A Malawian frontline midwife speaks

By: Mtondera Munthali for White Ribbon Alliance

Mtondera Munthali in Malawi. Photo courtesy of White Ribbon Alliance.

I am Mtondera Munthali, a midwife from Mzuzu city in the north of Malawi. My job is a very busy one. I’m in charge of the labor ward where 15 to 20 babies are born every day. I’m responsible for making sure there are enough midwives with enough resources to keep those women safe. I also coordinate safe motherhood services for the district and head up nursing and midwifery services for Mzuzu health center.

We have daily prenatal clinics with 200 women and family planning clinics daily with more than 100 women. When I left Mzuzu to attend the 31st ICM Triennial Congress in Toronto this past week, a bedside midwife had to be called away to cover for me.

We face many challenges. We are short of staff and overwhelmed with work. We often don’t have sterile gloves and medicines. We only have 12 beds, and yet, there are often 40 women in postnatal so they have to share those beds – sometimes two or three women and their babies on each bed.

Midwives in Malawi get paid only $160 a month, and out of that we have to pay our rent, food, children’s school fees, and transport to work. Some midwives walk long distances to save money on fuel. It’s a hand to mouth existence. Many of my colleagues work extra jobs such as selling potatoes, or second hand clothes, just to survive.

Despite this, we do love our work as midwives. We have many successes in saving the lives of women and resuscitating newborns who would otherwise have died.

In Mzuzu we had a big problem of women giving birth at home because of travel distance and the fear of midwives being rude. This means they lack quality care at birth. There is no equity or dignity.

To change this, I called on Mzuzu city councillors and together we organized a meeting for the community leaders. The leaders are very powerful in their communities and they decided to regularly sensitize the people on safe birth. They also followed up with all the pregnant women to make sure they attended antenatal clinics, and that they gave birth in the health facility.

I also did trainings on respectful maternity care in Mzuzu Health Center for all midwives. Many of the midwives had not realized they were disrespecting and abusing women; they thought abuse was only physical. So, they committed to being polite and kind to women and their families. It was a quick result and they did change their behavior. I even heard midwives reminding each other; they would call out and ask. “Have you forgotten? Be polite to women!”

The impact on the community was also big. The number of women giving birth at home without midwifery care went down by half across Mzuzu, and in two communities it went right down to zero.

So, I am proud to be a midwife, proud to bring lives into this world, and to save women and their babies.

Fostering the next generation of health workers

By Dr Sanele Mandela, founder of  Expectra 868 Health Solutions

This blog was originally posted on the NCD Alliance website.

Dr Sanele Madela gives NCDs Health Eduction During HealthRise campaign at Gcumisa Umgungundlovu. Photo courtesy of Expectra Health Solutions.

During a 70th World Health Assembly event on access to diabetes medicines and care in underserved populations, health worker Dr Sanele Madela said “diabetes care depends on health workers able to empower patients with knowledge to participate in care.” In this blog he illustrates this importance through his experiences as a health worker in South Africa.

 

“Every day when I show up for work, I think – I’m glad I get the privilege today to save lives. In life, it’s all about how you want to show up. For me, showing up means serving my community.” – Dr. Sanele Mandela

When I was just a boy, my best friend died of a completely treatable illness. One day we were playing outside, the next he was simply gone. His family hadn’t recognized his symptoms quickly enough and there was no healthcare worker for miles. I never wanted this to happen again. In that moment, I committed my life to providing outstanding healthcare services for all. And I’ve never looked back.

I write this as I’m heading to the 70th World Health Assembly, the annual convening of state delegations that advise the World Health Organization on important health policies- focusing on access to healthcare, the importance of quality healthcare for all and addressing critical healthcare infrastructure needs. I’m excited to attend such a proceeding and even more excited to serve as a voice of frontline health workers amidst the policy discussions. Let me share why this matters to me.

Frontline health workers are the glue for healthcare systems to function effectively. We’re the people who sacrifice our lives to deliver difficult care, who build trusted relationships with patients to improve their quality of life and who develop innovative healthcare solutions out of necessity. We take this responsibility very seriously and need our health systems to do the same by addressing critical priorities:

Priority 1: Invest in safety and training for frontline health workers.

Young people today are witnessing their family members dying in the line of healthcare duty from exposure to infectious disease and deadly outbreaks e.g. Ebola in Congo etc. Because there are limited frontline health worker safety standards and training opportunities, many young people are not interested in pursuing a healthcare career in underserved communities. Achieving universal health coverage will not be an easy task if this continues.

Priority 2: Adequately compensate frontline health workers.

As the global burden of chronic diseases continues to rise and healthcare becomes more about the management of diseases, frontline health workers play an increasingly important role in building effective healthcare systems. We work hard to build trusted relationships with families and communities to lead cost-effective prevention efforts and to provide outstanding follow-up care when needed. We believe in the work that we do, but we also need to earn enough to take care of our families too. Without adequate compensation, frontline health worker morale is reduced which negatively affects their quality and commitment to care. Ultimately this results in top talent leaving to pursue other sectors.

