I guess one of my favorite things about Esther Madudu was her laugh – almost a cackle at times – but unleashed with such gusto that it was impossible not to join her. And she laughed a lot – on this, her first trip to the USA. She laughed and took everything in stride, as if being in New York, the largest city in the country, was nothing different than living on the premises at the Tiriri health facility where she works as a government employee in rural Uganda. But in Tiriri, there’s no running water or reliable source of electricity to help her look after the 45+moms she sees and up to five babies she delivers daily.
One of the most frequent questions Esther was asked at the events in New York, Washington DC and San Francisco where she met Amref Health Africa donors and partners, was about the challenges she faced as a midwife in a remote, low-resource setting. Her answer – lack of infrastructure. This meant that most of the women in her community cannot even make it to the health clinic because of lack of decent roads, available transportation, gas for ambulances, great distances to the health clinics and no money to pay for taxis or ‘boda bodas’ (motorcycles that are used as local taxis).
Esther’s most harrowing story involved a woman who almost was a victim of that lack of infrastructure. While walking miles to give birth at the health facility, this very pregnant woman collapsed on the side of the road due to the long distance she had travelled. Concerned bystanders managed to contact Esther at her facility, but without gas for the ambulance, she had to pay a boda boda out of her own pocket to race to the woman’s side.
Upon arrival, she found the baby already crowning and immediately dug in to deliver. Esther quickly wrapped the newborn and handed her off to an onlooker, while she prepared to deliver the placenta. Instead, she found the feet of a second baby dangling out of the mother. Moving quickly, Esther had to maneuver the breech birth, but was able to deliver the baby in good health. Another quick wrap and hand off to a bystander. About to deliver the placenta once more, Esther met yet another baby, successfully delivered the third one, and took off her own sweater to wrap it, as the mom had no other supplies with her.
Quickly Esther rented four boda boda’s to get the mom and babies to the health clinic. In the nick of time, she hooked up the mother to an IV drip of oxytocin – her last dose of the life-saving drug that reduces postpartum hemorrhage in women. The mother survived. Not only did she survive, but apparently she was sitting up in bed an hour later demanding food…
A good luck story that could have ended in tragedy, but for Esther’s quick thinking and her skills as a midwife, many of which she learned in her advanced training with Amref Health Africa. This was just one of many stories she shared. It is really astonishing what difference a (single) health worker can make in a community. Talking about the challenges she faces, Esther also laments the lack of drugs, medical supplies and male involvement in births, which is slowly changing though, as men are being educated on the important role they have in helping their wives experience healthy pregnancies and healthy births.
Another highlight of travelling with Esther was observing how effortlessly and joyfully she interacted with midwifery colleagues from the American College of Nurse-Midwives (ACNM) in New York and DC. In fact she told me that when she’s with midwives, ‘she feels at home’. No wonder Esther is the face of Amref Health Africa’s Stand Up for African Mothers global campaign. Launched in the US in 2012, this campaign aims to train 15,000 additional midwives in 13 African countries by 2015. One skilled midwife can care for and educate 500 women each year, ultimately benefitting over seven million African women annually. The campaign also draws attention to the unacceptably high rates of maternal mortality, where almost 200,000 African women die every year from preventable causes in pregnancy and childbirth. On behalf of all African midwives, Esther Madudu is also seeking candidacy for the 2015 Nobel Peace Prize to draw attention to the plight of African midwives.
The US-based midwives were extraordinarily accommodating – inviting Esther to tour their facilities in both a hospital setting (Mount Sinai in New York and MedStar in DC) and the Developing Families Center, a birth centre, maternity care home, day care and source of guidance for new families targeted to low-income African-American families in DC. Amidst all this activity, Esther also found time to address Foreign Affairs staffers on Capitol Hill, hosted by Congresswoman Karen Bass, about the critical role of frontline health workers like herself, in creating lasting health change in Africa.
Her stories of what inspired her to become a midwife (her grandmother was a traditional birth attendant ), her passion for looking after women and the way she seems to overcome so many hardships – hardships that would paralyze most of us in a second – so inspired our donors, friends, partners and supporters at Amref Health Africa. I don’t think many Americans really understand under what kind of conditions Esther and other midwives like her actually work. It was a humbling experience to listen to her and to witness the profound satisfaction that comes from her work, despite the innumerable challenges she faces every day.
