Shar­ing mid­wifery skills abroad

Made-in-Al­berta pro­gram helps those in Ethiopia

Calgary Herald - Calgary Herald New Condos - - Weekend Life -

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.”



Pho­tos: David Zakus

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.

David Zakus

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