Priority 3: Adapt policies and regulations to allow frontline health workers to provide more care at the local level.

In many countries, we simply don’t have enough doctors or nurses to adequately treat a population. While it makes for a challenging healthcare environment, it also presents an opportunity for us to re-think healthcare delivery, to identify opportunities for frontline health workers to deliver increasingly important health services in their communities. In my work at Expectra 868 Health Solutions, we’re excited to provide frontline health workers with blood pressure machines and glucometers used at the community level. These simple devices provide incredible confidence and motivation to these health workers, knowing that when they visit a household they’re leaving it better than it was before. Research has also proven that post-surgery patients who recover in familiar surrounding with their loved ones, recover more quickly. Therefore, empowering frontline health workers with post-surgery care skills and appropriate hospital referral linkages go a long way in patient recovery.

As a primary healthcare physician in South Africa, working at the Pomeroy Community Health Centre, I share these statements on behalf of frontline health workers everywhere. Frontline health workers who don’t have time to complain about their working conditions and in-service training required because they are busy taking care of their patients. Frontline health workers who provide patient coaching at the community level and who educate community caregivers on how to promote and prevent disease including care for their loved ones at home. Frontline health workers who are directly saving lives every day, but so often don’t have a voice in key policy conversations.

Frontline health workers – a special breed whose stories need to be shared & considered

Those working on the frontline are a special breed, their stories need to be elevated for policy makers to understand the true plight of the critical role these frontline health workers play to the overall picture of the community health status. Linkage to care of patients, meeting of health targets, giving dignity to the sick and frail and ultimate improving the overall health status of the community, country and the world would not be possible if those in the frontline are not given the platform to influence the decisions in the sector they committed their lives to.

 

Dr Sanele Mandela is one of the health workers trained in storytelling by the Medtronic Foundation and IntraHealth International.

Why Investments in Frontline Health Workers Matter – Preventing needless deaths through trusted healthcare relationships

By Samalie Kitooleko, Nurse In-Charge of Uganda Rheumatic Heart Disease Registry and Belinda Ngongo, Global Health Leaders Fellow, Public Health Institute

This blog was originally posted at the Global Health Council blog.

Samalie’s Story

Samalie speaking at the panel “Against All Odds: Strengthening Health Systems to Better Serve Vulnerable Women and Children” during World Health Assembly.

It all started when I nursed a young female university student with Rheumatic Heart Disease (RHD). As a teen she had received a mechanical valve replacement requiring her to take an anticoagulant daily, which she did without fail. During her third year, she became pregnant and stopped taking her anticoagulant medication without medical consultation, thinking she was looking out for the best interest of her baby. Several days later, she lost her baby and I saw her passing away on her graduation day, suffering from valve thrombosis, a condition which could have easily been prevented if she hadn’t defaulted her medication. In that moment, I vowed to never see another woman die of preventable complications. No one should die because they lack appropriate healthcare knowledge in today’s world.

I began counselling women intending to undergo mechanical valve replacement, educating them about necessary medications and lifestyle changes. Initially, I dealt with very few women however in 2013, when the RHD register was established in Uganda, the numbers become rather overwhelming so I developed novel ways of addressing them at scale, forming a patient support group on WhatsApp. Patients used this platform as a way to pose questions to the broader group and it became an incredible group to share knowledge with.

As a nurse in Uganda, I spend most of my time caring for patients affected with chronic cardiovascular illnesses such as congenital heart disease, myocardial infarction, and rheumatic heart disease (RHD). My typical day starts at 7 AM and ends at 9 PM. During this time, my work involves updating the RHD registry with new patients, those that have died and identifying those that are lost to follow-up. I then spend the day in the outpatient clinic counseling patients, enrolling patients in the RHD registry, and administering Benzathine Penicillin injections in the Coumadin clinic which I run concurrently. Due to limited staff, I also work closely with patients affected by all other noncommunicable diseases including diabetes, hypertension and cancer. I’m proud to provide a patient-centered approach during delivery of care, spending time getting to know and following up with the women I serve.

The Case for Frontline Health Workers

Like Samalie, there are many other frontline health workers (FHWs) in developing countries committed to caring for patients and pressured to work long hours under poor conditions in deplorable infrastructure and limited sundries. To make matters worse, their hard work is rarely recognized and they are compensated poorly for their incessant efforts to improve health and wellbeing of populations. The exodus of FHWs from the health sector can be attributed to some of the current chaotic and constrained environment. The pursuit of non-health related employment opportunities compromises the quality of care already aggravated by the major shortage of staff in most health care facilities.  It is therefore important that we answer these questions – Why do we need to care about FHWs? What do we need to do to retain, satisfy and support FHWs?

