course, there is that, but there are also women and children. They are often the quiet victims. A woman in labour needs access to a safe birth, but war often prevents that. Babies need access to vaccination, postnatal care of sickness and infection; again, all often nearly impossible to access.”
The room used for birthing babies, Middleton says, is smaller than her kitchen at her home in Nanton, but 600 babies were being delivered naturally there per month. Nearly 100 caesarean sections a month were also performed there.
“Médecins Sans Frontières works hard to provide equipment and staff we need to provide lifesaving care to mothers and babies,” Middleton said. “One of the big challenges we were facing is the realization that even more people than we anticipated needed our services. As I left, the team was working to expand into neighbouring buildings so we could have more space, and thus serve more people.”
Middleton originally got her Nursing degree in Lethbridge and then received her midwifery qualifications in Australia. She also received two additional postgraduates in remote and Indigenous health in Australia.
“I kind of 'fell into' midwifery,” Middleton said. “I was a nurse first; in fact, my first jobs were as a maternity nurse/delivery room nurse in Lethbridge Regional Hospital. However, whilst working overseas, I discovered the important role of midwifery in the care of women. I went back to university to become a midwife so I could expand my practice. Over the years, I have become more and more passionate about women's health - and midwifery has been a part of that.”
Middleton says that her work as a midwife really began in the outback of Australia and then developed into international work with Doctors Without Borders. Middleton says she read about Doctors Without Borders when she was a teenager and always thought she would like to be involved with them because she liked their approach to humanitarian medicine then and now.
“I really, really love what I do, both as a nurse and as a midwife,” Middleton said. “Both positions have enabled me to work in some of the most amazing roles around the world and meet the most amazing people. I feel like I am constantly challenged, and as a result, am constantly having to learn and develop in my practice, which I love.”
Beginning in 2009, Middleton started working with Médecins Sans Frontières and has worked throughout Africa, Asia, and the Middle East on over 15 missions, spending time in Syria and Iraq this past year. In previous years, Middleton has done one tour or more to Bangladesh, Afghanistan, Pakistan, Lebanon, Sierra Leone, South Sudan, and Ethiopia. Middleton has also attended numerous training opportunities and conferences throughout Europe and Canada.
During her time in Mosul, Middleton says that she spent a lot of time training local staff. While the group was only allowed to work during the day, Middleton said that she often stood at a local midwives' or doctors' shoulders, provided encouragement and guidance, and ended up working a lot with the more complicated cases.
“I am constantly amazed at how much gratitude is shown for the simple things,” Middleton said. “The mothers do all the hard work in labour and birth! No matter where you go in the world, mothers want their babies to be born safely, and are so appreciative of support and care that makes this happen. The caregivers in Mosul are often mothers or mothers-inlaw of the woman, and I think I have been hugged and kissed by more mothers-in-law than anyone I know. They also are so appreciative.”
Middleton, however, admits that the experience of helping women in such terrible circumstances can also be very overwhelming.
Having never lived through what many of her patients have, Middleton does her best to be a listening ear, a shoulder to lean on, and a support to those who need it.
“A lot of women come after being told by 'private clinics' that they will require a caesarean section, which costs more,” Middleton said. I then often have to try and provide reassurance to family and mothers that a caesarean will be provided if necessary, but that the safe option is to have birth 'the old-fashioned way.”
Middleton recalls how one young woman came into the clinic with her grandmother in and they were both really scared after being told by a private clinic outside of Mosul had told them the baby would die if she didn't do an emergency C-section; all because the baby was overdue by two days.
The woman, however, was already in labour though and the family agreed eventually to try things Middleton’s way to have the baby. The grandmother threatened to punch Middleton if anything went wrong, but everything went smoothly and a beautiful, healthy baby was born.
Unfortunately, not all births were successful. Middleton also recalls one time when a mother tried to get to the clinic as fast as she could, but the baby had started to come by the time she crossed all the checkpoints; the baby ended up getting stuck. The clinic, Middleton says, was able to save the mother’s life, but was unable to save the baby.
“Health care in Mosul and other conflict areas is limited,” Middleton said. “There is very limited access to public health care. If you have a lot of money, there are some private facilities, but even they are hard to come by since the war. Doctors Without Borders is working to save lives. We aim to provide quality, emergency health care to the people of Mosul and surrounds until such time that services can be adequately restored within the region.”
The only regret Middleton has is that the assignments are too short, but each mission is long enough for her and others to realize the incredible need there is for medical help in conflict regions.
“I'm a Southern Alberta farm girl; until my work with MSF I had never been exposed to the reality of conflict settings,” Middleton said. “Bombs, guns, poverty, displacement, hunger; it can be overwhelming. However, the overwhelming need of women and children in these settings tends to stay in the forefront of my mind. I can truly say it is an honour to work with an organization that is so well regarded both nationally and globally.”
Middleton extends an invitation to people throughout Southern Alberta to contact Doctors Without Borders at www.doctorswithoutborders.ca if they are interested in working for the organization, or in knowing more about what they do.
“I hope that my work, and that of MSF in general, inspires people to remember that there are so many people around the world that need our assistance,” Middleton said. “I also hope that I have directly impacted on other health professionals’ decisions to do humanitarian work.”