Shirley Stronge reflects on witnessing the challenges faced by passionate students at Addis Ababa University. Each return visit provides its own insights about their challenging journeys: how far have they come and how far is there yet to go?
Queen’s University Belfast (QUB) School of Nursing and Midwifery was invited to visit and to be involved in teaching on a Masters in Maternal and Reproductive Health, in Addis Ababa University, Ethiopia. The first trip was in 2010 and since then we have been going twice every year to teach the direct midwifery part of the curriculum. Each year we have 20-25 students coming into Addis Ababa from all over the country, with some travelling up to 500-600 kilometers to undertake the course, which is part of a government strategy in Ethiopia to improve and retain health care professionals within the country.
Ethiopia is a large country situated in the ‘Horn of Africa’. It is a very beautiful place yet it is also very diverse. When you drive down the streets in Addis Ababa with internet cafés, shopping malls and hotels one could imagine that they are in any capital throughout the whole world, yet behind the exterior there are often other stories being lived out on a daily basis.
The World Health Organization inform us that as of 2009 the population of Ethiopia was over 80 million and presently only 6% of women have a skilled attendant with them for delivery. Perhaps that is not surprising when you also realize that presently there are two nurse/midwives per 10,000 people (
Although the maternal mortality rate in Ethiopia is slowly improving it is still one of the worst throughout the world, so it is relatively easy to justify the rationale behind the trips from QUB. What is not so easy to describe is the impact each trip has both at a personal and a professional level. We work with the same group of students for the two trips each year and it is encouraging to observe and to hear how they have embraced new teaching and techniques and how they have challenged and continue to challenge outdated practice within the clinical areas where they work.
Whether they are going to be working as educators or in the clinical area in the future, the students work long hours, with minimal amounts of staff and yet they remained focused and passionate as to how they could improve midwifery care in Ethiopia. Some of their reflections about lack of equipment, resources and staff are heartbreaking.
One would question their own ability to work in the environment they face on a daily basis, and yet remain passionate about making a difference to those they are caring for in Ethiopia. Considering that students in Ethiopia do not get the opportunity to choose a career they wish, this makes their enthusiasm even more encouraging. If the passion, dedication and eagerness were enough to save the lives of women in Ethiopia, then the students we work alongside would do the job easily.
However, as we know, this is not enough!! It is heartbreaking to recognize that Millennium Development Goal 5 (MDG5) is the one goal that consistently lacks behind the rest of the goals, not just in Ethiopia but in many developing countries and what is our response as midwives?
Personally and professionally each trip has challenged me to question what I do, or perhaps what I could do, as a registered midwife. We need to recognize that over 352,000 women still die annually worldwide. Whilst it is good to celebrate the reduction, it is better for us as midwives to question what we could all do to improve this even further.
World Health Organization (2011).
Shirley Stronge | Midwifery Teaching Fellow | Queen’s University Belfast | Photo credit: Shirley Stronge