  • Undoubtedly, to improve service delivery and lower staff turnover, appropriate compensation and recognition of frontlines’ efforts is imperative for increased motivation and morale. Such recognition can be in form of being acknowledged as best performers of a given period, promotions and better wages and including them in critical global health and health systems conversations. FHWs need to be well equipped with knowledge and skills and understand trends and strategies to accelerate the implementation of appropriate interventions to effectively combat disease. They also need to be provided with ongoing training and career advancement opportunities in order to ensure persistent delivery of quality services.
  • One stumbling block in the health systems arises from the fact that FHWs have limited decision making power and their potential contributions are hindered by certain rules and regulations. For example, in Uganda nurses are now allowed to provide a prescription but are limited to making a nursing diagnosis and care plan. Policies need to be reviewed and where appropriate influence of frontline should to be augmented and task shifting implemented. Promising models of how FHWs are managing NCDs can be found here.
  • The gender lens aspect is important to ponder when alluding to FHWs, especially since it is recognized that 75% of global health work is done by women. Women deliver the bulk of health care worldwide in the formal and informal sectors. Most FHWs are women. They usually work under pressure to balance family and societal responsibilities in resource – limited settings, leaving their lives and those of their families at stake. Despite working tirelessly to restore the health of other people, on many occasions’ health and life of FHWs are not carted and likewise despite their important contribution to global health and the dependence on women as providers of health care, according to a recent report women have very few leadership positions in the health systems.
  • FHWs play a vital role in initiating the referral process through timely and comprehensive communication, provide ongoing support and care to patients and their families. Referral of patients may affect treatment and continuity of care and can affect clinical outcomes and costs thus clear guidance from facility staff is critical. They need to be part of the referral process.

In sum, FHWs deserve to be recognized for their dedicated and generous contribution towards the health and wellbeing of the populations they serve. In return, they also need to be healthy in all aspects, valued, respected, supported, protected, compensated adequately and work in appropriate.

This week, WHA70 gives us an opportunity to further elevate the voice of FHWs to encourage further investment and support for those saving lives on the frontline. Join us in helping to elevate their voice!

Learn More:

The Case for Frontline Health Workers in Addressing Non-Communicable Diseases Globally.” By IntraHealth

RHD Action 

What social accountability means for frontline health workers–digging into the black box

By Eric Sarriot and Karen Waltensperger, Save the Children USA

Group Village Headman Kabwangala. Nkhunga Health Center. The USAID SSDI-Services Project, Malawi, scaled up the Community Score Card approach through a consortium of partners. Photo courtesy of Save the Children.

Social accountability in health refers to a group of approaches bringing health professionals, providers or managers, together with community members, or clients, in order to improve quality of services by strengthening the accountability of the health system to the population. USAID has supported innovations and social accountability scale up efforts, as illustrated in the picture from SSDI in Malawi. Our professional community is getting a pretty good picture of what works in this approach  and little by little, some questions percolate to the surface.

Scale Professor Jonathan Fox of American University was a speaker at a recent panel organized by the DC Health Systems Board and Save the Children and brought up the topic of scale. He suggested, as did others, that there needs to be a conceptual reboot of transparency, participation, accountability, and most notably, less time spent on ‘scaling up’ and more on ‘taking scale into account’ by promoting accountability at multiple levels to affect sustainable change.

Time We still live in the world of project cycles. But social systems need to develop ongoing, adaptive processes allowing health systems to address inevitable stumbles, face dysfunctions, and shocks, which may come from staff changes, aftermaths of a strike, election cycles, and many others. Evaluation and learning processes that go beyond pre-post, then-now, and intervention-control proofs-of-concept need to be in place.

Social dynamicsAt the micro level, evidence for what happens inside communities, as between communities and health providers, has been growing. And with that a significant question: what could social accountability mean for frontline health workers?

Social accountability and the frontline worker – A frontline health worker can be anyone directly serving clients or communities – a nurse, pharmacist, district supervisor, or other. Accountability mechanisms fundamentally aim to incentivize workers to take [the right] action. In the figure below, taking action is at the very top.  Some behavioral theories suggest that a health worker needs to have the “disposition” to act above a certain unknown threshold to take action. The health worker is part of a network and a hierarchy of functions, so right action at one level may affect how this threshold is crossed at another. And when the health system does not provide basic inputs (e.g. drugs), this threshold can be seen as insurmountable. Beyond that, how does disposition to act come along?

Disposition accrues from three tracks:

  • Deliberative disposition: “I know how to do this; this is what I’m trained for; this will lead to positive outcomes for my patients / my internal clients.”
  • Emotional disposition: sense of pride, agency, ownership, meaning, perhaps even fear or shame.
  • Social disposition: expectations we attach to social encounters, be they with supervisors, colleagues, clients, or community groups and leaders.

