Sharing midwifery skills abroad
Made-in-Alberta program helps those in Ethiopia
Every year in Ethiopia about 25,000 women die in childbirth, and the vast majority of these tragedies are unnecessary.
Indeed, in Canada with our current rate of maternal mortality all but about 150 would have been saved — most of the time with techniques and equipment that are neither difficult nor expensive to provide.
In the very near future, a great many more will survive in Ethiopia, thanks in part to a new made-in-Alberta project in which health professionals at Mount Royal University are playing a key role by improving the skills of midwives.
Perhaps, to an ear jaded by old stereotypes of corrupt governments and ineffective, paternalistic foreign aid, this sounds naively optimistic.
But it is not. Far from being an impediment to progress, today’s Ethiopian government has actively embraced the UN Millennium Development Goals for lowering childbirth mortality for both mothers and babies. And the idea of the Alberta project is not to say “step aside, we’ll do it,” but rather to work with local partners to help Ethiopian caregivers to do a better job themselves.
Over the last several years, Ethiopia has trained and deployed no fewer than 35,000 health extension workers and upwards of 10,000 midwives to the furthest reaches of a country where the vast majority still live in rural areas, and where 90 per cent of women still deliver their babies at home.
But as they know better than anyone, this haste driven by urgency has come at a cost of imperfect training.
Deborah Duran-Snell, co-ordinator of MRU’s midwifery degree program, says large classes were unavoidable, good teachers were too scarce, and as a result many students weren’t getting vital hands-on experience with simulations and live deliveries.
As she found on a reconnaissance trip to the Horn of Africa last year, this gap in experience has potentially dangerous consequences. Some women may decide it is better to stick with traditional care within the family and village than trust a young newcomer. In cases where pregnant women do come to health centres, Duran-Snell says caregivers may not “really know how to assess whether a woman is at low risk for complications, whether she is becoming high risk, or whether she should be transferred.”
Of course, mothers and midwifery are only part of the focus of the five-year project, which is being led by the University of Alberta and funded by a $4.6-million grant from Ottawa’s new, consolidated Department of Foreign Affairs, Trade and Development.
Rates of neonatal mortality — that is of children who die within 28 days of birth — are even worse than the toll among mothers, and the vast majority of those babies can just as easily be saved. The numbers have been improving in recent years, but just in 2011 an estimated 81,000 babies were lost before they were a month old.
But in a rural country with an unreliable transportation system, the birth attendant is key — for example for controlling excessive hemorrhaging (a major cause of maternal mortality, along with obstructed deliveries), and immediately resuscitating newborn babies who need initial help with breathing.
And for that reason, everything begins with a Senior Midwife Tutor Training Program. The first of four annual courses for 20 participants each will begin next month at St. Paul’s Hospital Millennium Medical College in Addis Ababa. The concept is a sandwich of learning, where classroom work occurs at the beginning and end, and eight weeks in the middle are spent in the field. There, participants will work one-on-one to further refine the teaching and clinical skills of regional midwife tutors. On return to class, they’ll learn from each others’ experiences.
In the first year, the opening four weeks will be taught by members of Mount Royal’s Faculty of Health & Community Studies and include midwives, registered nurses and faculty with related knowledge and expertise. Trips to Ethiopia were made last year in part to develop partnerships and ensure that they understand what midwives have to work with in the countryside, and what specific course materials would help them.
A second pillar of the project is improving the referral system to clinics and hospitals for both patients in the 10 per cent of births that are not incident-free in the natural course of events.
By the end of the project the goal is to have Ethiopians, who have been learning from veterans of earlier courses and other local experts, take over with the Canadians standing on the sidelines in a supportive role.
“Ethiopia’s midwives work very hard, are very dedicated and very professional.” Duran-Snell says. “They are making a difference in women’s lives, and they are the kind of women who are making a difference in their own families’ lives, as well.”
IS ASSOCIATE DEAN OF THE FACULTY OF HEALTH AND COMMUNITY HEALTH IN THE FACULTY OF MEDICINE AND
VINCE SALYERS, DAVID ZAKUS DAVID EVANS A doctor checks out a newborn baby in Ethiopia, a country where an estimated 25,000 women die in childbirth every year.
Ethiopian women meet do discuss health issues. Mothers and midwifery is part of a project being led by the University of Alberta.