Midwives save lives in rural Liberian hospitals
By Dr. Rhona MacDonald, Honorary Executive Director and Professor David Southall, Honorary Medical Director, MCAI.
In 5 district hospitals in rural counties of Liberia, every day, 21 health workers are expertly saving the lives of pregnant women experiencing life-threatening complications of pregnancy and childbirth in extremely challenges circumstances. Nineteen of the health workers are midwives and two are physician assistants that the Scottish medical charity MCAI (Maternal & Childhealth Advocacy International) is training to be obstetric clinicians in a three-year intensive task-sharing programme in advanced medical and surgical obstetrics.
Two have been fully qualified obstetric clinicians for nearly two years, nine are interns who are currently in the first months of their final year placements, and 10 new trainees began their training in February 2018.
In the first two months of their internship, the nine interns successfully undertook the following maternal life-saving activities in 203 patients: 24 patients treated for severe haemorrhage, 21 treated for eclampsia (fitting), 120 caesarean sections, 30 vacuum deliveries, 6 repairs of a ruptured uterus, 2 removal of ruptured ectopic pregnancies.
Liberia is one of the poorest countries in the world and its population has recently experienced civil wars and an Ebola outbreak. In order to improve hospital-based maternal and neonatal care throughout Liberia, a Partnership between the Liberian Ministry of Health, WHO, UNFPA, and MCAI, started an innovative task-sharing project in advanced obstetric care in 2013.
Given the severe shortage of doctors in Liberia, especially in rural areas, task-sharing is an effective approach to fill the clinical gap in obstetrics and maternal care as midwives can be appropriately trained to assist doctors as part of a team to treat serious complications of pregnancy and childbirth.
In this project, experienced midwives (and occasionally, physician assistants) are carefully selected to undertake extensive training and undergo rigorous continuous assessment to become qualified obstetric clinicians after three years, including a final year as obstetric clinician interns. At the end of their training, each qualified clinician must be capable of safely performing advanced obstetric care, including abdominal surgery, such as Caesarean Section. But even while training, they are still capable of saving lives as shown in the 203 procedures that they undertook in the first two months, as outlined above.
The trainees are trained by experienced Liberian doctors with support from MCAI expert volunteer doctors. MCAI experts also conduct weekly distance-learning tutorials with the trainees and monitors the progress of the trainees in weekly exams and analysing, from their logbooks, the data from every single procedure they undertake.
Now in its fifth year, because of the success and effectiveness of this task-sharing obstetric project, the Partnership has recently started a similar task-sharing programme in advanced neonatal care.
For more information; see www.mcai.org.uk
Three of the obstetric clinician interns having just arrived at their first rural hospital placement at Martha Tubman Memorial Hospital in Grand Jedeh County, Liberia (one of 4 hospitals for internship). From left to right: Emmanuel Hne, Ariza Jolo, Jonathan Lobbo.
Five of the 9 obstetric interns travelling in January 2018 to 3 of 4 rural public Liberian hospitals (thanks to WHO for transport). From left to right: Jonathan Lobbo, Emmanuel Hne, Jeremiah Akoi (MCAI Logistician), Jackie Sudue, Ariza Jolo and Lucretia Kokoi. Jackie and Lucretia are on their way to Tellewoyen Hospital in Lofa County and Jonathan, Emmanuel and Ariza on their way to Martha Tubman Memorial Hospital in Grand Jedeh County and Fishtown Hospital, River Gee County.