One impressive woman, Esther Madudu has dedicated her entire life to being a health care worker.
Everyone around her was completely taken by her passion and commitment to the ‘job’ she has made her life’s calling. Those women in Katine are lucky to have her – and so are we at Amref Health Africa!
As you may know, the Stand Up for African Mothers campaign is aimed at training 15,000 African midwives by 2015 to reduce maternal mortality. At this time, we are proud to report that we have 5,313 midwives trained or currently in training! This means that up to 2,656,500 women in sub-Saharan Africa will be recieving the pre- and post-natal care they need!
The Telegraph just ran a story by Mary Raphael, a midwife in Tanzania who is having her skills upgraded - please read further to hear her story! :
" Delivering a baby can be challenging, as we've seen from the latest series of Call the Midwife. Delivering a baby in the dark is even more challenging. But helping mothers to give birth by the light of candles, kerosene lamps – or even mobile phones – is not unusual if you’re a midwife in Africa.
Once, I was helping a mother deliver her baby in the middle of the night when the power went off. She was already in labour, so I had to keep going using only the light from my mobile. The lights might go out, but we’ve still got mobile phones. I had to keep pressing buttons on my phone just to illuminate the room. To complicate things further, the colleague who was helping me had to rush off and help another woman in labour. The baby became very tired and I had to resuscitate him when he arrived. Thankfully, both he and mother came through.
I’m a midwife in Tanzania and delivering babies by the light of a mobile phone is just one of the challenges we have to contend with. Tanzania has one of the highest rates of maternal mortality in the world, registering 454 deaths for every 100,000 live births.
Poverty; limited access to health care services in rural areas; plus an insufficient number of qualified nurse-midwives and other skilled health care workers all contribute to these high death rates. There are just four midwives to every 10,000 women in my country, so many women end up giving birth without a health care worker beside them. They might just have the help of a so-called ‘traditional birth attendant’, especially if they live in rural areas. Of all deliveries in Tanzania, only 51pc are assisted by a skilled nurse or midwife.
Being a midwife is all I’ve ever wanted to do. As a girl, I loved children and was fascinated by pregnancy. The first time I helped deliver a baby was frightening, though – all I knew of birth was what I’d heard from the labour wards and I got quite a shock. Luckily, the birth wasn’t complicated – which made it less traumatic for the mother, and for me too. That was 12 years ago. Since then, I’ve helped deliver hundreds of babies.
As a midwife, I want to give mothers and their babies a better chance. There’s so much for them to look forward to, but there’s much to worry about too. Like mothers anywhere, they’re anxious about caring for their baby without much money and how a new addition to the family might affect their lives.
That’s why my colleagues and I don’t just deliver babies. We work in the hospital and in the community to support the well-being of mothers as well as their newborns. We monitor babies to check their feeding and weight. As for the mother, we’ll make sure she’s healing well after the delivery and provide advice on family planning – it’s important mothers feel they can have these discussions with us.
All this means that life is pretty hectic. I wake up at about 5am and make breakfast for my family. I have a daughter of my own and also care for my brother’s daughter. We all live at my mothers house and she’s a big help. Both girls think I’m too busy at work, but they understand I’m doing a good job.
Usually, I’ll get to work about 7.30am, when I’ll look at the night nurses’ report. I’ll also get the instruments and medication ready for the day ahead, and have everything on standby for any deliveries. I’ll then start on my ward round, checking up on post-natal cases. I’m involved in deliveries from start to finish and the length of my working day varies depending on the number of cases we’ve got.
At the moment, I’m also fitting further study around my work. I want to do more for mothers and their children. But with limited resources, I couldn’t go back to school. So, I’m doing a distance learning course to develop my skills. I’m one of 89 students in Tanzania studying through an ‘e-learning’ programme that is supported by Africa’s health development organisation AMREF and the health care company GSK. The two organisations have worked together for a long time to help strengthen health care systems in countries like mine.
Education like this will help us swell the ranks of skilled midwives, allowing us to care for more women and children. The training I’m doing means I’ll be able to manage more cases on my own. It gives me more confidence in diagnosing problems and offering advice to colleagues – even the doctors. I’ve started giving talks to patients too. They ask me why I’m doing this and I tell them I want to share what I’ve learned.