‘Normal’ health systems functions are already affecting these three paths: we train, disseminate information, certify, and supervise to reinforce deliberative factors. We speak about ‘supportive’ supervision, to influence both emotional and social factors. We create quality teams–probably as much a social disposition driver, as a way to cognitively review data. But gaps in performance and quality remain frequent. And accountability mechanisms are proposed to palliate some of these gaps, building micro (health workers’) positive behaviors and accruing system changes through these same pathways:

  • Deliberative and cognitive factors are addressed through problem definition (“How do you understand this problem?”), followed by the recourse to measurement and assessments;
  • Initiatives often start with our proverbial ‘low hanging fruits’ [cringe] – the reason for this might lie with the emotional value of achieving some success; and
  • Finally, accountability may be one of the ways through which we perhaps unwittingly create different types of social capital within groups (providers, communities) and between these groups.

Questions need to be explored in all three pathways. How do we balance objective measures of service performance with subjective assessments and self-assessments? How much ‘demotivation’ is rooted in fatigue from business as usual, and how can initial positive changes snowball to larger ones? How do we address power and conflict as we take scale into consideration? Etc.

If we believe in this accountability business, we will need to advance on our macro (scale and time) questions, while continuing to build on experience and evidence about community capacity and social capital. We may also have to dig a bit more into the black box of how health workers’ disposition to act is supported and strengthened by more than cognitive processes. Donor investments for research, and implementation will be needed to help us move frontline health workers into the sort of functional and learning system, which transparency, participation, and accountability can help advance.

 

Nurses and Stories Are a Powerful Combination

By Cecilia Amaral, IntraHealth International and Frontline Health Workers Coalition

This blog was originally posted on Vital, the IntraHealth International blog.

Samalie with a small group of clients. Photo courtesy of Samalie Kitooleko.

Samalie Kitooleko wants you to know that nurses are independent professionals who undergo years of education and do not simply take orders given by doctors. She should know. She’s one of them.

In fact, Samalie is “changing the face of nursing leadership in Uganda to one of a confident, critical thinker who takes initiative and leads by example.” Those are the words of her supervisor, Dr. Chris Longernecker.

Samalie is also one of twelve women who will be honored tomorrow ahead of the World Health Assembly in Geneva at the Heroines of Health Gala Dinner. Samalie will add storyteller to her resume as she shares the story at the gala of her endless support for her clients.

She is one of several health workers trained by IntraHealth International and Medtronic Foundation in effective storytelling.  Policymakers need to understand what is actually needed to support health workers’ roles in health service delivery, and powerful storytelling can help convey just that.

Samalie’s nursing journey started over two decades ago. For the last 15 years she has worked at the Uganda Heart Institute, rising through the ranks from a smart and conscientious nurse taking care of clients with chronic cardiovascular illnesses to a leader and trainer of health workers—and a strong advocate for patient-centered care.

She understands that care is not just about the treatment, but also about building relationships with her clients, being there for them, listening to their stories, explaining their conditions and treatment, welcoming calls at 3:00 in the morning, or making follow-up calls when they miss an appointment.

“The best thing about being a nurse is seeing someone coming to the hospital very sick and seeing that person going home with a smile on their face,” Samalie says.

Resolutely seeking these smiles, she championed the formation of a national patient support group for young women living with rheumatic heart disease and also holds leadership positions on other projects at the Uganda Heart Institute.

Being a nurse, particularly in a resource-limited setting, comes with challenges. Cardiovascular diseases require a lot of medication, which poorer clients often can’t afford. Though Samalie can’t help them financially—and doubtless she would if she could—she does provide the social support her clients need, even if that requires showing up at their houses. Somewhere, somehow Samalie finds a way to care for them.

“There’s always something that you can do for a patient,” she says.

At the World Health Assembly, Samalie aspires to convey the crucial role that nurses can play in bridging communication gaps between health workers and clients. Often, clients have difficulty understanding their illnesses or treatments, which can hinder the condition. By sharing her story she hopes to inspire stronger policies that facilitate access to the medical treatment women from poorer social backgrounds deserve.

Working with Jeff Polish, a storytelling coach, taught her to translate her experiences into carefully crafted narratives that will touch and stay with her audiences. “Samalie is pretty incredible, if you ask me,” he says. We completely agree, Jeff.  

Hear Samalie Kitooleko speak at the Heroines of Health gala and reception hosted by Women in Global Health and GE Healthcare on May 21 ahead of the World Health Assembly. Co-sponsors of the event include IntraHealth International, the Frontline Health Workers Coalition, Global Health Council, the United Nations Foundation, Women Deliver, and the Global Health Centre at the Graduate Institute, Sweden. 

Through the Pharmacy Window

by Margarite Nathe, IntraHealth International

Elina Nantinda, an assistant pharmacist dispenses ARVs for a patient at the antiretroviral (ART) clinic at Omuthiya District Hospital, Namibia. Photo by Morgana Wingard, courtesy of IntraHealth International.

