Meet the Midwives: Martha Malolela, Tanzania

Monday, September 30, 2019
By: Ruby Irene Pratka, Cuso International

Even after 35 years as a midwife, Martha Malolela still lights up when she talks about attending a birth. “I love this profession because if you do it well, you see life,” she says.  

She’s attended thousands of births throughout her career. During her first appointment to a hospital labour ward, she said it wasn’t uncommon to see upwards of 20 cases in a single overnight shift.  

In 1994, a decade after she donned her uniform for the first time, Martha decided to become a midwifery instructor, so she could help others in her profession. Since then, she has trained hundreds of midwives in emergency obstetric care, postpartum family planning and providing prenatal and postnatal care.  

“In those days, there were no other options for professional development unless you wanted to become a specialist in pediatric nursing,” she says. “I felt that if I became a trainer, I could share my knowledge with a lot of people.”  

In December 2018, Martha was one of four experienced instructors at a workshop on postpartum family planning through the Midwives Save Lives (MSL) project, a partnership between Cuso International, the Canadian Association of Midwives (CAM) and the Tanzania Midwives’ Association (TAMA).  

Nurse-midwives in Tanzania often finish their training with a limited understanding of the practical aspects of the profession, especially when it comes to complications.  

“Midwives are being trained to deal with normal births. With anything abnormal, they are trained to refer the mother to a specialist,” says Martha. “Now how can they refer something they are not knowledgeable about? How would they help this woman get the care she needs?”  

Pregnancy complications such as postpartum hemorrhage or infection, blood pressure disorders and obstructed labour pose a major threat to the survival of Tanzanian mothers, according to the World Health Organization.  

More than half of Tanzanian mothers give birth at home without the help of a trained midwife, and many rural women need to travel long distances to reach a health centre, which contributes to an increased risk of complications and death. Martha believes every midwife in the country has probably witnessed a preventable maternal death.  

“Sometimes a woman arrives with a postpartum hemorrhage and you don’t have blood to replace the blood that’s lost. Or she arrives too late and you don’t have the chance to do first aid,” she explains. “Sometimes a woman can have postpartum hemorrhage and have to be transferred more than 100 kilometres. Now, with that distance, the woman is in critical condition, and then what can we do? It makes me sick.”  

Fortunately, the Tanzanian government and partner organizations are working to reduce preventable maternal deaths by expanding access to emergency skills training for midwives. These professional development activities play a fundamental role in equipping midwives to deal with emergencies and to counsel families on nutrition, birth spacing and preparedness.  

Martha wants her students to leave her workshops with the understanding that with every birth, they hold in their hands not only a baby’s life, but a family’s survival.  

“If a midwife is able to diagnose early, it means she can take action early. It means the mother would have the required services and timely care, and reduce the complications,” says Martha. “When they listen to someone’s story, they should take it seriously and be ready to help. Because when a woman dies, it means the family dies.” 

Martha says she’s optimistic for the future of mothers and newborns in Tanzania thanks to the willingness of her students and the importance the country is placing on maternal and newborn care.   

“If midwives are well-skilled, our country will be happy and healthy. We will reduce the number of deaths of women, we will reduce the number of deaths of children, and we will even increase our lifespan. Because if you are healthy from the beginning, we expect you to continue to be healthy over a lifetime.” 

Midwives Save Lives (MSL) is a four-year initiative in Benin, DRC, Ethiopia and Tanzania. Led by Cuso International in partnership with the Canadian Association of Midwives (CAM) and local midwifery associations, MSL is contributing to the reduction of maternal and newborn mortality by improving the supply and demand of health services and strengthening the work of midwives’ associations. MSL is funded by the Government of Canada through Global Affairs Canada.   

This article is published with permission of Cuso International.  Midwives Save Lives is managed by Cuso International in collaboration with the Canadian Association of Midwives and local partners including MAs in each of the countries.

Meet the Midwives: Emmanuel Nicus Nyagor, Tanzania

Thursday, September 23, 2019
By: Ruby Irene Pratka, Cuso International

Emmanuel Nicus Nyagor politely brushes off the offer of an interpreter as he walks into the maternity ward of a hospital in Kahama, Tanzania. He and a small group of midwives have arrived to discuss birth preparedness with new mothers at the hospital as part of a workshop on family planning. 

It’s a far cry from 2010, when he was first assigned to the agricultural district of Ushetu, where the majority of the population speaks Sukuma. Educated in Swahili and English, and from a Luo-speaking community near the Tanzania-Kenya border, Emmanuel didn’t speak a word of the local language. 

“A lot of the mothers would come to me talking in Sukuma, but I couldn’t understand. From the beginning, learning the language was one of the things I wanted to do,” he says, adding he would often ask someone in the community to work as a translator when he met with mothers.  

“We continued like that for one year, two years, and I started understanding more and more Sukuma,” says Emmanuel. “Now there are many words of Sukuma that I know.”  

He’s comfortable enough in the language to chat and laugh with the mothers in the labour ward, and confidently discuss family planning and birth spacing with Elizabeth Maduhu, a Sukuma farmer from the Kahama region who recently gave birth to her seventh child.  

His willingness to adapt to the Sukuma language and culture, as well as his skills as a midwife, have earned him high praise in the community where he works.  

“Many children in the village, their parents give them my name,” he says with a grin. “They call the baby Emmanuel if it’s a boy. If it’s a girl, I’m married, so the mother or the father sometimes names the girl baby after my wife, Catherine. There are a lot of little Catherines out there.”  

Midwives play a large public health role in the country. They educate mothers about the signs of a high-risk pregnancy and speak to families about the importance of birth planning and of giving birth in health facilities with a skilled attendant.  

