Meeting a Traditional Midwife in Malawi
Marianne Littlejohn and I volunteer for Operation Smile by teaching the Helping Babies Breathe (HBB) programme. In June of 2014 we were flown to Malawi to teach at the Kamuzu Central Hospital in Lilongwe . Over five days we taught approximately 40 people each. Malawi is an amazing country. It is incredibly poor but we were really pleasantly surprised by the hospitality and kindness and receptiveness of everyone we met. What I love about the HBB programme is its focus on normal birth, its simplicity and its adaptability to whatever environment it is presented in. We have so far taught in high tech hospitals, to home birth midwives, low resourced settings, to doulas and mothers. Each course is different because it works with the experiences and environments the people being taught bring to the workshops. Kamuzu Central Hospital is a reasonably well equipped hospital with sensitive and compassionate midwives. Some of the people we taught were very experienced midwives, doctors and paediatric nurses with many years of experience with very compromised babies. There was interesting discussion and sharing of stories and knowledge – we definitely learned a lot from the people who attended these workshops. One of the women we taught, Violet, a highly experienced midwife, told us about the work she used to do providing training and education and equipment to Traditional Birth Attendants (TBAs) in her region. TBA is the term used to describe traditional or lay midwives who have no ‘officially’ recognised training. Usually they have learned their skills from other traditional midwives. It is a controversial title as it takes away the centuries old title of ‘midwife’ from those women who have always attended pregnant and labouring women and who often carry skills and knowledge passed down through generations. Violet told us about a TBA living in a village not far from Lilongwe and offered to take us to meet her if we could organise the transport. The following day we organised a car and a driver and were driven about 45 minutes outside of Lilongwe over dusty and bumpy clay coloured roads, past simple handmade clay brick homes and thorn trees and goats and women wearing colourful cloth skirts. Along the way, Violet told us that TBAs had been the backbone of maternal care for a very long time in Malawi. She told us that the Malawian government had trained many TBAs in basic midwifery skills to provide care for pregnant and labouring women. The government had also provided updates and further education every month to the TBAs to ensure their skills were kept up to date. The government had also provided the TBAs with equipment and medications. It had been Violet’s job to provide these updates and education to ensure that the TBAs were following best practice when caring for pregnant and labouring women. Violet’s duties had also been to ensure that the TBAs were stocked with the medicines and equipment they needed. She had enjoyed this work. She had enjoyed the travelling and admired the TBAs she was responsible for. Two years previously, in a drive to encourage women to seek care from hospitals, the Malawian government had banned TBAs. This had not really changed the birth statistics in the hospitals, Violet said, all it had done was driven the TBAs underground and yet most rural women still sought care from the TBAs they knew and had grown up with, and who had probably attended their mothers when they themselves were born. Lack of transport to the hospitals made it difficult for mothers to get to the hospitals even if they wanted to. The government...
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