“When I was in grade 8, I was into two things: fashion and medicine,” says Elina Nantinda, a 25-year-old pharmacy assistant in rural Namibia. “So I decided to study hard. I thought, ‘It would be so nice to work with medicine and to know more about yourself and how medicine works in your body.’”

Today she runs the pharmacy at Omuthiya District Hospital’s HIV clinic in northern Namibia, dispensing antiretroviral medicines to a hundred clients per day, on average. People come from miles around—most on foot—for HIV services at Omuthiya. And most come to see Elina at some point.

When she started this job at Omuthiya last year, Elina spent two days working with a senior pharmacist. But then that person was moved to the main clinic, and she’s been on her own ever since.

“Being alone, you learn more and faster,” Elina says. “But we need another person in our pharmacy, so that when one is dispensing the medications, the other is entering data into the computer.”

Like all the other health workers at Omuthiya, Elina is constantly busy. Yet she’s always on the watch for clients who look lost or in need of help, and her watchfulness helps the whole clinic run more smoothly.

“I watch their facial expressions,” Elina says, particularly those of clients who come to pick up their medications—and especially when they don’t ask questions. “If they look confused or uncertain, I know I have to find a way for them to understand. I know any error on their part is going to be my fault. And sometimes patients don’t want to hear instructions about their medications because they think they’ve been taking them so long, they already know everything.”

In fact, HIV has become a way of life for many in Namibia. Today, according to the Ministry of Health and Social Services, overall HIV prevalence in the country is 17.2%, and slightly higher in Omuthiya.

So Elina asks them, quietly and kindly, to describe to her how they take their meds. This is how she sometimes finds out a client may be taking too many pills at once.

“This is really bad,” she says. “They have heart pains and they don’t sleep, so they usually come back to us within days.”

Or she sometimes finds that clients are taking the pills at the wrong time.

“Today a patient came from Onyaanya,” Elina says, which is 39 kilometers away from Omuthiya. “I could see the patient didn’t look normal. I asked, ‘How do you feel?’ The patient told me, ‘Sometimes after I take my medication, I feel like I’m drunk after two hours, and I want to sleep. I just feel like I’m not normal. It’s not me.’ So I asked, ‘How are you taking this medication?’ I found the patient was taking a tablet in the morning”—which is contrary to current guidance.

So Elina explained that the client should start taking the medication at night before going to bed.

Hard-working lady

Elina at the clinic at Omuthiya District Hospital. Photo by Morgana Wingard, courtesy of IntraHealth International.

I ask Elina why she chose medicine over fashion.

“I’ve always been a hard-working lady,” she tells me. “I used to visit the orphans in Windhoek, and I wanted to help them. I worried that God would feel bad about me if I’m not doing something to help.”

She hopes to become a full-fledged pharmacist someday, but will have to raise money for school.

Then I ask Elina if there are any other health workers in her family. She tells me no, she is the only one. So when any of her relatives is feeling bad, they always come to her.

“I feel so proud about that,” she says.

Elina Nantinda is employed through IntraHealth International’s USAID HIV Clinical Services Technical Assistance Project in Namibia, which is funded by the US Agency for International Development through the President’s Emergency Plan for AIDS Relief (PEPFAR). IntraHealth is working with the government of Namibia to increase the number of health workers providing HIV services and provide the support and training they need to reach the country’s goal of an AIDS-free generation. Read more about IntraHealth’s work in Namibia.

Valery Mwashekele and Cherizaan Willemse contributed reporting to this story.

International Day of the Midwife: Midwives, Mothers and Families are Partners for Life

By Nancy Kamwendo, White Ribbon Alliance for Safe Motherhood Malawi

Midwives everywhere understand that by working in partnership with women and their families they can support them to make better decisions to have a safe and fulfilling birth. Today, May 5, the world commemorates their day – the International Day of the Midwife.

A midwife providing postnatal health education to mothers. Photo Courtesy of White Ribbon Alliance.


In Malawi, midwives are frontline providers of maternity care, safely delivering babies, providing comprehensive sexual and reproductive health services, and playing a critical role in addressing health issues in their communities. Malawi has made progress in reducing its maternal mortality rate to 439 deaths per 100,000 live births, down from 574 deaths per 100,000 live births in 2010. This rate remains far too high – to save more lives of women and newborns, midwives must become even stronger partners with mothers seeking care and their families to best support them.

Neema Uzeni Phiri – Matron at Bwaila Maternity Unit. Photo Courtsey of White Ribbon Alliance.

Bwaila hospital is a maternity facility located in Lilongwe, the capital city of Malawi. “This is the busiest maternity hospital in Malawi and probably in central Africa,” said Nemma Uzeni Phiri a Unit Matron at Bwaila.

Prenatal care from a skilled provider is important to monitor pregnancy and reduce morbidity and mortality risks for the mother and child during pregnancy, delivery, and the postnatal period (within 42 days after delivery). According to Nemma, the fewer than 20 midwives of Bwaila clinic attend to approximately 700 women on Mondays and from three to as many as 400 women the other days of the week. About 50 babies are delivered per 24 hours with two shifts of six midwives per team. Despite the work overload, Midwives at Bwaila hospital work hard every day to ensure mothers and their families receive the quality care that they deserve.

