Training of Midwives
Nimco Cabdillahi, 25, completed her 3-year general nursing training at Edna Hospital in January, 2009. She followed that with another year of post-basic midwife training. For the past year and a half, she has worked at a small hospital in the Somaliland town of Balligubadle on the Ethiopian border where she handles all maternity cases with the help of two community midwives.
Balligubadle is about 3 hours drive from Hargeisa, the capital of Somaliland, which also happens to be Nimco’s home city. It contains little more than a police station, a restaurant and some shops as it is an old trading station for nomads on both sides of the Ethiopia and Somaliland border. But it’s to the hospital, which receives funding from the Somaliland government and from World Vision, that people come from all around, seeking help.
The various departments of the District hospital include beds for maternity and for general emergencies; as well as a pharmacy and laboratory. There is only one delivery bed, which is not enough. There should be at least two delivery beds.
Video from Half The Sky
Nimco does an average of 35 to 40 deliveries monthly, and has done as many as five in a single day. When there are serious complications, she may send the mother in her hospital’s own ambulance to Edna Hospital, together with the patient’s complete medical records. Such cases include severely anemic patients and cases where a C-section is called for. If the patient is diagnosed with pre-eclampsia or eclampsia then Nimco is able to treat the patient herself as she has received training to help her cope with many of the Obstetrical Emergencies that are likely to occur.
At the time of graduation, Nimco feels that she had little practical hands-on experience but now she has a lot. She enjoys telling the story of a woman who arrived in the company of some other women and had an otherwise routine birth, except that the placenta did not appear. The women were confused and frantic, and some cried. Nimco brought out her stethoscope and discovered a fetal heartbeat. Mystery solved. Twins! Nobody was expecting that. The woman should have come in for pre-natal check-ups, and she would have known about the twins, but many do not. Her babies were born weighing just 2kg each.
Nimco and the community midwives recommend to pregnant women that they visit the hospital 4 times: once in each trimester, and then when they’re about to give birth. They are urged to eat a healthy diet so as to avoid anemia during pregnancy and are given multivitamins, iron supplements and folic acid. In the case of severe malnutrition, the mother is referred to the Hargeisa Medical Clinic.
After they give birth, the women are advised that, in the best interests of the child’s health, they should breastfeed exclusively for six months.
The mothers are also recommended to bring their babies back for a series of immunizations. The first, for tuberculosis, is usually given after 24 hours (except if baby is under 2.8Kg). Others follow:
- 6 Weeks: DPT
- 3 months DPT x2
- 6 months DTP x3 + Polio oral drops
- 9 months Measles
Edna’s comments on Nimco Cabdillahi’s Performance
Nimco is a midwife who makes me proud.
Before the Balligubadle Hospital was opened, we were getting many complicated cases from that Region which comprises many villages and settlements along the Ethiopian/Somaliland border. Cases were reaching us after three or four days of travel on the back of a truck, many were terminal by the time they reached us, and we are sure, some never reached us or died on the way.
The Midwives at Balligubadle and the male nurse, who was also trained at our hospital, have made a real difference for the people of the Region. When they have a serious patient needing transfer, they call us, explain the situation to us, we get ready for the case and can help that patient better. Sometimes, we just give advice or guidance on the phone which also helps.
For me, this is living proof that with well trained and dedicated health workers, the health of communities improves dramatically which further re-enforces my dream to train 1000 more Midwives for Somaliland like Nimco Cabdillahi and the other 200 we have trained during the past decade.
Family Planning is the next concern and so the mothers are advised that, in the best interests of the health of the child, they should continue to breast feed for two years. While breastfeeding, the woman will not again become pregnant, will not ovulate; but this detail is not stressed. It is true that children spaced further apart will be healthier while the children of a woman who gives birth every year are very likely to be in poor health.
Breast Feeding also reduces the likelihood of pneumonia, malnutrition and diarrhea – which are common causes of infant mortality here.
Birth Control which we call Child Spacing is available but most are reluctant to use it. Women are offered an injection which prevents pregnancy for three months. Husbands are more often resistant to birth control than are the women, but Nimco says that it “never happens” that a woman would go behind her husband’s back and ask for the injection. In Balligubadle, there is one woman with 14 children, one of whom was delivered at Edna Hospital by C-section.
Hygiene and Sanitation are encouraged. Women are taught to avoid bad water and provided with chlorine tablets. They understand and appreciate this assistance, which works. Mother Child Health (MCH) – teaches about sanitation.
Food Supplements are given as the traditional diet is very poor. Many people consume little else but rice and tea. They are encouraged to eat more vegetables, meat and eggs; and to give their children milk from camels and goats. The World Food Program (WFP) supplies prepared rations in the schools. In rural areas, the dry form is provided and the recipients prepare and cook it at home.
Ethiopians cross the border because this is the nearest available medical care. They speak a mix of Somali and Ethiopian but Nimco is usually always able to communicate with them. The great majority of Ethiopians arriving at the hospital are women.
Maternity Kits are anticipated to arrive soon and will include a variety of supplies: Catheters, IV saline, antibiotic injections, anti-convulsion, eclampsia drugs, IV line insert, syringes, 8 types of scissors minimum, gloves, vacuum with which to pull on head, suction bulbs for clearing the airway of the newborn.