Ethiopia: A tale of a desperate midwife

Traditional Birth Attendants save lives in Liben

Sometimes, I stay up at night, contemplating what has happened and pondering ways to find a solution to prevent these avoidable maternal deaths,’ Aisha Akello, Médecins Sans Frontières (MSF) midwife.

In the left corner of the maternity ward of Dolo Ado health centre, MSF midwife Aisha Akello has an emotional discussion with a woman sitting on the hospital bed. Unlike the rest of the women in the modest ward, lying next to their new born babies in their respective beds, Rabiya Osman, 23, is all by herself.

She looks weary and pale. She seems a bit inattentive to what the midwife is saying – lost in deep thoughts of her own. Shyly, she looks into the midwife’s eyes and nods her head. Rabiya had gone into labour at home two days before. Her home is just two hundred metres away from the health centre. She had an obstructed labour that lasted hours and the traditional birth attendant couldn’t help with that. She lost her baby and lost consciousness due to excessive bleeding.

“When she was carried to the health centre by some relatives she was on the verge of death,” said Aisha “She was bleeding excessively; her blood level was very low and she was unconscious. We managed to stop the bleeding, but she was already severely anaemic, we needed to do a blood transfusion. Unfortunately, her family was against it. When she regained consciousness, we spent hours trying to convince her and her family but all our efforts were futile.”

Rabiya’s story is reiterated in the cases of many women Aisha treats every day. “Many women are against major life-saving procedures in the maternity ward, such as blood transfusions and caesarean sections,” said Aisha. By the time they make up their minds to accept the procedures it is often very late, when either the baby is dead or the mother is in critical condition.”

According to Aisha, the lack of awareness and fear of delivering in a health centre come from traditional beliefs that giving birth at home is safer than in a health centre, and by and large contribute to women shying away from institutional delivery. Moreover, the fact that men, not women, have the right to make decisions on matters that concern them makes it even more difficult as many people are involved in decision making process and this takes a long time - time which could have been used to save the lives of the women and their children.

Aisha has worked as midwife for more than 13 years. For seven of these, she has worked with MSF in different countries including Uganda, Nigeria, South Sudan, Sudan and Ethiopia, where she started working in the south before joining the Dolo Ado project, in the Somali region, where she currently works.

Comparing her work in various countries, she rates maternal mortality in Liben one as one of the highest and the work as one of the most challenging. “We lose women to conditions like obstructed labour, pre-eclampsia and eclampsia antepartum and postpartum bleeding, which we can handle, but just because they come too late our capacities are limited,” remarked Aisha.

“Had these mothers arrived in good time, we would have saved their lives and their children’s. I feel very sad to see women die from avoidable conditions just because of lack of awareness,” said Aisha. “It’s heart-breaking, and sometimes I stay up at night, just contemplating what has happened and pondering ways to find a solution to prevent these avoidable maternal deaths.”

In December 2014, MSF initiated a programme bringing together traditional birth attendants (TBAs) to work as educators in its community health promotion work. Eleven TBAs were identified and trained. One TBA is deployed to each of the eleven villages of Dolo Ado. The community health workers accompany the mothers to the health centre and help the team to conduct health education on maternal and child health as well as help bring mothers to the health centre for delivery, antenatal and postnatal care.

Reports show that since they started conducting health promotion sensitisations, deliveries in the health centre have shot up from an average of 18 to 20 a month to 50 to 70. For example, there were 54, 70 and 51deliveries in March, April and May respectively at the centre.

This is a step in the right direction and one that Aisha hopes will continue and will make more mothers come to the health centre for deliveries, antenatal and postnatal care and to get immunisation for their children.

Dolo Ado town is located in Liben zone in the Somali Regional State of Ethiopia. The town’s population is around 130,000 people. MSF has been working in Dolo Ado town since 2009, providing primary and secondary health services at the Dolo Ado health centre. MSF, in coordination with the Ethiopian government and UNHCR, provides medical and humanitarian support to Somali refugees in the Buramino and Hiloweyn camps.