Cecilia Kapheni, a midwife and team leader of one of the midwife teams at Bwaila labor ward, said, “My team of six midwives conducts about 30 deliveries per shift. Women come to the labor ward escorted by their mothers and mother in-laws, we interact with the family members throughout labor and delivery. We involve them to assist us in comforting the woman as labor progresses. We work under very strenuous conditions; we do not have time to rest throughout the 9-hour day day shift or 15-hour for night shift. However, the arrival of the new born in the world is my great motivator and when the baby is born, seeing both the mother and family members happy, makes my day. Despite the poor working conditions, I love being a midwife.”

Cecilia discussing care of a woman with her family member. Photo Courtsey of White Ribbon Alliance.

Many factors prevent women in Malawi from getting medical advice or treatment for themselves when they are sick. Barriers that women face in seeking care during pregnancy and at delivery include: getting permission to go for treatment from either their husband or other family members according to their culture; distance to health facility and transport cost; and not wanting to go to the hospital alone. Considering that access to proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may lead to death or serious illness for the mother, baby, or both, a midwife comes in as an educator, a counsellor, an advocate, and a skilled birth attendant.

Midwives partner with the mother and family members to deal with these barriers. Midwives sensitize the families to allow and encourage mothers to seek care even if the one responsible to provide permission is not available. One man from Kang’oma village said, I don’t have powers to take my wife to the hospital even when we see that she is in labour unless the older women at the household say so. If we leave without their consent, and something wrong happens, I am held responsible. So even if the women are not available, we still have to wait for them. They take labor and delivery as a no go zone for men, a field for women only and only them have to make decisions.”  

Midwives provide birth preparedness education at the prenatal clinic so that families prepare for birth. Mothers are encouraged to come to the clinic with their husbands so that they go through the education session together. Midwives encourage families to save money for transport and to buy other necessities for the delivery. Midwives encourage women coming from very far from the hospital to come to the waiting homes at the eighth month of pregnancy. This way when labor starts, they are close to the hospital and assisted by a skilled birth attendant. Spouses are encouraged to escort their wives to the hospital for delivery together with any female relations. Because the husband is not allowed inside the labour ward due to privacy reasons, female relations are encouraged to come and assist women throughout labor.

All of this promotes the partnership between the midwife, mother and families in taking care of women during pregnancy, labor, delivery and postnatal period.

Happy mothers, happy families, happy midwives; indeed a partnership for life.

The Power of Storytelling: Unlocking Energy for Change

By Michelle Korte, IntraHealth International and Frontline Health Workers Coalition

Albert Medina, a paramedic with the Chicago Fire Department, tells the story of his inspiration to train his community on CPR. Photo by Michelle Korte for the FHWC.

Listening – that’s what I’m here to do at SwitchPoint, IntraHealth International’s annual “unconference” hosted in rustic Saxapahaw, nestled along the Haw River in an arrestingly green North Carolina wood.

Listening is what we’re aiming for in our most recent undertaking with Medtronic Foundation, too. A few months ago, IntraHealth International and Medtronic Foundation recruited a handful of health workers from projects and locations across the globe to participate in a few months of intensive storytelling training – admittedly, a bit of an experimental undertaking. Why storytelling, of all things?

Simply put, storytelling in advocacy is about improving feedback loops. It’s about better ensuring that dire needs and specific proposals are communicated effectively and persuasively to people who make influential policy and financial decisions. While conferences and reports are rife with technical experts and statistics, sometimes these policy discussions lack the critical element of voice – the humanity behind the numbers.

This dearth often frustrated me in quantitative research; the statistics we collect simply can’t manage to convey all the the complexity that exists beyond the page or computer screen. I’m a huge proponent of harnessing data for decision-making (as are IntraHealth and the Frontline Health Workers Coalition). But for messages to be communicated more effectively – meaning they are absorbed, understood, and acted upon – audiences need a fuller picture. Data provides the skeleton to an argument, but human experience fleshes it out to form a whole with which you can empathize.

It’s precisely this notion that drove IntraHealth and Medtronic’s collaboration to enrich dense policy dialogues with real, frontline perspectives. Specifically, we wanted to equip frontline health workers with the skills to present their experiences as a form of advocacy for improved health workforce conditions, at venues like SwitchPoint and beyond.

It’s striking to say that 400 million people around the world lack access to essential health services, or that the world will be short 18 million health workers by 2030. But these figures can be so daunting as to be virtually incomprehensible – what does a shortage of 18 million health workers really look like? Giving a face and personal story to these statistics breathes life and import into them.