Hopefully, the more skills I can get, the more women I can reach – and the more lives I can help save.
Mary’s e-learning programme has been supported by the African Medical and Research Foundation (AMREF) and GSK, through GSK’s initiative to reinvest 20 per cent of profits in developing countries back into strengthening the health care infrastructure in those countries."
As you may know, the Stand Up for African Mothers campaign is aimed at training 15,000 African midwives by 2015 to reduce maternal mortality. At this time, we are proud to report that we have 5,013 midwives trained or currently in training! This means that up to 2,506,500 women in sub-Saharan Africa will be recieving the pre- and post-natal care they need!
Women are dying needlessly in sub-Saharan Africa due to a lack of access to basic medical care. With the Stand Up for African Mothers campaign, AMREF is working tirelessly to stop these deaths, thanks to donors like you.
Esther Madudu, an AMREF-trained midwife in Uganda, notes the need for more midwives:
Although she lives with her family at the Atirir health center staff quarters, Esther has to spend more than 13 hours every day at the health center. "I am always here Monday to Monday, only getting a day off occasionally. Deliveries are unexpected and I have to rush whenever and wherever I am needed."
Esther sees clients every half hour for the entire day, only being interrupted by patients who have gone into labor. During her brief breaks, Esther rushes to the staff quarters to feed her baby. "Our work can be very challenging. We are too few to cope with the demand. A health center such as this should have at least six midwives. Yet there are only three of us interchanging between day and night shifts."
As you may know, the Stand Up for African Mothers campaign is aimed at training 15,000 African midwives by 2015 to reduce maternal mortality. At this time, we are proud to report that we have 4,909 midwives trained or currently in training! The break down is as follows: 90 in Mozambique, 232 in South Sudan, 412 in Tanzania, 73 in Uganda, 3,478 in Ethiopia and 624 in Kenya. This means that up to 2,454,500 women in sub-Saharan Africa can now and will be recieving the pre- and post-natal care they need!
Americans certainly get fired up about the Oscars, the Golden Globes and Grammys. Every year, several awards are given to recognize the accomplishments of celebrities, actors, singers, athletes and entertainers. But what about the REAL people who don’t just play a doctor or nurse on TV? The ones on the frontlines who are changing and saving lives every day?
This year people who rarely receive recognition or accolades are being honored – health workers around the world – with a REAL Award.
According to the Frontline Health Workers Coalition and Save the Children, founders of the REAL Awards, they are a ‘first-of-its kind awards platform designed to develop greater respect for and appreciation of the life-saving care provided by health workers around the world'. The objective of the REAL Awards is to demonstrate the universal and urgent need for more trained, caring health workers on the frontlines. By some estimates, the world is short more than five million health workers including one million frontline health workers. Existing health workers are often overworked and under-appreciated. REAL Awards should remind the public that people everywhere depend on health workers every day’.
At AMREF, we were thrilled to learn that one of the thousands of health workers we train or whose skills we upgrade through our eLearning, mHealth or onsite programs, was recently selected to receive one of the first, global REAL awards for the work they do as a REAL person on the frontlines of health care.
Esther Madudu, an AMREF-trained midwife working in rural Uganda in a remote health center, was presented last week with a REAL Award to celebrate and honor the life saving work she performs day in and day out.
In a small, poorly equipped health center, often under harsh conditions, Esther and her one midwife colleague are among the few skilled and trained professionals able to deliver babies and look after Moms who come not only from the immediate area, but often walk for miles from surrounding villages.
This past week though, Esther’s health center was a place of celebration and support for frontline health workers. The Ugandan Minister of Health herself, the Hon. Dr Christine Ondoa, presented Esther with her REAL Award which was presided over by Uganda’s Deputy Minister of Health and AMREF’s own Country Director in Uganda, Dr Abenet Berhanu, along with our Deputy Country Director, Dr Susan Wandera. There were also a number of individuals from AMREF’s senior management team who attended the event, including many representatives of regional and local district government offices, with whom AMREF Uganda works hand-in-hand to implement our programs.
The REAL Awards celebration in Uganda last week was just that – a lot of dancing, refreshments and overall jubilation to pause and take a moment to honor and celebrate frontline health workers everywhere whose dedication and commitment to their work is literally life-saving.
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