MAPUTO (TrustLaw) – The world’s leading hospital in horrific childbirth injuries, known as fistula, is rolling out an ambitious midwife training programme aimed at cutting maternal mortality and preventing fistula.
The Hamlin Fistula Hospital in the Ethiopian capital Addis Ababa plans to deploy midwives to 25 locations in the country, which has one of the world’s worst maternal mortality rates.
Just four percent of women in Ethiopia give birth with the assistance of a skilled attendant. This is a major factor behind the high mortality rate - 673 in 100,000 women die in childbirth.
An additional 100,000 develop fistula every year, a devastating injury where women start leaking urine and/ or faeces uncontrollably. When women labour for many hours without getting a Caesarean section, the tissues die to pressure from the baby’s head, creating a hole, called a fistula.
In the last 10 months, the Hamlin has deployed the first graduate midwives, in pairs, from its new training centre to five health centres around the country.
Initial results are impressive, with 522 deliveries and 144 hospital referrals for Caesareans recorded since the deployment started.
The most successful health centre achieved 16 deliveries a month, up from an average of three. The target is to get each centre to carry out 25 deliveries a month.
Mark Bennett, Hamlin’s Chief Executive Officer, believes the model is a success because the government is already imitating it by deploying midwives in pairs, rather than alone, increasing supervisory support and seeking donor funds to buy 800 ambulances for health centres.
DYING AT HOME
Experts say the only way to make childbirth safer is by getting more women to have attended deliveries.
Trust in Ethiopia’s health services is so low that most men surveyed said: “We’d rather our women died at home,” Bennett said.
“People come very late because they don’t want to go to the hospital and when they go there their fear is realised. The staff there can’t manage the crisis and the person dies,” he told TrustLaw at a meeting of the International Obstetric Fistula Working Group in Mozambique.
By establishing centres that save mothers’ and babies’ lives, the Hamlin hopes to win families’ confidence. Women who receive antenatal care from midwives are less likely to die because their pregnancies are monitored and they are referred for emergency surgery in good time.
“Building trust is very important,” Bennett said.
“These midwives won’t have an impact upon communities unless they can build the trust of women in those communities, unless those women see that coming to the health centre is actually ‘good for me and for my family.’.”
MODEL FOR GOVERNMENT?
In mountainous Ethiopia, 85 per cent of people live in rural areas. Roads are so poor that they often get cut off from health facilities during the rainy season.
“One of the issues for fistula and maternal deaths is making a good decision about when a higher level of care is required,” Bennett said.
“A midwife is a key link between the community and the location where comprehensive emergency care can be given.”
Hamlin sends its midwives to work in government clinics within 80 km of a referral hospital that can perform a Caesarean. It spends $25,000 a year providing them with drugs, equipment and an ambulance to serve a community of up to 200,000 people.
“We make sure that the midwife can succeed because we want to demonstrate what’s required to make a midwife succeed in a rural area,” said Bennett.
With fewer than 2,000 midwives serving 83 million people, Ethiopia needs to increase their number about 50-fold, Bennett said.
But the Hamlin can’t train the numbers Ethiopia needs. Instead, the aim is to set a standard of excellence for midwifery training which it hopes the government and non-governmental organisations (NGOs) will adopt.
“Most of the institutions in Ethiopia that are starting to train midwives don’t have competent staff to do that. They really don’t have clinical experience,” Bennett added.
Next year, the Hamlin will start training midwives employed by the government and NGOs.