Members of the storytelling project meet during the SwitchPoint conference in Saxapahaw, NC. Pictured: Michelle Korte (IntraHealth and FHWC), Vince Blaser, (FHWC), Albert Medina (Chicago Fire Department), Jeff Polish (The Monti), Shawn McKinney (Hennepin County Medical Center), Vania Almeida (Health Rise) Sanele Madela (Expectra 868 Health Solutions), Anne Katherine Wales (Medtronic Foundation). Photo by Cecilia Amaral for the FHWC.

Maria Valenzuela did just that at a Congressional briefing we organized in March. Experts from multilateral organizations began by presenting the facts of the global health workforce shortage. But it was only when Maria, a community health worker from Phoenix, Arizona, presented her personal narrative that the audience was moved to tears. I was so captivated myself that I almost forgot to scan the crowd; when I did, I noticed that her story of a tumultuous childhood and impassioned community service career had utterly enthralled the room of nearly 70 people – congressional staffers, health professionals, students and fellows, government officials, researchers, and more.

Maria’s story was the subject of audience comments amid lingering exchanges over empty breakfast plates. People could relate to the humanity in her tale – they could imagine themselves as the young child bouncing helplessly from foster home to foster home, or their own daughter who received community nutrition classes and was inspired to become a social worker rather than succumb to the negative influences around her. When you’re prompted to make this sort of connection through a compelling story, it sticks. You care. And ideally, when you pair this with an assessment of the facts, you’re moved to action.

Storytelling ultimately comes down to fostering empathy and establishing trust. Wouldn’t global health as an enterprise be immensely better served with a bigger dose of both of those qualities?

Yesterday at SwitchPoint, Albert Medina presented a moving tale of his 12-year career as a paramedic with the Chicago Fire Department. Over time he learned about the fatal consequences of the widespread lack of cardiopulmonary resuscitation (CPR) training among the community, and now he’s in conversation with his local alderman to institutionalize grassroots CPR training for community members.

Likewise, Vânia Soares de Oliveira e Almeida Pinto spoke of the importance of her patients’ backgrounds and hopes in their decisions to seek care. She now wants to incorporate storytelling techniques into training for medical students as well as patient therapy groups, because the trust to share stories and the willingness to listen to them would strengthen both the provider-patient relationship and the quality of services.

Moments like these here at SwitchPoint remind us just how powerful individuals, and their individual stories, can be. So today, the final day of SwitchPoint, we’re excited. We’re excited that these health workers feel empowered to utilize their stories to influence change in their hometown, their state, their country, and their world.

The project wasn’t meant to “give them a voice;” we’d be remiss to conclude they ever lacked voices in the first place. Rather, we wanted to provide them guidance on how to structure and present their personal stories to drive change. We wanted to seed their confidence to do so proactively, however they see fit according to their community’s needs and their own expertise. While their testimonies here at SwitchPoint may be the culmination of this project, their persisting place within local policy dialogues is the real gem of this undertaking.

As for Maria, the rockstar speaker at our Congressional briefing in March and on the SwitchPoint stage yesterday, soon she’ll be meeting with her Congresswoman’s office to further discuss her role as a community health worker and trusted conduit of community feedback. Maria had met with her representative’s office in Washington during her visit in March, after which the staff followed up with her directly, eager to engage with her in Phoenix to discuss ways to improve healthcare in the city’s varied communities. I suspect they sought to reconnect with Maria because they saw the authenticity in her eyes when she spoke her story; heard the passion in her voice when she described her job and her mission; believed her years of accumulated community experience when she decried the gaps in service provision that still remain. That’s the incredible power of storytelling.

And that’s why I’m here at SwitchPoint – to listen to and absorb the plethora of insights from the frontline experts around me. We’d all be wise, and humbled, to do the same.

From the frontlines of care: Q&A with Ugandan midwife Venny Musasizi

By Gillian Leitch, Jhpiego Uganda

At the 2017 Nurses and Midwives Symposium in Kampala, Uganda, I had the opportunity to speak with Venny Musasizi, an inspiring midwife working in one of the hardest to reach districts in Uganda. The symposium was co-hosted by Jhpiego, Seed Global Health, Peace Corps and Voluntary Service Overseas (VSO) and brought together more than 100 nurses and midwives from across Uganda as well as Ministry of Health officials, academic institutions and international donors.

Could you introduce yourself, and tell us a little about the health center and region where you work?

My name is Venny Musasizi and I have been a midwife for more than 18 years. I studied in Mutolere School of Nursing and Midwifery and trained in Mutolere Hospital. I currently work as a Registered Midwife in Mparo Health Center IV in Kabale District. Kabale is a mountainous district in south-western Uganda, along the border with Rwanda. Given the terrain, it can be difficult to get around in Kabale and many health facilities are located in remote areas, far off the main road. It has made it difficult for us to attract and retain highly qualified health care workers.

What initially inspired you to become a nurse/midwife and what continues to inspire you today?