“The first challenge for midwives in Tanzania is that many women arrive too late for us to help,” he says. “Another challenge is that many women, many people in Tanzania, are not aware of what health facilities offer.”   

Emmanuel has participated in workshops on emergency skills training and postpartum family planning, offered through Cuso International’s Midwives Save Lives project in partnership with the Canadian Association of Midwives (CAM) and the Tanzania Midwives Association (TAMA).  

“If an organization like Cuso wants to help the midwives of Tanzania do their jobs better, keep doing what you have done, offering opportunities for them to improve their skills,” he says. “The postpartum family planning workshop helped me better perform procedures and provide health education and family planning counselling. I’d say it helped me in many things.” 

Emmanuel comes from a long line of health professionals; his grandmother and mother were midwives and his father was a doctor. He still remembers, in detail, the very first time he attended a delivery. 

“It was in 2009, and I was still at college. It was late at night and I was on the maternity ward,” he says. “When I went into the labour ward, I saw the mother push. I didn’t even have time to call anyone and—delivery! It was a baby boy. By the time my supervisor came, he saw that I had already delivered the baby and he appreciated it. That was my first delivery, and now I deliver, deliver, deliver.”   

Even after a decade of practice and working long hours, he still enjoys every birth.  

“Delivery is my favourite,” he says, adding a midwife requires both skilled hands and a committed heart. “When you choose to work in a health field, you’re supposed to help people. My advice is to love the job in order to help people.”        

Midwives Save Lives (MSL) is a four-year initiative in Benin, DRC, Ethiopia and Tanzania. Led by Cuso International in partnership with the Canadian Association of Midwives (CAM) and local midwifery associations, MSL is contributing to the reduction of maternal and newborn mortality by improving the supply and demand of health services and strengthening the work of midwives’ associations. MSL is funded by the Government of Canada through Global Affairs Canada.   

This article is published with permission of Cuso International.  Midwives Save Lives is managed by Cuso International in collaboration with the Canadian Association of Midwives and local partners including MAs in each of the countries.

Meet the Midwives: Loveluck Mwasha, Tanzania

Thursday, September 17, 2019
By: Ruby Irene Pratka, Cuso International

Loveluck Mwasha, Vice President of TAMA

Loveluck Mwasha is living her childhood dream.  

“When I was still at school, if you asked me what I wanted to be, I’d say I wanted to work in nursing and midwifery,” says Loveluck, now a midwifery instructor at Aga Khan University in Dar es Salaam, Tanzania.  

“I used to pray a lot, and I would ask God to guide me so that I would work in this field. Everyone in my family was not wanting me to go to nursing school. But I said, ‘Nobody’s going to make me change my mind.’”  

The first birth Loveluck attended after graduating nursing school was at a rural dispensary. She was alone on duty, working by candlelight because the power had gone out, when a mother arrived “almost ready to deliver.” 

“The baby came out and it was flat, not crying. Thank God, I stayed so calm. I just told the mom, ‘Don’t worry, the baby’s out, I’ll do everything I can.’ I cleared the airway, I resuscitated, and once the baby was showing signs of life, I went back to the mom and finished with the delivery.” 

Ever since that first birth, Loveluck, whom everyone calls Mama Mwasha, has continued working with mothers and babies. “I guess it all started with the way I was brought up,” she says. “There are six of us in our family, but my mother has many ‘voluntary children’ because of how she helped people. That’s where I got this passion for service to people, specifically women and children.”  

Promoting respectful maternity care is one of the core objectives of the Midwives Save Lives project, and of Loveluck’s own teaching. A mother of three grown children, Loveluck thinks of respectful maternity care as much more than a phrase on a checklist.  

“I’m a mother too; I’ve been there. After going through labour you appreciate the human touch, that gesture of support from the person who is with you,” she says.  

She acknowledges it can be challenging to give respectful, individualized care to each mother in a crowded delivery room. The biggest challenges midwives in Tanzania face include a heavy workload and poorly supplied hospitals, where the environment isn’t necessarily conducive to respectful care. 

“I’ve been in labour rooms where there are five women giving birth and only two or three skilled midwives. It’s easy to give a nasty answer to a patient, or ignore a patient. People are running around, and the care can be highly compromised in terms of quality, safety and respect of human dignity,” Loveluck says.  

“You have to be stable, calm and quick in that situation. Just tell the next patient, ‘Hold on, I’ll be there,’ and finish the delivery. Regardless of the situation, be there and make her feel that you’re there for her.”  

Several years after Loveluck delivered that first newborn by candlelight at the rural dispensary, the child’s mother tracked her down. 

“I was staying with my brother and his family in Dar es Salaam,” she recalls. “I came home from work and my niece came running—‘Aunty! You have a guest!’  

“There was this lady sitting there with a girl, four years old. She said, ‘I know you don’t remember me, but I met someone who knew you and brought me here to your brother’s house. I just wanted you to see this girl because, had it not been for you, maybe this girl would not be here today.’ And this lady brought me a basket of cassava and a hen. That’s the most precious gift I’ve ever received in my life.”  

Midwives Save Lives (MSL) is a four-year initiative in Benin, DRC, Ethiopia and Tanzania. Led by Cuso International in partnership with the Canadian Association of Midwives (CAM) and local midwifery associations, MSL is contributing to the reduction of maternal and newborn mortality by improving the supply and demand of health services and strengthening the work of midwives’ associations. MSL is funded by the Government of Canada through Global Affairs Canada.   

This article is published with permission of Cuso International.  Midwives Save Lives is managed by Cuso International in collaboration with the Canadian Association of Midwives and local partners including MAs in each of the countries.