I still remember when I was offered to go to Afghanistan. I felt so excited but I hid this feeling because I knew what people would think: bombs and terrorism.
Afghanistan was the worst places to be born in between 2010 and 2011, according to State of the World’s Mother by Save the Children. Since then, women’s health in Afghanistan has improved a lot, but still too many women die; 400:100,000 compared to UK 8:100,000 in 2013 (World Bank).
Many women still die during the most powerful and normal event in their lives: childbirth.
The 7th of November I left my job in UK. At that moment I didn’t know what to expect. I was excited and scared.
I stayed in Afghanistan for 7 months. I lived every day to the full, I felt completed, I felt I was doing and living something special.
I have been a midwife since 2008. I’ve worked previously in Africa, the UK and Italy, and I thought leaving for Afghanistan would change my life again.
I worked in a private hospital for a NGO, free for the population, a maternity service serving 1 million people. Half of the women gave birth in our hospital. About 50 to 60 births per day, everybody called this place the baby factory. I didn’t like that name. It sounds like women come here to pop out their babies and that’s all.
I went there with the intent to change the philosophy of childbirth. For many years I have advocated for normal births and for a positive birth experience. I knew 50 births in a day meant stress, emergencies and mess. My position was Midwife Activity Manager, I was managing the hospital: delivery room, post-natal ward and neonatal unit. My “normal” day started by participating in the morning meeting then doing a quick round to all departments, greeting all the day staff and then I was checking in my agenda what to do for the day.
Planning was something impossible, there was always something to do out of schedule and I had always had to run for emergencies. I usually participated to the round in the labour room to check on complicated cases; there was daily bed coaching for the staff, doctors and midwives. I was the most experienced midwife; I, together with the gynaecologist, supported all the team to manage the complicated cases.
One of my objectives was to train the staff. This was something I wanted to accomplish in this 7 months, so I scheduled trainings for 6 months including introductions of skills, drills and lectures. I had 150 staff to supervise (midwives, doctors, assistants) and also 3 international staff (two midwives and a paediatrician).
One night I was called by one of the senior midwives asking to come immediately because there was an emergency. The woman was bleeding too much. When I arrived at the delivery room, the staff were already hands on starting cardio pulmonary resuscitation.
When I arrived in Afghanistan, the midwives were low-level skilled and after a few months of regular training, they were very effective. I was glad the training worked. Unfortunately the mother died from postpartum haemorrhage (PPH).
PPH is the worst killer, the most dangerous emergency. She was the mother of 6 children; she bled until death despite everything that was done. It was not my first time to assist with a maternal death. It is something I can’t bear.
I strongly believe training is essential in developing countries.
I always taught the staff to be respectful with women, to respect the labour process and to always be alert. In this environment it is very easy to have a PPH, women bearing many children, one of the risks factors for PPH. One day I was walking through the corridor close the entrance of the hospital. A guard shouted at me saying a woman was brought in and was in a bad condition. I ran to the door and I found a dead woman on a stretcher.
The mother of the woman crying was explaining me that she gave birth in a car while they were bringing her to the hospital and she bled to death. It was too late, we couldn’t do anything. This is very sad but all of these stories encouraged me to believe more in what I was doing and not to give up.
Being a midwife there is something special and overwhelming.
We also saved many lives too, there were many happy children crying at every minute in this maternity hospital. In addition, the midwives were improving day by day and the quality of care in our hospital was increasing too.
80% of women gave birth normally in our hospital. In a big hospital with so many births we expected more than 50% of complications. Our mission was to treat the complications and reduce maternal mortality. We thought the women were still hidden in the community. For security reasons we couldn’t go outside to find out. So I proposed a new referral system called Helpline, which consists in having a phone kept by our midwives in the admission room. The idea was to spread the telephone number around and to get called by women who are having difficulties during pregnancy or labour. This way we could realise how many women have complications and are stuck at home, and need help, sending transport to get them to the hospital.
The midwife responsible for the phone should be very experienced in order to understand the problems over the phone and be able to give the first aid, as well as understanding when to refer to the hospital. I proposed my idea to the coordination and it was accepted.
These new proposal has different steps. The 1st one: reinforce the triage area and train our midwives. The 2nd one was to involve the community health workers to inform the communities about this referral system. I left Afghanistan at the first step when we were reinforcing and training our local staff. I handed it over to the staff with the hopes to come back next year to see how effective it has been. The objective is to help and treat as many women as possible, as well as the one unable to reach the hospital.
This experience has changed me; Afghanistan is a country with a wealth of history, but not the best place to be a woman.
I was happy to be part of this community. Afghan midwives were the most important people I met in this experience. They are essential to helping other women to give birth safely.
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