I was inspired by my grandfather to become a midwife. My grandfather was a traditional birth attendant and he would allow me to watch him while he cared for mothers and delivered babies. I was always excited to see a pregnant woman come in and then leave with a happy, healthy baby. I was also encourage to become a health worker by my biology teach in secondary school. He helped me focus my studies and supported me to pursue a career related to science.

Venny and fellow midwife from Kabale demonstrate how to safely insert and remove contraceptive implants during the “Mini University” segment at the Nurses and Midwives Symposium. Photo by Gillian Leitch for Jhpiego Uganda.

What lessons have you learned through your work?

Some of the most important lessons that I have learned are about what leads to a successful delivery. First, antenatal care visits are incredibly important. If you encourage mothers to take up healthy practices early on in their pregnancy and ensure they stay healthy throughout, you will get good results at the time of delivery and postnatal. Additionally, it is very important to speak with women about engaging their husbands to ensure they have a safe delivery. I encourage all couples to come in before the birth to discuss and develop a birth plan. And lastly, a careful midwife leads to a successful delivery. If you are careful, you will have a successful delivery.

I’ve also learned about the power of women to carry on positive messages about health. I have seen this with family planning and HIV testing. Once a message is passed on to a mother, it is passed on to a nation.

Describe one of the greatest challenges of working as a nurse/midwife.

Unfortunately, the biggest challenge is that midwives are not appreciate for what we do. Despite all of the work that we do, we still lack the support. From the national level, to the district level, to the facility level, we do not get the same recognition as other health providers for the work that we do.

What advice would you give to nursing and midwifery students today?

I would advise nursing and midwifery students today to stick with the profession and take it to heart. While it may not be the highest paying profession, you are rewarded everyday doing the job by saving the lives of children and mothers.

The health needs of populations and communities are constantly evolving and new issues continue to arise. How do you stay up-to-date and aware of the latest technologies and innovations in the health sector?

I typically get information about updates in reproductive, maternal and newborn health practices from the implementing partners who we work with. Especially the organizations that are working closely with our facility, like Jhpiego and the Elizabeth Glaser Pediatric AIDS Foundation. They provide us with job aids, trainings and email updates.

How do you think nurses and midwives in Uganda could be better supported to provide quality health services to their communities?

Nurses and midwives should be supported more to continue their education once they are practicing. There should be more opportunities for them to go back to school to gain more knowledge and skills and be exposed to the latest approaches to health care delivery. Even in school, midwifery must be better prioritized and appreciated.

Meet four African Women on the Frontlines Fighting Malaria

By Spencer Crawford, ONE Campaign

Filumba, Judy, Bertha, and Sule are protecting their communities from the world’s deadliest animal — the mosquito.

They work for a US-funded project called Africa Indoor Residual Spraying (AIRS) that helps prevent malaria by spraying the walls of homes with insecticide. And thanks in part to their efforts, this program has protected over 54 million people from malaria.

Here is more about the work they do and why they do it.

Photo courtesy of Abt Associates.

Meet Filumba, pictured here with her son Richard. As a Team Leader, Filumba manages a team of seven spray operators in the Samfya District in Zambia.

In an interview with the AIRS team, she explains, “As a woman I have experienced what it is like to care for sick family members because of malaria. When I had my house sprayed, my problem was solved. So as a woman, I understand how to explain the benefits to people. Our strength comes from experience.”

And her perseverance has paid off: The income she’s earned from the project has enabled her son, Richard, to attend university.

Photo courtesy of Abt Associates.

Meet Judy, pictured here using her mobile phone that doubles as her bank account. Judy works as a Team Leader in the Mansa District, a neighboring district to Filumba’s.

A single mother of three children, she tells AIRS staff “the project has changed my life. I’ve built a house and sent my children to school with the money I’ve earned.”

“In the future, we don’t want children to be denied access to their rights like women were in the past. The world is recognizing that a woman has a role to play and there is nothing she can’t do.”

Photo courtesy of Abt Associates.

Meet Sule, a 20-year-old spray operator working in the Bunkpurugu District in Ghana, far from Ghana’s capital city of Accra.

Like Filumba, Sule says that being a spray operator is a hard job. She works for hours in the hot sun, wearing layers of protective clothing and gloves. Knowing that she is protecting people from getting sick keeps her motivated.

Photo courtesy of Abt Associates.

Meet Bertha, AIRS’ information, education and communications manager in Bunkpurugu District in Ghana.

She grew up in the district’s capital and speaks the local language, Moar, which is important because many people where she works cannot read.

Communicating in a language familiar with the community, she uses community meetings, radio talk shows and pictures to educate the community about indoor residual spraying.

 

Through strong treatment and prevention efforts – like what Filumba, Judy, Bertha, and Sule do – the world has cut malaria deaths in half since 2000. Still, this preventable and curable disease takes the lives of nearly 50 people every hour, most of whom are young children living in Africa.

We shouldn’t let the progress we’ve made stall now. Call your elected official today and ask him or her to #DefendAid.