Not your average midwife …Thursday, 4 May 2017
I was intrigued to meet Ben. When I asked my colleague, Peter, to recommend a midwife to interview for International Day of the Midwife he immediately suggested Ben. Not because he was someone he knew personally, or someone he had previously worked alongside. Instead, it was hearing how the community spoke about Ben that made Peter realise he is not your average midwife, and not just because he is male.
Ben is a 56-year-old father of seven. Since starting work in Bungoma County, Kenya in 1988, he has assisted in the delivery of approx. 5,000 babies. Such is the respect that the local community has in him pregnant mothers have followed him from his old workplace at Chwele Hospital to his new workplace, Sikhulu Dispensary, significantly increasing, month on month, the number of deliveries at the dispensary.
The Maternal and Newborn Improvement (MANI) project has supported women to get to Sikhulu for delivery through the provision of transport vouchers, allowing them to pay for transport they would otherwise be unable to afford. It has also supported the CHVs in raising awareness and educating women on the benefits of facility based deliveries.
On visiting the facility, it’s clear Ben makes best use of the small space available. He offers a quality service by ensuring clients have adequate privacy and that the environment is clean using equipment provided by MANI, such as colour-coded bins for waste segregation and mop buckets. However, the dispensary currently does not have a power supply, meaning Ben uses just a lantern to help with night-time deliveries. MANI is in the process of providing solar panels to power the lighting and a vaccine fridge.
Ben told me about a case where a woman, who was being assisted by a traditional birth attendant (TBA) at home, experienced an inverted uterus. The community thought she had already died. But Ben drove her by ambulance to Chwele Hospital where he resuscitated the mother and saved the baby. Seeing Ben successfully save the life of both the mother and her baby encouraged others in the community to seek his services, instead of a TBA.
Sikhulu dispensary is only officially open eight hours a day, and the difficulties in travelling to the nearest hospital had previously meant that pregnant women relied on TBAs at night. However, Ben shares his mobile number with all women who attend antenatal care, meaning he is on call 24/7.
He has become friends with many of the women whose lives he’s saved, and frequently visits them in the community. He also goes to the funerals of those who sadly die from maternal related causes. He uses these opportunities to tell the community about the dangers of unsafe abortion, the use of TBAs, and the importance of having a skilled healthcare professional at delivery. He encourages TBAs in the area to bring women in labour to the facility immediately, and in return covers the cost of their transport.
Two weeks before I met Ben, he had assisted a 30 year old mother with the delivery of her fourth child. Her first child had been delivered by caesarean section, and many facilities had refused to admit her for the subsequent deliveries, saying she had to have another caesarean section. But she didn’t want one.
“Nurses are sometimes very cruel to mothers. Sometimes a mother is in labour and they neglect her and forget about her. With the first child I was ignored all night, and then my husband was asked to sign a form to send me to theatre.
“We heard about Ben when he was at Chwele Hospital. He has served many women in this community. The community know him so well. When he was at Chwele most women would go there. When he moved to the dispensary the women followed him. Most of the community go there. Now very few go to TBAs.”
For her most recent delivery, she phoned Ben at around 1am and he arrived at the facility immediately. He welcomed her, took her vital signs and the delivery went smoothly.
In another case, community members had carried a woman on their shoulders, for around 30 kilometres to Chwele Hospital, as she was suffering from a breech presentation and the baby had already died. Ben drove the woman to Bungoma Referral Hospital where she had a caesarean section and survived. But he was sad that the mother had not arrived sooner so that he could have saved the baby’s life as well.
As a result of MANI-supported training on Maternal and Perinatal Death Surveillance and Response, Ben is able to ensure factors contributing to preventable deaths are documented and reviewed within the system. This allows him and others to make quality improvements to help prevent future deaths.
Working at a dispensary gives Ben more freedom to act quickly when there are complications. At larger facilities decision-making protocols during emergencies can cause fatal delays.
The weak referral system is still one of the biggest challenges Ben faces. Often when Ben needs an ambulance, there isn’t one available, so he drives patients in his own car. When an ambulance is available, but there is no driver, he has driven the ambulance himself to the community to collect patients. He’s frequently left out of pocket from having to buy petrol, gloves and oxytocin himself. In order to address this, MANI has recently provided the facility with essential equipment and supplies, including gloves and examination/delivery couches. The facility is also included in the MANI performance based financing scheme, giving it flexibility in how to spend any additional resources it earns based on quarterly quality of care assessments.
Through the MANI-supported training on a ‘rights-based approach’ to maternity care we are aware of the high prevalence and normalisation of abuse by midwives, so I ask Ben what advice he has:
“First of all, midwives should know that the patient has come to you for help. She has trusted you, you have to empathise, talk to her nicely, and attend to her concerns. Labour is painful. Midwives need to be understanding. Women need constant reassurance that pain is normal, that it will go away after delivery. Even if someone screams in pain, you have to reassure them that it’s ok. When women call and ask for their back to be rubbed, I respond. Midwives need to treat clients how they would like to be treated themselves.”
An extraordinary midwife and an inspiring man. No wonder so many mothers in the local community name their sons Ben!
Written by Sarah Barnett, Technical Specialist, Options